Blood Flow Restriction Weight Training Is AWESOME for Pelvic Organ Prolapse

"You Have Prolapse"

Is often a scary thing to be told. But it doesn't have to be.  

Over 50% of women, worldwide will experience Pelvic Organ Prolapse (or POP) throughout their lifetime, whether they've had a baby, or not.  

And while it is a common diagnosis, it is NOT NORMAL for it to be symptomatic, AND it does not necessarily mean that you need surgery.  In fact, pelvic floor physical therapy (which also includes global strength training, and potentially fitting for pessaries) are over 80% successful at eliminating prolapse complaints!  That's the same success rate as surgery!  Woo-Hoo!

Hi, there.  It's me, Dr. Kelly Sadauckas, Double Board Certified Pelvic Floor Physical Therapist, and I'm here today to introduce you to a neat-o, burrito, study, from 2019, by Kennedy-Guess, Johnson and Jacobs, titled, "Blood Flow Restriction (BFR) and Its Potential Use in Women With Pelvic Organ Prolapse and Stress Incontinence." ...Ohhh...sexxy name!!!  Let's dive into the sexy details!!!

In this case study, the researchers did standard biofeedback (little electrodes on the OUTSIDE of the pelvic floor (which Dr. Kelly has a SLIGHT BONE TO PICK WITH, because it doesn't account for the internal pelvic floor muscles...but that's for another blog post), pelvic floor training, and functional progressions (please support research and buy the article for specifics on what this was EXACTLY, if you are interested, link to the journal here) for 4 weeks.

Following that protocol...the client did not report significant functional change :( Meaning she did "all the things" her PTs asked her to do...and she had the same pressure and leaks.  Boo.

BUT...then the researchers added these TWO (ONLY TWO!) BFR activities, dosed at inflating cuff to perceived pressure of 7/10 (180-210mmHg), with each exercise performed for 30 reps, then 45-sec rest with cuff staying inflated, then the final 3 sets were performed at 15 reps with 45sec rest between each set. The cuff was deflated and removed after the last set, and at least 5 minutes of rest was provided before occluding the same extremity for the second exercise.

The two exercises were resisted hip and thigh extension, and resisted adduction, shown here by the ever-amazing Dr. Kelly, sponsored by Theraband (not really, but kind of).  

The results??  (Drumroll, please....) 

This Case Study Supports the use of Blood Flow Restriction to Reduce Pelvic Organ Prolapse Symptoms

1. In just 4 weeks of doing these TWO exercises 3 x a week...after doing the other things for 4 weeks and reporting NO CHANGE... the participants reported a 75% reduction in pelvic organ pressure!!!  THAT IS AWESOME!!

2. IMPROVED biofeedback values (meaning improved ability of the people to "use the muscles in the ways that the physical therapists wanted the people to use the muscles"

3. IMPROVED functional outcome scores!  Meaning these humans could do much more activity with less pelvic organ pressure, AND less leaking, in this specific case.  Which, if it's me and my pants, I am signing up for trying this!  

This is so great!!  But what?!?  Why??!  How?!?

1. The compression of the blood vessels causes the blood to build up in a target area 

According to Cognetti et al, 2022, using the blood flow restriction to block the blood flow mimics the effect of a much higher intensity exercise, therefore it makes the muscles being worked (in this case, the hamstring, gluteals and inner thighs) think they are getting a much more strenuous workout than the "3 sets of 45 seconds" that we are providing them with.  

And as countless other studies show the importance of these groups in shock absorption and in overall support of the global pelvic fascia, improving the hypertrophy of these muscles will improve their ability to support the pelvic organs, thereby potentially improving their ability to support the prolapse better than just "the standard exercise and interventions alone", which had been done for 4 weeks prior, without any significant reported change to the client's symptoms.  

2. The "unique" stress of BFR might also create "unique" hormones to optimize strength gains!

Saraf et al, 2022 also showed that Blood Flow Restriction Training stresses the tissues in a specific way that increases growth hormone and a growth factor called IGF-1, which are REALLY IMPORTANT for muscle development, and which many humans (women, specifically), might lack otherwise...and therefore which adding in the blood flow resistance training might specifically provide!

3. That's Cool.  And it's relatively FAST to see gains, which is nice if you're feeling FRUSTRATED!!

Yes it is. 

And the great thing is, that while there are cuffs for as little as $120 available on Amazon, many local gyms and therapy clinics will have them for use by patrons, and newer literature shows that cranking those up to that discomfort level of 6-7/10, then working out for 45-seonds, resting for 2- minutes (or enough time to crank up the other limb, and work for 45-seconds), then repeating that for 2-3 sets), participants doing JUST these 2 exercises, 3 times a week, reported reduced pelvic organ prolapse pressure complaints in as little as 3 weeks!!!  That's pretty remarkable!!  

If I was your Physio, I would also recommend Foam roller spinal mobility work (1-2 minutes), and My Big 3, which take 3 minutes and work to separate your abs from your pelvic floor with easy tasks (remember that is A KEY part of what makes the Pelvic Floored method unique from other pelvic floor programs.  We believe that you CAN and SHOULD be able to uniquely contract your pelvic floor individually from your deep abs with easy tasks, and that people who say otherwise have obviously never felt a pelvic floor muscle inside a vagina or rectum before, because the muscles are only 100% coupled to the abdominal muscles or diaphragm when they are improperly firing, OR with "hard tasks".  But that's for another time and Ted Talk :).  

I might also be so bold as to suggest a few other exercises to add to this Blood Flow Restriction Regime, for added clinical benefit, like abductors and hip flexors through full range of motion, but if time was limited, as this case study showed benefit with JUST these two exercises, this would be a great place to start.   And...there's a new SYSTEMATIC REVIEW OUT that I'll be blogging about soon that holds a bit more weight than this case study...so stay tuned!!

In Summary: Pelvic Organ Prolapse Does Not Mean Surgery as A First or ONLY Resort.

The most important thing to know is that Prolapse doesn't have to mean surgery. And it should NEVER mean surgery as a first resort. Conservative Rehab is successful at eliminating or controlling symptoms in 80% of individuals, and there is no reason to not try rehab first. If your physician is pushing surgery without offering prehab, please ask them to document in your chart that you requested the preoperative pelvic PT, and they declined to provide the referral for it...and they will then give the referral, because there is literally no reason to not do that. Only arrogance and ego.

Okay, done with my soapbox for today :)

I am so glad you are here.  It is my goal to empower you with pelvic knowledge, so that you can make educated decisions, and ask the right questions FOR YOU and your loved ones.  If you found this blog post helpful, please tell others about it. If you have other questions, please let me know!  Please consider following me on Instagram, or joining my mailing list, for more fun, silly, updates, or subscribing to my Treasure Chest, which is a monthly subscription to a "vault" of exercise and educational videos on all things from nutrition to pelvic floor, to general orthopedic rehab to help you not only survive...but thrive :) 

XOXO

Dr. Kelly 

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Want to Geek Out More About the Science??  Me too...here's the Juicy Deets...

Cognetti DJ, Sheean AJ, Owens JG. Blood Flow Restriction Therapy and Its Use for Rehabilitation and Return to Sport: Physiology, Application, and Guidelines for Implementation. Arthrosc Sports Med Rehabil. 2022 Jan 28;4(1):e71-e76. doi: 10.1016/j.asmr.2021.09.025. PMID: 35141538; PMCID: PMC8811521.

Kennedy-Guess, Sheila PT, DPT, CLT; Johnson, Andrea J. PT, DPT, OCS; Jacobs, Patrick G. PT, DPT, ATC. Blood Flow Restriction and Its Potential Use in Women With Pelvic Organ Prolapse and Stress Incontinence: A Case Report. Journal of Women's Health Physical Therapy 43(4):p 194-201, October/December 2019. | DOI: 10.1097/JWH.0000000000000145

Saraf A, Goyal M, Goyal K. Blood Flow Restriction Training-An Overview and Implication in New Generation Physical Therapy: A Narrative Review. J Lifestyle Med. 2022 May 31;12(2):63-68. doi: 10.15280/jlm.2022.12.2.63. PMID: 36157885; PMCID: PMC9490016.

Wang B, Chen Y, Zhu X, Wang T, Li M, Huang Y, Xue L, Zhu Q, Gao X, Wu M. Global burden and trends of pelvic organ prolapse associated with aging women: An observational trend study from 1990 to 2019. Front Public Health. 2022 Sep 15;10:975829. doi: 10.3389/fpubh.2022.975829. PMID: 36187690; PMCID: PMC9521163.