Blood Flow Restriction Training

Smart Cuffs Pro - System used by The Obstacle Doc

Where does blood-flow restriction training (BFR) come from?

Rooted in Japanese bodybuilding from the 1960s known as KAATZU, blood flow restriction training became a catalyst for strength in the rehabilitation setting. In the early 2000s, military providers struggled with developing ways to help patients build strength and hypertrophy (muscle mass) for limbs that had suffered from ballistics and other high-velocity traumas. These injuries often rendered the service member with loss of limb muscle bulk as a result of surgical procedures or the time to allow adequate tissue healing. This made it difficult to apply traditional strength and conditioning principles within the rehabilitation setting to build strength and mass as their bodies and/or involved areas could not tolerate these necessary higher resistance loading methods.

The breakthrough for these clients was the use of blood flow restriction training, in combination with lighter load exercises for a period of time, to force the body system into a state of strength and muscle development.

How does blood-flow restriction training work?

Muscle strength and development are based on training under high enough loads (>65% of your one repetition maximum for a typical lift) to induce an anaerobic state within the body. Through a myriad of muscular metabolic processes, this oxygen-deprived state will trigger growth hormone secretion from the brain, and growth factor secretion from the body to build muscle as it is being broken down from high-load exercise. Without getting too thick, this is how physiologically high load/stress training can improve our strength and muscle mass within a given tissue(s).

Through the use of a temporary tourniquet device, occluding/blocking 50-80% of blood flow to a given limb during selected exercises that are well below 65% or greater of our one repetition maximum (more like 20-30%!) we can induce the same metabolic processes, growth hormone, and factor cascades as if we were actually lifting under those similar higher loads!

Why is this breakthrough so important?

This allows patients who are not able to go through the appropriate higher load training to help build the necessary strength and muscle mass, allowing them to have a better capacity to transition to these higher loads, ultimately getting them back to what they want to do best!

Who can benefit from this?

Knee arthroscopic surgical reconstructions, such as ACL repairs, meniscal repairs, and total joint replacements. Shoulder surgeries, like rotator cuff repairs or labral repairs, just to name a few. BFR can be an integral piece to your puzzle if done at the right stage post-operatively.

For clients who may have had a history of orthopedic surgery or multiple procedures and never really got back their full strength and muscle mass, even after doing their conventional therapy and returning to exercise, BFR can still be a great opportunity to help these clients finally break through the wall of weakness and atrophy that often plagues them long term!

What do BFR sessions or planning look like?

Traditional BFR training consists of a specific set and repetition algorithm, guided by your therapist over a selection of four to five exercises. A program can average four to eight weeks, with approximately two to four BFR sessions per week. While there is variety, on average this is what has been shown to have strength and muscle mass results.

While the method of training is safe, it is recommended patients be followed by physical therapists who are credentialed in Blood Flow Restriction training and use devices that are recognized by the FDA, as well as who can understand whether you are an appropriate candidate with a medical history that would be acceptable for this type of training.

Personal Thoughts on BFR

I have found this to be a great tool for my practice, most notably with my post-operative cases who are struggling to build strength and muscle mass in their operative limb. Most of these patients were able to overcome barriers through the use of BFR on their way to higher-intensity activities, such as running, jumping, cutting, and other movements unique to their sport of choice.

Oftentimes, it is mentally helpful for active clients who have felt down or depressed that they cannot work out the way they are used to because their recovery restricts them. BFR is a great way to give clients back that feeling of working out again and getting that BURN we all know and love from training.

It can be a big psychological boost for the right person!