Blood flow restriction training has been shown to be a safe and effective technique that has been performed for years.
The American Physical Therapy Association considers BFR to be within the scope of practice of physical therapists, but the state of New York has recently stated that it is not.
In this episode, we talk about this disappointing news and why not only should BFR be within our scope of practice, but why it’s imperative that we can be allowed to perform this to maximize the safety and efficacy.
To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.
#AskMikeReinold Episode 297: Is Blood Flow Restriction Training Within the Scope of Practice for a PT?
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Show Notes
- Blood Flow Restriction Training Online Course
- The Ultimate Guide to Blood Flow Restriction Training
- The Best BFR Cuffs
Transcript
Student:
I got it. So Rob from New York asks, the recent announcement from the New York APTA has stated that blood flow restriction training is not within the scope of practice of physical therapists. So, essentially we are no longer allowed to perform BFR. This is disappointing. What are your takes on the safety of BFR, and if physical therapists should be allowed to perform it.
Mike Reinold:
Sorry. I hit the wrong button. Very awesome job there, Pete. Very important and timely question, for those that haven’t heard, recently the state of New York is discussing and potentially have already released this. The licensing board is saying that blood flow restriction training is not within the scope of practice for physical therapists. I think the community is taking this obviously by surprise, but I think everybody’s a little upset about this. This is a technique, BFR has been something that’s been done for years by physical therapy in the state of New York. It’s a really interesting dynamic that’s happening when a licensing board comes in and says something so definitive. Because as new techniques come out, like BFR, dry needling is another one that pops up.
Mike Reinold:
There’s always that discussion, because it’s not specifically within the writing of our practice act. It doesn’t say dry needling. Anytime there’s a new technique, I think there’s always these debates, but this is the first time this one’s been a surprise. I don’t know, who wants to jump in and start talking about this first? What’s your initial gut reaction, do you think there is any concern on this? Do you think this is too much> I don’t know who wants to start.
Lenny Macrina:
I do. I’m very concerned. When I saw that somebody posted it, and I don’t know who the person is. I don’t remember who it is, so I can’t credit them, but they first brought it to my attention on Facebook and then Twitter as well. I’m afraid that this sets a precedent for other states too, but New York seems very picky in how they handle things. They don’t allow dry needling as well. They’ve never allowed dry needling. Now they have, I think BFR just kind of happened, I’m going to guess in New York. And then the board was just like, “Wait, what is this? We have to look into this and potentially regulate it.” And they just put the kibosh on and just said, “Nope, you guys are done.” So now the APTA of New York has to hopefully take him to court and get this to slow down a little.
Lenny Macrina:
I worry that this precedent could hit other states where other states are like, “You know what, we don’t really know if PTs should be doing this. If it puts a safety issue into the community for the patients that are being treated, then we need to stop this.” But there is no safety issue. We know that the research is completely safe for most populations. There are contraindications like any other modality or any other technique or exercise. You got to have certain indications and contraindications and precautions, even for exercise. I’m very surprised and disappointed. I hope the state of New York, I want to hear their rationale as to why they did this, ’cause I’m a little upset with it, and I’m hoping that they overturn this, obviously,
Mike Reinold:
All right. State of New York, you’ve just been called out by Lenny. If you want to reply on Twitter to him, feel free.
Mike Reinold:
I always try to take, I don’t want to say both sides because that’s weird, but you got to wonder what exactly it is they’re thinking. I hate to say this, but you could argue this comes down to politics, too. Was there somebody out there actually advocating against this?
Lenny Macrina:
Who is doing this, that they don’t want PTs to do it? It was strength coaches? Athletic trainers, occupational? I don’t even know who would benefit if we can’t do it. The problem is we are licensed by the states, so we are highly regulated, more so than other professions. So they can do this to us, but other perfections won’t have this regulation put on them, which seems unfair.
Mike Reinold:
Theoretically, right now you could say that. MDs, chiropractors, athletic trainers, personal trainers. Heck, you can keep going down the list if you want to keep going there.
Lenny Macrina:
Bodybuilders, power lifters, and all the regular people who are just doing it on their own.
Mike Reinold:
Dentists. All these people can do BFR, but for some reason, physical therapists are specifically not allowed to now, because we added this wording. What do you think, Dave?
Dave Tilley:
Confusing, because physical therapists, our main thing, you could argue all the other stuff we do, but it’s exercise. That’s what we’re supposed to be really, really good at, is prescribing the right dosage of exercise for pain or injuries. I feel like BFR is the definition of a microdosage of exercise, or a type of exercise. I don’t know. I feel like it’s getting murky, because if BFR is a little bit outside of our scope, then what other forms of modifications of exercises are also not out of our scope? A running program out of our scope, because it involves a higher intensity, where BFR is a metabolic higher intensity. I think it just gets really gray, because like you have said, I think if anyone is the person to do it, athletic trainers, physical therapists, sports chiropractors, we are the people who are literally in charge of prescribing exercise programs for people who are in pain or coming back from an injury.
Dave Tilley:
I don’t know, maybe people get nervous about the cardiovascular risks and the side effects that could come if you do it haphazardly, which I understand. That’s like a straw man, you can make an argument with anything. If you give someone exercises for their hip, day two post-op, that they’re not supposed to be doing, that’s of course another concern. I don’t think it’s so much that the tool is the issue. I think it’s the application sometimes. I think sometimes it’s just mind boggling to be like, okay, where do you draw the line in the sand for what is proper doses of exercise versus not? I just think it’s very, very murky if you start saying that.
Mike Reinold:
I like how you said too, how exercise is a big component of PT. If I were to say, what would probably be as an equal of a big component of our profession is safety. We learn more about safety and precautions and contraindications than probably most of the other professions out there where everything is, let’s get people back as fast and as safely as possible. It’s very interesting of such a profession that has so much classwork and background information on medical diagnosis and safety and precautions and stuff, as we do. It’s really surprising to me, what’s next? Can we not take blood pressure? Because we may occlude the arm for 30 seconds. Can we not take blood pressure? That’s really weird. Dan Pope, you like to restrict blood flow in people as a hobby. What’s your gut here on this? What are you thinking?
Dan Pope:
Well, it doesn’t feel good. I think I could make the argument that close to a hundred percent of my patients could benefit from BFR, so I love it. I think it’s been phenomenal for me as a practitioner. We’ve been using it for years. I don’t think we’ve had any adverse issues. Every once in a while you make a wound, a little CP and then you maybe back off. That’s probably the biggest problem that I’ve experienced. This one doesn’t make sense to me. I guess needling, acupuncturists don’t want us to needle. They’re the experts in terms of medication, we don’t give anti-inflammatories, doctors do that. There’s pushback from other professions, but this doesn’t make sense to me. I think we are probably the best profession to do this, and I don’t know anyone else that uses BFR as much as we do, or is better for it.
Dan Pope:
I think at the end of the day, I can understand maybe why a state would be against it, because it’s a little gray, and they don’t want to try to push interventions that maybe are dangerous. But like we said, there’s no reason for this, at least as far as we know. I think it does set a bit of a precedence that physical therapists potentially don’t want to take responsibility, which I think if we want to grow as professionals, and be that go-to expert for people with orthopedic problems, we have to take responsibility for the safety or the harmful effects of some of our interventions. I speak to my wife about this all the time, ’cause she’s a physician and they have too much responsibility. It’s like everyone is throwing the responsibility back at the physician, but then some of the other professionals aren’t taking some of the responsibility. I know this, we take the responsibility for it, but I don’t like the idea that certain states are not allowing us to utilize good interventions because there might be this perception of danger.
Dan Pope:
I don’t think that’s a good thing, and the patients are the ones that suffer. You have this awesome intervention we know is helpful. It’s going to really improve our outcomes significantly. There’s a ton of research to support it. There’s very little concern, and we’re going to block people from getting this intervention? This doesn’t make any sense to me.
Mike Reinold:
There’s actually been some great publications recently too, specifically talking about the safety of it, and the adverse effects that potentially happen. We actually have publications stating that. What else? Mike, did you have something?
Mike Scaduto:
Well, I just wanted to throw some fuel on the fire, maybe. I think you guys all make great points. If you do look at the literature, it’s pretty clear that BFR can be used safely with the right patient population. When I see something like this, my first reaction is, it’s reactionary to something that we don’t know about that maybe went on.
Mike Scaduto:
Maybe there’s a lawsuit against the physical therapist, or against the doctor in the state of New York, and this is their reaction, is to ban it right away. It’s interesting. Maybe it’s something that in the future will require a specific prescription from an MD, which would kind of make it a little bit interesting. You have to have it prescribed, similar to other modalities, maybe something like shock wave therapy or something like that, where you may need a physician’s prescription. Maybe that’s the direction that they want to head, and they’re just getting out in front of it, and doing a blanket ban for now and then they’ll go back and rewrite it. I think there’s probably something that we don’t know going on behind the scenes, that the information will come out in the future.
Mike Reinold:
That makes sense.
Lenny Macrina:
Release that. Tell us there was a case, tell us there was an incident, and they are halting it. Let us know that. Maybe somebody knows that, maybe somebody on the APTA of New York knows that, and they haven’t released it yet, but put it in your explanation, not just like, “Hey, we’re shutting you down and good luck.” It’s just, there’s got to be a reason, and tell the public so we have an understanding and we’re not creating conclusions that are false. I don’t know, I would run it differently, but that’s me. I’m a normal person.
Mike Reinold:
Don’t forget the American Physical Therapy Association defines this specifically as within the scope of practice for physical therapists. I guess there’s some bias there, perhaps. You would think that would be something that a licensing board would take into consideration. It’s almost like they’re disagreeing, which is kind of odd. For me, I think one of the things we teach in our BFR course that I have with Dan Lorenz, is that safety is of utmost importance. And as a healthcare provider, as a physical therapist, I think we excel in that. Right now, you can go buy straps off Amazon and apply them to yourself, and essentially strangle your leg with absolutely no amount of known pressure, without any monitoring of how much pressure there is during the exercise, for example. It’s so easy for somebody to do this themselves.
Mike Reinold:
What we’re saying is, we’d like to jump in and actually do this as safe and as effective as possible. To me, I think that’s what’s most mind blowing about this decision, is that it’s not like BFR is banned in the general public. So right now, a personal trainer, a strength coach, or even a person, an individual themselves, they can get any strap and apply it at any pressure without any monitoring of that at all. I think one thing that we really excel at, one thing we teach in our course, is that if you’re a healthcare provider and you want to be as safe and effective and as reliably safe and effective, as consistent as you can, then you have to do things like measure limb occlusion pressure, and you have to monitor that, and you have to use the devices that can actually do that.
Mike Reinold:
So that way, you can prescribe a specific dose. A specific amount of pressure, so that way you can get the response that you’re looking for. Heck that’s science. It’s kind of crazy that we’re actually doing it in a way that you could argue is so much more safe and effective than what the general public are doing. That healthcare officials and licensing boards should actually be pushing people to come to us to do this, not away from us and do it themselves at home or in the gym. I think that’s where it really blows my mind, is I don’t think there’s a profession out there that is going to do it safer than us. I’m not saying others are doing it unsafe, but there’s no doubt we’re going to do it well. That’s one of our policies, at Champion.
Mike Reinold:
If we’re doing BFR on somebody, we have to measure limb occlusion pressure and do it at a prescribed amount of pressure. Otherwise, we’re just taking a guess, and that’s not what’s in the best interest of the person. Who knows. Let’s see. Hopefully this is a reactionary thing like Mike said. Something’s going to come out of this, hopefully, maybe positive, and it leads to just maybe better oversight, which you could argue might be beneficial for the profession of physical therapy down the road. But I do think this is something where we do have to stand up, and we have to advocate a little bit for this, because I think there’s some general misunderstandings.
Mike Reinold:
So, APTA of New York, I appreciate your response. Licensing board of New York, if you’d like to respond, just Tweet directly at Lenny Macrina at lenmacpt, and hopefully get into a nice pleasant debate on this. Very disappointing, hopefully this doesn’t set a precedent for the future for things like dry kneeling, and some other states, even to jump on this, let’s see where it goes. I think the more we can do for some publications and research and some of the leaders out there. The Johnny Owens group, and Owen’s Recovery, they’re just doing such a great job pumping up the research to support this stuff. We got to just make sure that doesn’t fall on deaf ears. Great question, Rob. I know it wasn’t really necessarily a question. I think we’re all kind of disappointed by this decision. If this is new to you, and you haven’t heard about this and you believe in this, look around. There’s ways to support this cause a little bit.
Mike Reinold:
I know a lot of people are starting to talk about getting some groups, and petitions going, and position statements going. Take a peek around, be as supportive you can. I think it’ll be great for the profession as a whole. Great question, Rob. Thanks again. If you have a question like that or anything else you want to talk about, head to mikereinold.com, click on that podcast link, and you can fill out the form to ask us a question. In the meantime, please, please rate, review, subscribe to us, and we will see you on the next episode.
