Novice Guide to Blood Flow Restriction Therapy

Novice Guide to Blood Flow Restriction Therapy

An injury or prolonged illness that immobilizes you for a duration of time can profoundly impact your posture. In many cases, after you heal and recover, you may not be aware of shifts in your body alignment. But suboptimal posture can cause a variety of movement deficiencies and pain syndromes, and it can set you up for further injuries down the road.

Postural restoration therapy identifies and corrects postural misalignment, to restore fluid pain-free movement and reduce the risk of future injuries.

How Injuries and Illness Affect Posture

How Injuries and Illness Affect Posture

Good posture depends on the mobility and stability of joints, which in turn are governed by the neuromuscular system. In effect, postural alignment requires a balance between the force of gravity and the forces generated by muscle contraction. When muscles are tight or weak, or when muscle tension is out of balance, it redistributes your body mass in suboptimal ways that affect movement and function.

After an injury or prolonged period of inactivity, muscle firing patterns are altered, and compensation patterns become habitual. You develop compensation patterns to unload and protect an injured body part while it heals. For example, if you sprain your right ankle, you will automatically shift most of your weight to your left limb to avoid pain and prevent further injury. Over time, your left limb becomes stronger and your right weaker, affecting the way your joints align along your entire kinetic chain.

Unfortunately, once damaged tissues are healed, there is no mechanism in place to signal your brain to restore normal loading patterns, and compensation patterns become the norm. Proper injury rehab needs to address the brain-body connection, to retrain optimal loading patterns and restore postural alignment.

Proprioception and Posture

Proprioception and Posture

Proprioception is your sense of the position of your various body parts relative to gravity. Proprioceptors are sensory nerve cells that send messages to your central nervous system about body position, to help you maintain balance and posture while sitting, standing and moving.

Proprioceptors are located throughout your body, in the:

  • Inner ear
  • Palms of your hands
  • Soles of your feet
  • Joint capsules
  • Ligaments
  • Muscles and tendons
  • Skin

Proprioceptors allow you to identify the position of your limbs and joint angles, to regulate the motor control of your body. Injury can disrupt proprioception, causing alterations in muscle firing patterns. An important part of posture restoration therapy is to restore the communication pathways between your proprioceptors and your central nervous system.

Common Injuries and Dynamic Posture

Athletes and people who are physically active are prone to certain common injuries. Even after surgery and rehab, when pain is gone and muscle strength is restored, instability can linger, impairing performance and increasing injury risk.

Common Injuries and Dynamic Posture
  • Foot and ankle injuries. Because your feet and ankles form the foundation of all bipedal movement, foot pain and injuries can have a profound effect on dynamic posture and physical performance. Ankle sprains and stress fractures create an unstable base that places stress on structures up the entire kinetic chain, and contributes to other conditions like Achilles tendinosis and plantar fasciitis, Restoring foot and ankle stability is key to restoring optimal dynamic posture.
  • Knee injuries. Knee injuries like ACL ruptures can affect joint alignment both above and below the knee. One recent study of female athletes (Delahunt et al., 2020) found that athletes who had ACL reconstruction surgery and returned to competitive sports had significant deficits in dynamic postural stability, along with changes in hip and knee joint kinematics. Deficits in knee stability can also affect foot and ankle mechanics as they compensate for the unstable knee.
  • Injuries to the hip and pelvic region. The hip and pelvic complex plays a major role in weight bearing and the transfer of force loads between the upper and lower body during physical activity. It is impossible to run, walk or throw without the transfer of forces through the pelvic region, placing huge demands on its muscles, ligaments and joints. The acetabular region itself that encloses the head of the femur at the hip joint is lined with key proprioceptors that govern hip and pelvic movement and stability. Most hip and groin rehab programs focus on muscle strength, balance and gait, but fail to address joint proprioception.
  • Shoulder injuries. Shoulder injuries, especially to the rotator cuff, are common in overhead sports that involve throwing, striking and swimming. Because many overhead sports overload the dominant shoulder, an injury can create multiple muscle imbalances throughout the upper body. Proprioceptors in the rotator cuff can also suffer damage, impairing optimal dynamic posture. Shoulder rehab should address muscle imbalances in the upper body, and deficits in proprioception that affect posture.

How We Diagnose Misalignment and Restore Posture

In the past, postural deficits were mostly detected by observation, along with primitive tests for dynamic stability. Today, technology takes the guesswork out of postural evaluation and gives us quantitative data for diagnosis and treatment.

At NYDNRehab, restoration of proprioception and posture are integral to our rehabilitation protocols. But many people suffer from instability and sub-optimal posture from old injuries that were never properly rehabilitated. In many cases, patients come to us with new injuries that could have been avoided, had an old injury been properly treated.

Some of the technologies and methodologies unique to our clinic used to assess and treat postural alignment include:

How We Diagnose Misalignment and Restore Posture
  • Kineo artificial intelligence for muscle testing and retraining
  • Proteus motion 3D collinear resistance sport-specific training
  • Gait and running analysis and 3D biofeedback
  • Force plate jumping, and rate of force development analysis and retraining
  • SEBT (star excursion banner testing) state-of-the-art motion and kinematic analysis for postural stability and retraining
  • Myolux – ankle stability and proprioception testing and retraining device
  • 3D motion capture video analysis
  • Sonoelastography (muscle and tendon stiffness/elasticity analysis)
  • DNS (dynamic neuromuscular stabilization)
  • AIM (anatomy in motion)
  • FMS (functional movement systems)
  • ISM (integrated systems model)
  • Contextual rehab

If you have old injuries, suffer from chronic pain, have impaired performance or frequent injuries, you may need to see a posture doctor for posture restoration therapy. Physical therapy for posture can alleviate pain, enhance performance and dramatically reduce your risk of injuries. Contact NYDNRehab today for whole body technological motion analysis and dynamic posture retraining.

Range of Available Unique Physical Therapy Treatments at Nydnrehab


  • Anderson, Vincent B., and Elin Wee. “Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology.” Archives of physical medicine and rehabilitation 92.7 (2011): 1146-1151.
  • Delahunt, Eamonn, et al. “Lower limb kinematics and dynamic postural stability in anterior cruciate ligament-reconstructed female athletes.” Journal of athletic training 48.2 (2013): 172-185.

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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