Football Features

Explained: How Harvey Elliott is using NASA technology to expedite his recovery from ankle injury

By Dr Rajpal Brar

Published: 17:18, 26 October 2021 | Updated: 16:12, 15 September 2022

Liverpool midfielder Harvey Elliott recently provided an update in his rehabilitation following an ankle injury suffered in the win over Leeds last month.

Elliott was on the end of a strong tackle from Patrick Struijk in the 63rd minute of the 3-0 victory at Elland Road, bringing an abrupt end to a positive start to the season in which he had started three of Liverpool’s opening four matches with an ankle fracture-dislocation.

The 18-year-old’s update came via a curated video on his Instagram, providing multiple insights into his current recovery protocol including two pieces of state of the art sports medicine technology.

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In the video, there are two instances (during a free-weight squad and a seated leg extension on an extension machine) where Elliott is wearing what looks like a black collar cuff around his left quadriceps. This isn’t simply a style statement to make the quads pop, it’s something called ‘blood flow restriction training’ or BFR for short.

What this technology does is enhance muscle development and hypertrophy by partially restricting blood flow – inflow (arterial blood flow) is partially restricted and outflow (venous blood flow) is fully restricted – by using a tourniquet system and cuff (the black band you see on Elliott’s leg) to apply external pressure around the muscles.

This might sound like some “new age science” but it actually dates back to the 1970s in Japan where Dr. Yoshiaki Sato invented and applied the concept – known there as “KAATSU training” or “training with additional pressure” – to help train geriatric populations at lower load levels.

What the blood flow restriction does (I’ll spare you the physiological details) is allow for greater muscular development at lower levels of load and weight added. You can probably see how that would benefit Elliott and other players in the early stages of rehabilitation who cannot yet handle higher intensity loads. It expedites regaining strength and mitigating strength deficits which is one of the key goals of physiotherapy. The quicker you can normalise that, the better the outcome.

The technology has become increasingly used by physiotherapists and there’s an increasingly robust volume of research supporting its use not only in rehabilitation but also skeletal muscle strength in young, healthy populations too.

The second piece of technology Harvey is harnessing in these early stages of physiotherapy looks like a giant bubble that you can see him running in. This piece of equipment is called an “AlterG treadmill” and uses technology that was originally designed and patented by NASA. Yes, that NASA.

The AlterG uses a technique of differential air pressure to create a pressurised bubble in which body weight can be modulated. It was originally designed by NASA to train astronauts going into space and aid with exercise and maintaining conditioning while up in space.

The treadmill allows Elliott to decrease the amount of weight through his injured left foot by up to 80% (so only 20% of his body weight is actually going through the foot). This of course allows for a methodical progression in which body weight is gradually increased as the injured leg acclimates and further allows him to maintain some level of conditioning while returning him quicker to his normal running gait – another key goal of early physiotherapy.

It’s a very useful tool on many levels because nothing can truly replace running as an activity and it also gives players a lot of confidence in their ability to recover. Running is something they have done their entire life so the quicker you can restore some of those “normal” movements, the more normal and comfortable the athlete is going to feel with their body.

The world of sports medicine rehabilitation – particularly at the elite sports level – continues to push the envelope in harnessing technology to help improve outcomes and expedite recoveries. These two pieces are prime examples of that and I also previously made a video about Elliott using “oxygen therapy” to improve recovery as well. At this level where money is no object, clubs will leave no stone unturned to help their players and rightfully so.

Dr. Rajpal Brar, DPT, (@3cbperformance) is a physiotherapist, movement expert, fitness trainer, sports scientist and mindfulness coach. He runs the LA and online based wellness and athletic performance clinic 3CB Performance, and you can subscribe to his Youtube channel (which posts analyses of Lionel Messi and more).