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Investigating the use of Blood Flow Restriction Exercise to improve pain, functional outcomes, and the effectiveness of exercise-based rehabilitation of injured UK military personnel Ref: RDFC22/HLS/SER/CAPLAN

   Faculty of Health and Life Sciences

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  Prof N Caplan, Dr Luke Hughes  No more applications being accepted  Funded PhD Project (UK Students Only)

About the Project

Pain is among the primary limiting factors to progress in individuals experiencing musculoskeletal injury and may be caused by trauma or degenerative factors. In both scenarios a period of off-loading is often required. This increase in physical inactivity or immobilisation can result in rapid disuse atrophy which can weaken the muscle tissue and surrounding connective tissues. Greater complexity of an injury can significantly increase the duration of rehabilitation, and if pain isn’t managed effectively it can manifest into chronic pain. In both scenarios the individual is likely to be medically downgraded and unable to fulfil their primary job role, reducing operational readiness and at significant cost to the Ministry of Defence (MOD). Few rehabilitation strategies are available to mitigate the pain responses following complex musculoskeletal injuries in military personnel, which consequently often leads to pharmaceutical based intervention with opioids being a commonly used intervention. Clinicians seek therapeutic interventions that may help alleviate symptoms of pain thereby facilitating greater engagement in exercise-based rehabilitation to promote muscle hypertrophy, strength, and physical function. It is these clinical challenges that justify ‘rehabilitation following musculoskeletal injury’ being among the top research priorities for Defence Medical Services (DMS).

Over the previous 5 years, blood flow restriction (BFR) resistance exercise has become a cornerstone of rehabilitation practices worldwide. Applying BFR during low intensity resistance (i.e. 20-30% of maximum strength) and aerobic (i.e. <50% VO2max) exercise can elicit improvements in muscle strength and hypertrophy in individuals unable to tolerate heavy load resistance training (i.e. 70% of maximum strength). Importantly, there is now a growing body of evidence that supports the use of BFR exercise as an acute and chronic pain modulator in individuals with musculoskeletal injury.

The overall aim of this PhD is to investigate the effectiveness of using different modes of BFR application to treat pain and complex musculoskeletal injuries in military personnel, and explore the associated mechanisms, optimisation of this intervention and the impact and possible integration of this technique into the unique rehabilitation paradigm of DMS.

Eligibility and How to Apply:

Please note eligibility requirement:

·        Academic excellence of the proposed student i.e. 2:1 (or equivalent GPA from non-UK universities [preference for 1st class honours]); or a Masters (preference for Merit or above); or APEL evidence of substantial practitioner achievement.

·        Appropriate IELTS score, if required.

·        Applicants cannot apply for this funding if currently engaged in Doctoral study at Northumbria or elsewhere

·        Applicants will be registered with Northumbria University but will be based full-time at UK Defence Medical Rehabilitation Centre in the East Midlands. Applicants will visit Northumbria from time-to-time for mandatory training purposes and progress reviews and will have full access to Northumbria resources for the duration of the studentship.

For further details of how to apply, entry requirements and the application form, see  

Please note: Applications that do not include a research proposal of approximately 1,000 words (not a copy of the advert), or that do not include the advert reference (e.g. RDFC22/…) will not be considered.

Deadline for applications: 24th October 2022

Interviews: November 2022

Start Date: 1st March 2023

Northumbria University is committed to creating an inclusive culture where we take pride in, and value, the diversity of our doctoral students. We encourage and welcome applications from all members of the community. The University holds a bronze Athena Swan award in recognition of our commitment to advancing gender equality, we are a Disability Confident Employer, a member of the Race Equality Charter and are participating in the Stonewall Diversity Champion Programme. We also hold the HR Excellence in Research award for implementing the concordat supporting the career Development of Researchers. 

If applicants have any questions or wish to discuss this opportunity in more detail, please contact:

Dr Luke Hughes: [Email Address Removed]

Professor Nick Caplan: [Email Address Removed]

Dr Pete Ladlow: [Email Address Removed]

Funding Notes

The studentship supports a full stipend, paid for three years at RCUK rates (for 2022/23 this is £16,062 per year) and full tuition fees. Only Home candidates may apply, due to funding constraints.
Please note: to be classed as a Home student, candidates must meet the following criteria:
• Be a UK National (meeting residency requirements), or
• have settled status, or
• have pre-settled status (meeting residency requirements), or
• have indefinite leave to remain or enter.


Hughes L, Grant I, Patterson SD. Aerobic exercise with blood flow restriction causes local and systemic hypoalgesia and increases circulating opioid and endocannabinoid levels. J Appl Physiol 131: 1460–1468, 2021. doi: 10.1152/japplphysiol.00543.2021.
Hughes L, Patterson SD. Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect. Med Hypotheses 132: 109370, 2019. doi: 10.1016/j.mehy.2019.109370.
Hughes L, Patterson SD. The effect of blood flow restriction exercise on exercise-induced hypoalgesia and endogenous opioid and endocannabinoid mechanisms of pain modulation. J Appl Physiol 128: 914–924, 2020. doi: 10.1152/JAPPLPHYSIOL.00768.2019.
Hughes L, Rosenblatt B, Haddad F, Gissane C, McCarthy D, Clarke T, Ferris G, Dawes J, Paton B, Patterson SD. Comparing the Effectiveness of Blood Flow Restriction and Traditional Heavy Load Resistance Training in the Post-Surgery Rehabilitation of Anterior Cruciate Ligament Reconstruction Patients: A UK National Health Service Randomised Controlled Trial. Sport Med 49: 1787–1805, 2019. doi: 10.1007/s40279-019-01137-2.
Ladlow P, Coppack RJ, Dharm-Datta S, Conway D, Sellon E, Patterson SD, Bennett AN. Low-load resistance training with blood flow restriction improves clinical outcomes in musculoskeletal rehabilitation: A single-blind randomized controlled trial. Front Physiol 9: 1–14, 2018. doi: 10.3389/fphys.2018.01269.
Ladlow P, Conway D, Hayhurst D, Suffield C, Cassidy R, Coppack RJ. The integration of strength training into UK Defence Rehabilitation. BMJ Military Health, 2020:doi: 10.1136/bmjmilitary-2020-001590
Hayhurst D, Coppack RJ, Ingram C, Conway D, Cassidy R, Ladlow P. Integrating blood flow restriction with low-load resistance exercise in a UK specialist military primary care rehabilitation facility. BMJ Military Health, 2021. doi: 10.1136/bmjmilitary-2021-001897
Coppack RJ, Ladlow P, Bennett AN. Developing UK Defence Rehabilitation Research Priorities: A 2020 clinical practitioner engagement exercise. BMJ Military Health, 2020: doi:10.1136/bmjmilitary-2020-001676
De Martino E, Hides J, Elliott JM, Hoggarth MA, Zange J, Lindsay K, Debuse D, Winnard A, Beard D, Cook JA, Salomoni SE, Weber T, Scott J, Hodges PW and Caplan N (2022) The Effects of Reconditioning Exercises Following Prolonged Bed Rest on Lumbopelvic Muscle Volume and Accumulation of Paraspinal Muscle Fat. Front. Physiol. 13:862793. doi: 10.3389/fphys.2022.862793
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