Equine blood flow restriction training: Safety validation.
Authors: Johnson, Frisbie, Griffenhagen, King
Journal: Equine veterinary journal
Summary
Blood flow restriction (BFR) training has proven valuable in human orthopaedic rehabilitation, yet its safety and application in horses remained unvalidated until this 2023 study. Johnson and colleagues exposed four horses to unilateral forelimb BFR daily over 56 days whilst measuring limb occlusion pressure (LOP) via Doppler ultrasonography and assessing gait biomechanics at baseline, day 28, and day 56 using both clinical examination and objective kinetic/kinematic analysis. No significant differences emerged in forelimb lameness, stride characteristics, or kinetic parameters between BFR-exposed and control limbs, with no complications such as thrombosis or dermatitis observed, though the study revealed considerable individual variation in LOP requirements: mean values ranged from 173.78 mmHg (right forelimb) to 204.48 mmHg (left forelimb) across horses, with an overall mean of 189.1 ± 22.2 mmHg. For practitioners considering BFR as a rehabilitation tool, these findings provide reassuring safety data, though the substantial inter-horse and inter-limb variation in occlusion pressure—suggesting a pressure range of 75–151 mmHg for 50–80% vascular occlusion—emphasises the critical importance of individualised assessment rather than standardised protocols. Whilst this validation work opens the door to BFR application in equine practice, further research is needed to establish optimal occlusion percentages and training protocols that deliver measurable clinical efficacy.
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Practical Takeaways
- •BFR appears safe for equine forelimbs without inducing gait dysfunction, making it a viable rehabilitation option for orthopaedic conditions
- •Individual limb occlusion pressure measurement via Doppler is essential rather than using standardised pressures, due to significant inter-horse and inter-limb variation
- •Current evidence is limited to four horses over 56 days; clinical efficacy protocols remain undefined and require further validation before widespread adoption
Key Findings
- •Daily unilateral forelimb BFR exposure over 56 days produced no significant differences in lameness, kinetic or kinematic gait parameters compared to control limbs (p > 0.05)
- •No clinically apparent complications such as thrombosis or dermatitis were observed in BFR-exposed limbs
- •Significant inter-horse variation in limb occlusion pressure (p < 0.001) with mean LOP of 189.1 ± 22.2 mmHg, and significant left-right asymmetry (left 204.48 mmHg vs right 173.78 mmHg, p < 0.001)
- •Applied pressures of 75–151 mmHg would likely simulate 50%–80% vascular occlusion in horses, but individual assessment is warranted due to physiological variation