Blood Flow Restriction Rehabilitation
This is an article providing information on BFR, if you’re looking to schedule an appointment at PhysioStrength Physical Therapy to train with us using BFR, click here.
Effects of BFR:
- Increased strength gains
- Increased hypertrophy (muscle mass)
- Increased protein synthesis
- Increase release of growth hormone
- Increased capillarity
- Increased VO2 Max
- Decreased delayed-onset muscle soreness compared to heavy resistance training
I recently completed a continuing education course to become a certified provider of Personalized Blood Flow Restriction Rehabilitation. The course was put on by Owens Recovery Science, the leading researchers of this topic. For those of you who don’t know what blood flow restriction training is, I’ll provide a brief overview.
Blood Flow Restriction Training
You may have heard of blood flow restriction training (BFR) as it has gained popularity in the media with professional and collegiate athletes. Many athletes and teams are using this method of training for rehabilitation from injury as well as performance enhancement. Why are they using it? BFR allows people experiencing injury to sustain muscle mass, get stronger faster, and get better faster. BFR is not just for athletes. Many clinicians are using it to get their patients better faster. PhysioStrength is currently the only place in Tacoma that utilizes this new technology. Let’s dive into the science behind it.
What is BFR?
Blood Flow Restriction Training (BFR) involves application of a tourniquet device to a limb during exercise. Why would anyone want to do that!? Using BFR allows people to exercises at very light loads, while still getting the same training effects as if they were using heavy loads. Under normal conditions, the only way to increase strength is by lifting loads that are >65% of a persons 1-repetition maximum (1RM). In fact, some guidelines suggest that loads need to be even higher, above 80% 1RM. This type of training is not always an option, especially in certain populations such persons rehabilitating after injury and the elderly. The literature on BFR has consistently demonstrated comparable strength and hypertrophy gains to heavy resistance training, but without the increased joint stresses and microdamage to the muscles. When using BFR, you can exercise at very light loads 20-30% 1RM and get the same (sometimes better) results that you would get under normal conditions using heavy loads.
How Does BFR Work?
The tourniquet is applied at a distinct pressure that reduces arterial flow to the limb by 80% and occludes venous flow by 100%. This allows the limb to continue receiving blood flow, but causes increased pressure within the system. The increased pressure in the system does multiple things. First, it forces your muscle to call on the larger (Type II) muscle fibers in order to sustain the workload. As these Type II (anaerobic) fibers are active, it causes an increase of metabolic byproducts such as lactic acid. This triggers the metabolic cascade that leads to hypertrophic changes (muscle growth). This effect is not localized to the limb exercising. There are systemic signals that trigger your pituitary gland to release more growth hormone to account for the metabolic stress that is being applied to your body. What does growth hormone do? It aids in collagen repair by triggering collagen synthesis pathways. The benefits of BFR can be seen on a systemic level, not just at the muscles being exercised.
Secondly, BFR causes a plasma fluid shift that results in muscle cell swelling. As the muscle cells swell, a protein synthesis pathway is triggered that results in increased protein synthesis and thus muscle growth. This mechanism has even been observed using BFR in the absence of exercise. Simply applying the tourniquet to increase cell swelling has been shown to result in up-regulation of the same protein synthesis pathways. That means muscle mass can be preserved using BFR even in people who are unable to exercise. This has huge implications for early post-operative rehabilitation in which people are immobilized and even in severe situations such as comatose patients.
What About Blood Clots?
Many people think that applying a tourniquet to an exercising limb could result in clotting. In fact, the physiology is the exact opposite. Similar to heavy resistance training, BFR actually increases anticoagulant activity and stimulates the fibrinolytic (clot breakdown) system. There have yet to be any studies that suggest BFR aides in clot formation. Most of the available literature on the subject shows that BFR instead triggers an anticoagulant pathway.
Who Is Appropriate for BFR?
You’d be surprised how little precautions and contraindications there are for this type of training. Certain precautions and contraindications do exist, but most of them are the same that apply to participation in any exercise program. Generally, if your patient is an appropriate candidate for participating in an exercise program, they are likely appropriate for BFR. With that said, there are possible risks associated with BFR when not used correctly, including nerve injury and skin damage. Always remember, it is best to use clinical judgment.
How Do You Use BFR?
I’m not going to get into the details of how to use this because it requires on-site clinical training. I do not advocate that anyone use BFR who is not certified. However, understand that there are various protocols and that it can be used for improving strength as well as endurance (VO2 Max).
Clinical Importance of BFR:
BFR has changed the world of rehabilitation. BFR is a great tool for people rehabbing from an injury that have a tissue issue that impedes their ability to participate in heavy resistance training. It is great for the elderly or anyone with decreased bone density that may not be appropriate for heavy resistance training. It is a tool that allows us biohack the body and preserve muscle mass when tissue is healing. It has a place in both rehabilitation and sports performance. I
Interested in Learning More About BFR?
Feel free to get in touch with me. I’m happy to answer questions and direct you to some of the literature on BFR.
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