Optimising remote conservative and post-operative rehabilitation of traumatic knee injuries using Blood Flow Restriction Exercise in UK Defence service personnel (Ref RDFC26/HW/SER/HUGHES)

About the project

About the Project High rates of musculoskeletal injury (MSKI) are well documented in the UK Military. Lower limb injuries consistently account for the largest proportion of MSKI, with the knee joint representing the most commonly affected site. Within the UK armed forces, knee related MSKI accounted for 9% of all medical discharges in 2024/2025. Traumatic knee injuries therefore have a substantial impact on service personnel, affecting operational effectiveness, long-term functional outcomes, and employability. Within UK Defence Rehabilitation, traumatic knee pain is managed either conservatively or surgically. Best-practice pathways aim to deliver timely, high-quality care, with surgical patients undergoing accelerated postoperative rehabilitation and conservative patients following analogous protocols. Early rehabilitation strategies that mitigate muscle atrophy, inhibition and strength loss are critical for returning service personnel to duty. However, these interventions are often limited by pain, reduced load tolerance, and logistical constraints such as restricted access to rehabilitation services in remote or deployed environments. Low-load blood flow restriction (LL-BFR) training has emerged as a promising intervention to address these challenges – a recent randomised controlled trial in a military population demonstrated significant improvements in pain and function in individuals with anterior knee pain following an intensive, supervised LL-BFR programme delivered in a residential setting. This technique provides controlled restriction of oxygenated blood supply to the working muscles during low-load resistance exercise, and has been shown to elicit improved rehabilitation outcomes (i.e. increased muscle strength, hypertrophy, and function, alongside reductions in pain) following traumatic knee injury and surgery (specifically anterior cruciate ligament rupture) in NHS care pathways. Therefore, LL-BFR may provide an effective intervention to improve rehabilitation outcomes following traumatic knee injury in UK Defence service personnel. However, this has not been investigated in UK Defence service personnel, for either conservative or post-operative rehabilitation of traumatic knee injury, and it is unclear whether these benefits can be realised earlier in the care pathway or through remotely delivered interventions requiring minimal resources. Furthermore, the underpinning mechanisms driving improved rehabilitation outcomes with LL-BFR following traumatic knee injury have not been elucidated, including neurophysiological adaptations. Therefore, the aim of this PhD is to evaluate the effectiveness of a remotely delivered, intensive, low-resource LL-BFR rehabilitation programme for the early conservative and postoperative management of traumatic knee injury in UK service personnel, and to elucidate the underpinning mechanisms – including neurophysiological adaptations – driving any improvements in rehabilitation outcomes. This research will be conducted in collaboration with the Academic Department of Military Rehabilitation at Defence Medical Rehabilitation Centre Stanford Hall. The candidate will based full-time at DMRC, using the laboratories available within ADMR. It will run in parallel with a complementary PhD investigating the clinical outcomes of LL-BFR, with the two students working in close collaboration; this project will focus on the mechanistic basis of LL-BFR – including neurophysiological adaptations – underpinning improved rehabilitation outcomes following traumatic knee injury. Findings will inform the design of larger clinical trials and support the development of innovative, accessible rehabilitation models that enhance recovery whilst reducing burden. We are seeking a highly motivated individual with a background in exercise physiology, sport science, physiotherapy, or a related medical discipline, and demonstrable experience in quantitative research, including the collection of physiological data in laboratory settings. Prior experience with neurophysiological measurement techniques (e.g. peripheral nerve stimulation and transcranial magnetic stimulation), LL-BFR research, or clinical environments is desirable but not essential. Academic Enquiries This project is supervised by Dr Luke Hughes, Dr Justin Andrushko, Dr Pete Ladlow, Dr Robyn Cassidy, and Dr Russ Coppack MBE. For informal queries, please contact Dr Luke Hughes ( luke4.hughes@northumbria.ac.uk ) or Dr Justin Andrushko ( justin.andrushko@northumbria.ac.uk ). For all other enquiries relating to eligibility or application process please use the email form below to contact Admissions. Eligibility Requirements: • Academic excellence i.e. 2:1 (or equivalent GPA from non-UK universities with 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 if they are already a PhD holder or if currently engaged in Doctoral study at Northumbria or elsewhere. To be classed as a Home student, candidates must: • 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. If a candidate does not meet the criteria above, they would be classed as an International student and would not be eligible. Applicants will need to be in the UK and fully enrolled before stipend payments can commence. For further details on how to apply see https://www.northumbria.ac.uk/research/postgraduate-research-degrees/how-to-apply/ In your application, please include a research proposal of approximately 1,000 words and the advert reference (e.g. RDFC26/…). Deadline for applications: 29 October 2026 Start date of course: 1 March 2027 Northumbria University is committed to creating an inclusive culture where we take pride in, and value, the diversity of our postgraduate research 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 Leader, 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 and are members of the Euraxess initiative to deliver information and support to professional researchers.

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