After leading a mostly injury-free life, I’ve had quite the run over the past few months leading up to my 50th birthday.  A neuroma surgery for my left foot, followed by an ankle sprain playing basketball which in retrospect was due to my lack of regaining full proprioception (balance) after the surgery, and more recently a fall off my bike while riding downhill resulting in a right elbow and wrist fracture 2 days before my 50th birthday, for which I’m wearing a cast.

One of my goals while recovering from surgery, the ankle sprain, and now my arm injury has been to minimize the loss of strength and muscle mass in the affected limb.  I’d like to share these strategies with you because even if you are not recovering from injury or surgery, some of these techniques can be applied to accelerate strength gains even when you are uninjured.

Preserving and enhancing strength and muscle mass is not just for athletes.  It’s essential for aging well and avoiding future injury and disability.

My approach during recovery involved what I call are the “4 Cs” as outlined below.

  1. Constriction (aka BFR or blood flow restriction) Training
  2. Contralateral Limb Training
  3. Creatine Supplementation
  4. Collagen Supplementation

Let’s dig deeper into each of these.


The Japanese practice of Kaatsu, popularly known as BFR (blood flow restriction) training, was discovered by Dr. Yoshiaki Sato in 1966.  It involves using tourniquet-like devices to reduce blood flow to an exercising limb in an effort to limit oxygen and nutrient delivery. 

For example, lactic acid, a product of the anaerobic metabolism triggered by cutting down blood supply to the area, is a potent stimulus for naturally releasing anabolic (growth-promoting) substances like growth hormone.  

My hand surgeon after my injury told me I could only lift 2 pound weights with my affected arm.  I used a BFR band below while I did very slow 2 pound bicep curl reps up and down to maximize muscle fatigue and benefit from all the growth factors that pooled in the constricted muscle.  The 2 pound weight limited the joint load so my bones could continue healing, but the constriction was able to reproduce the physiological effects of lifting much heavier loads in an effort to preserve strength and muscle mass.

BFR Training

Kaatsu is being used actively in Japanese seniors as a way of preserving muscle strength and daily functioning.  Below is a 104-year old Japanese woman doin Kaatsu for some inspiration!  If you have people in your life, especially seniors, who want to spend the least amount of time training for muscle strength, have them look into Kaatsu.

My only disclaimer here is to do it safely.  There are some ridiculous videos on Youtube and social media of celebrities and fitness personas demonstrating unnecessarily intense and prolonged sessions of Kaatsu.  I also do a “poor man’s Kaatsu” where I just use more affordable BFR bands I bought online for less than $50 rather than the official Kaatsu machine found on their website here.

Talk to your doctor or a health care professional before doing Kaatsu since there are some contraindications and possible side effects as summarized here.  I have done Kaatsu intermittently in the past, but felt it was a great biohack to help with preserving strength and muscle mass during my recovery.  I can see myself doing it more often in the future as an anti-aging strategy.

Contralateral Limb Training

Any time you injure a limb, be sure you continue exercising the unaffected limb.  This is a practice called CE (Cross Exercise) and this study in the Journal of Applied Physiology really resonated with me since they had students wear a hard cast to immobile one arm, while they exercised the free arm.  The researchers examined the wrist muscles using ultrasound and CT scans and measured strength in the wrist extensor and flexor muscles.  The placebo group wore a cast too, but they did not exercise their good arm.  After a month, the casts were removed and they found the following:

  • The placebo group (cast without exercise of uncasted arm) had significant atrophy of their casted arm and the wrist muscles were 20% weaker with a 3% reduction in muscle mass
  • The exercise group (cast with exercise of uncasted arm) maintained almost all size and strength of the casted arm.
  • The benefits were muscle-specific, since they only exercised the wrist flexor muscles and noted the wrist extensor muscles did atrophy and become weak.

Many people lose motivation to exercise when they injure a limb and often fear developing more asymmetrical strength if they continue exercising the healthy limb.  This study shows you that the injured limb benefits from exercise of the uninjured limb.

Creatine Supplementation

Like Kaatsu, I’m an intermittent consumer of creatine supplements.  I’ll do a future dedicated post on creatine, but I’ve taken it off and on for many years.  It’s one of the safest, most intensively studied workout supplements with an excellent track record of safety.

How does creatine work? In short, creatine supplementation provides a greater supply of ATP energy to the muscle so it can withstand greater volumes of exercise before fatiguing.  Greater training volume leads to greater strength and muscle mass.

Fortunately I was already taking a maintenance dose of creatine before my injury and I reloaded with a higher dose after my injury to help further preserve lean body mass.

Like Kaatsu, creatine is not just limited to strength athletes, but is also being looked at as an anti-aging supplement to help preserve muscle as shown in this meta-analysis.

In addition, this study with a very small sample size, but similar to the contralateral limb study where they casted subjects, found the creatine supplemented group that wore an arm cast had better preserved strength and lean body mass than the placebo casted group (no creatine).  That was sufficient evidence to convince me to continue supplementing with creatine during my recovery.

Collagen Supplementation

Unlike the other 3 strategies, collagen supplementation had the least data to support enhanced recovery.  However, I was highly motivated to accelerate the repair process and there are other benefits to increasing collagen in the diet and possibly through supplementation as well.  There also does not appear to be much safety concern.  Feel free to scratch this off your injury recovery plan until there are better studies available.

Closing Thoughts

Most of you reading this post have been injured, are currently injured, or may face an injury in the future.  The human body becomes increasingly vulnerable as we age, especially if most of our days are sedentary.

I often turn to athletes, experienced trainers, and sports medicine research to see what interventions I can pull and apply to my own life and those of my patients to improve recovery and enhance overall performance.  These are goals not just for athletes, but for anyone who wants to age gracefully.

Here’s to hoping I’ve filled my injury quota for now.  It’s been an enlightening process over the past few months, but I’m done using my injured body as a self-teaching tool and ready to get back to my previous uninjured life!