Category: Blood Flow Restriction
BFR therapy for tendon in clinical settings.

Blood Flow Restriction Training for Tendon Health

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Blood flow restriction (BFR) training, a novel technique in the field of rehabilitation and sports medicine, has been gaining traction because of its benefits in muscle growth and recovery. Although the validity of BFR’s role in muscle hypertrophy is well documented, the question has arisen as to whether the low loads associated with BFR therapy leave the associated tendons behind in terms of growth, thus increasing the risk of tendon injury. This blog post delves into what BFR training entails, the science behind its effectiveness, and how it can be applied to treat and improve tendon size and strength both for rehabilitation and overall health.

What is Blood Flow Restriction Training?

Blood flow restriction training, also called blood flow restriction therapy, involves applying a cuff to the proximal part of the arm or leg to safely restrict both venous and arterial blood flow to the involved limb. This type of training is typically conducted while performing low-intensity resistance exercises, between 30-40% of one’s one repetition maximum (1RM). The idea is to create an environment within the limb that mimics the effects of high-intensity workouts (>65% 1RM), thereby promoting muscle strength and hypertrophy with significantly reduced loads. The reduced load is critical because many people can not lift heavy loads but still need the stimulus to increase muscle size and strength. These individuals may be older, injured, post-surgical, or just not able to tolerate heavy weights.

The Science Behind BFR Training

The mechanism of BFR training hinges on the concept of creating a hypoxic (low oxygen) environment for the targeted muscles. When the muscles are deprived of oxygen, they are forced to work harder to perform even low-intensity exercises. When hypoxia is combined with muscular tension, muscle protein synthesis, type II muscle fiber recruitment, and cellular swelling, which are all critical factors in muscle growth and recovery, are stimulated. Also evidence of both local and systemic endocrine signaling that may play a role in strength and hypertrophy has been found.

BFR training leads to the accumulation of metabolites further down the limb or distal to the cuff. Metabolites like lactate and hydrogen ion, which are believed to help in the production of growth hormone and testosterone (Yinghao et al., 2021), stem cells (Montgomery et al., 2019), and vascular endothelial growth factors (Ferguson et al., 2018) all critical players in tissue repair and growth. Notably, the application of BFR at low intensities helps prevent the strain and stress that high-intensity workouts impose on muscles and tendons, making it a suitable option for both injury rehabilitation and post-surgical rehabilitation.

BFR therapy for tendon in clinical settings.
SmartCuffs 4.0 during a TRX squat.

BFR Training for Tendon Health

Tendons, the tough bands of fibrous connective tissue that connect muscles to bones, require a balanced approach to strengthening healthy tissue and healing injured tissue. BFR has been shown to increase size and strength in healthy tendons (Vergara et al., 2023), tendinopathies (Yow et al., 2018), and post-surgical rehabilitation(Gerber et al., 2004). Tendon injuries, such as tendinopathies, are notoriously slow to heal because of the low blood supply to these structures. Current thinking is that damaged tissue never fully heals, so new tissue needs to be formed around the injured tissue. (Docking & Cook, 2019) Herein lies the potential of BFR training to contribute positively to tendon health:

1. Enhanced Collagen Synthesis: Research indicates that BFR therapy can increase the synthesis of collagen in tendons, which is vital for their strength and flexibility. The stress caused by the restricted blood flow followed by reperfusion when the cuffs are released (free flow) may encourage collagen production in the tendon tissues. Proper nutrition plays an important role in enhancing collagen synthesis. (Baar, 2019)

2. Reduced Load on Tendons: Since BFR training can be performed with lower loads, it allows individuals with tender or healing tendons to strengthen the muscles around the tendon without placing excessive stress on it. This is particularly beneficial in the early stages of tendon rehabilitation, both post-surgical and during the injury process.

3. Pain Management: There is evidence that BFR training can help in reducing pain perception, which is a common issue in chronic tendinopathies. The exact mechanism is not well understood but is believed to be linked to the muscle fatigue induced by BFR, which may alter pain signals sent to the brain.

BFR cuffs for ACL injury
Blood Flow Restriction Therapy for Achilles’ Tendinopathy

Implementing BFR Training in Tendon Rehabilitation

To safely incorporate BFR training in the context of tendon health, it is crucial to follow a structured approach under professional guidance. Here’s a step-by-step guide on how to get started:

– Consultation with a Healthcare Professional: Before beginning any new exercise regimen, particularly one involving blood flow restriction training, it is essential to consult with a healthcare professional, such as a physical therapist or a sports medicine doctor certified in BFR. They can provide guidance based on the specific tendon issue and overall health. Not everyone is a candidate for BFR based on injury type and the individual’s medical history. Diagnostics such as MRI or Diagnostic Ultrasound may be necessary to understand the degree of injury and how long the recovery process may take.

– Proper Equipment: Use FDA-listed blood flow restriction cuffs that are designed for this type of training. These BFR cuffs offer precise control over the amount of applied pressured via limb occlusion pressure calibration, which ensures safety and effectiveness.

– Starting with Low Intensity: Begin with exercises that are low in intensity but effective in stimulating the muscles around the injured tendon. Gradually increase the intensity as tolerated. My favorite technique is to use isometric contractions in the early stages, three times per week.

– Monitoring and Adjustment: Regularly monitor the response to BFR training. Any signs of extreme discomfort or adverse effects should prompt an immediate reassessment of the technique and adjustments by a professional.

– Integration with Other Therapies: Combine BFR training with other rehabilitation modalities such as Extra Corporeal Shock Wave Therapy (ECSW), Dry Needling (DN), Instrument Assisted Soft Tissue Manipulation (IASTM), or Active Release Technique (ART) for the best results. Don’t forget to address not only the injured site but also look for tissue and joint movement abnormalities (aka densification of the tissue) above and below the focused tissue.

Conclusion

Blood flow restriction training represents a promising advancement in the rehabilitation of tendon injuries and the enhancement of tendon health. By allowing for muscle and strength development at lower intensities, BFR training can help manage the delicate balance between exertion and recovery in tendon rehabilitation. With proper implementation and supervision, BFR can be a valuable tool in the arsenal against tendon-related issues, offering a safe and effective pathway to faster recovery and stronger, more resilient tendon structures.

For anyone considering BFR training, particularly for tendon health, it’s crucial to approach this method thoughtfully and under the guidance of professionals who can tailor the program to individual needs and ensure safety throughout the process. As research continues to evolve, the scope and efficacy of BRF training will become more apparent, potentially opening new avenues for effective treatment options in physical therapy, sports performance, and longevity.

 

About the Author:

Ed Le Cara, RN, DC, PhD, MBA, ATC, CSCS is the owner and full-time clinician at Body Lounge Park Cities in Dallas, TX, and the director of education for SmartTools.  Dr. Le Cara can be reached on LinkedIn.

 

 

Reference list

Baar, K. (2019). Stress Relaxation and Targeted Nutrition to Treat Patellar Tendinopathy. International Journal of Sport Nutrition and Exercise Metabolism ,  29 (4), 453-457. https://doi.org/10.1123/ijsnem.2018-0231

Docking, S. I., & Cook, J. (2019). How do tendons adapt? Going beyond tissue responses to understand positive adaptation and pathology development: A narrative review. J Musculoskelet Neuronal Interact,  19 (3), 300–310.

Ferguson, R. A., Hunt, J. E. A., Lewis, M. P., Martin, N. R. W., Player, D. J., Stangier, C., . . . Turner, M. C. (2018). The acute angiogenic signalling response to low-load resistance exercise with blood flow restriction. Eur J Sport Sci , 1-10. https://doi.org/10.1080/17461391.2017.1422281

Gerber, C., Meyer, D. C., Schneeberger, A. G., Hoppeler, H., & von Rechenberg, B. (2004). Effect of tendon release and delayed repair on the structure of the muscles of the rotator cuff: an experimental study in sheep. J Bone Joint Surg Am ,  86-A (9), 1973-1982.

Montgomery, R., Paterson, A., Williamson, C., Florida-James, G., & Ross, M. D. (2019). Blood Flow Restriction Exercise Attenuates the Exercise-Induced Endothelial Progenitor Cell Response in Healthy, Young Men. Frontiers in Physiology, p. 10. https://doi.org/10.3389/fphys.2019.00447

Tendinitis | UK Healthcare. https://www.ukhealthcare.uky.edu/orthopaedic-surgery-sports-medicine/conditions/general-orthopaedics/tendinitis

Vergara, I. B., Puig-Diví, A., Alonso, B. A., & Milà-Villarroel, R. (2023). Effects of low-load blood flow restriction training in healthy adult tendons: A systematic review and meta-analysis. Journal of Bodywork and Movement Therapies.

Yinghao, L., Jing, Y., Yongqi, W., Jianming, Z., Zeng, G., Yiting, T., & Shuoqi, L. (2021). Effects of a blood flow restriction exercise under different pressures on testosterone, growth hormone, and insulin-like growth factor levels. Journal of International Medical Research ,  49 (9), 030006052110395. https://doi.org/10.1177/03000605211039564

Yow, B. G., Tennent, D. J., Dowd, T. C., Loenneke, J. P., & Owens, J. G. (2018). Blood flow restriction training after Achilles tendon rupture. The Journal of Foot and Ankle Surgery ,  57 (3), 635-638.

What Can BFR Physical Therapy Help Treat?

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What Types of Injuries Can BFR Be Used to Treat?

What do muscle strains, tendon injuries, and even bone stress injuries and fractures all have in common? 

They all can be treated with Blood Flow Restriction (BFR) therapy. 


How Does BFR Work With Different Injuries?

BFR is quite the versatile tool when it comes to rehab. It can help with a variety of common rehab injuries including:

  • Soft tissue (also known as muscle) injuries,
  • Tendon/ligament injuries, and
  • Fractures  and bone stress injuries

 

Soft Tissue (Muscle) Injuries

BFR is an amazing tool to use when treating soft tissue injuries.

Under normal conditions, if you damage muscle tissue — which is common if you perform resistance training under heavy loads or until failure — the body is able to recover through muscle regeneration. This is actually a good thing as muscle regeneration helps muscles rebuild and get stronger. 

However, if you strain a muscle and cause excessive damage, the body has to rely on other inferior pathways to get the healing job done as fast as possible. Unfortunately, this usually means that scar tissue and tissue that is inferior in quality compared to muscle tissue is formed. 

Why is myostatin worth noting, and why do we want it inhibited? Well, myostatin is part of the TGF-beta superfamily, which is the bad scar tissue pathway we mentioned earlier. 

Thus if we do BFR, we promote muscle protein synthesis aka muscle regeneration while limiting scar tissue formation, which is essential for optimal muscle performance.

Tendons

Tendon injuries are complicated as they require mechanical load (and a lot of it) to heal. This is because the cells that make up tendons respond well to adequate mechanical stress. Tendon issues like Achilles and patellar tendinitis eventually need to be loaded in order to heal. However, mechanical load can be very painful for an unhappy tendon. 

A recent article by Centner et al. 2019 has provided us a significant glimpse of hope for less mechanical load (and potentially less pain) necessary to induce positive adaptations in problematic tendons. The study found that throughout a span of 14 weeks, combining BFR with a progressive calf raise program significantly improved the health and function of the Achilles tendon. The tendon got bigger and stiffer, while the calf muscle size and strength improved, all of these things are super helpful and beneficial when dealing with any kind of tendinopathy or tendon issue.

Bone

Bone injuries are complicated and very different from soft tissue and tendon injuries. 

The main dilemma with bone injuries is that you have to provide extra care and protection when injured, and you cannot overload an injured bone as the potential risks (a bone stress injury turning into a full-fledged stress fracture/broken bone) outweigh the benefits. However, for bones to heal and get stronger, they actually need mechanical load. This is why doctors will recommend walking programs for older adults as weight-bearing activities are healthy for bones. This is also why space and the absence of gravity can be harmful to astronauts’ bodies.

Exercising a healing bone can be tricky because what is painful for one patient may not be for another, so you don’t always know if you’re making the bone worse or not as pain can be subjective. However, according to a systematic review by Bittar et al. in 2017, we have substantial evidence to show BFR coupled with low-intensity and low-impact exercises can improve bone formation biomarkers by upregulating bone metabolism. This means we can exercise bones safely in a pain-free manner while also promoting optimal bone health.

Using BFR

BFR has changed the game as we know when it comes to rehabbing soft tissue injuries, ligaments, and even bone injuries. Due to its versatility and effectiveness, BFR should be equipped in every single rehab clinic.

References

  1. Ozaki H, Loenneke JP, Buckner SL, Abe T (2016) Muscle growth across a variety of exercise modalities and intensities: contributions of mechanical and metabolic stimuli. Med Hypotheses 88:22–26. doi:10.1016/j.mehy.2015.12.026
  2. Fry CS, Glynn EL, Drummond MJ, Timmerman KL, Fujita S, et al. Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. J Appl Physiol.
  3. Centner C, Lauber B, Seynnes OR, et al. Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared to high-load resistance training. J Appl Physiol. November 2019. doi:10.1152/japplphysiol.00602.2019
  4. Bittar ST, Pfeifer PS, Santos HH, Cirilo-Sousa MS (2018) Effects of blood flow restriction exercises on bone metabolism: a systematic review. Clin Physiol Funct Imaging. https://doi.org/10.1111/ cpf.12512

 

How Long Do Soft Tissue Injuries Take to Heal

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How Long Do Soft Tissue Injuries Take to Heal

Everyone has likely experienced a soft tissue injury at some point during their life — from injuries as severe as a torn rotator cuff to as simple as an ankle sprain. And the first question usually asked is, how long is this going to take to heal? 

The answer to that question is complicated and depends on a host of factors and conditions. Not all soft tissue is created equally, and therefore, not all soft tissue injuries take the same amount of time or rehabilitation to recover. 

What Is Soft Tissue?

Soft tissue plays a crucial role in your body’s makeup, movement, and ability to function. It is the unhardened parts of your body, such as muscles, tendons, and ligaments, that help support and connect your body. 

Each soft tissue, from muscles to ligaments, is constructed of collagen, elastin, and ground substance. Ground substance is a gel-like material that is active in the movement and development of tissues. The amount of each of these in the soft tissue gives it its properties and helps determine its function. These properties include strength, the ability to stretch (extensibility), and the ability to recoil from being stretched (elasticity). 

What Is a Soft Tissue Injury?

If you have ever sprained your ankle, you know just how severe the pain from that type of injury can be. 

These kinds of injuries are relatively common in sport or physical activity. They are usually the result of overstressed muscles, which become weaker over time, leading to a soft tissue injury. 

Common types of soft tissue injuries include sprains, strains, tendinitis, bursitis, and other contusions. Sometimes more severe and serious soft tissue injuries occur, such as rotator cuff, Anterior Cruciate Ligament (ACL), and Medial Collateral Ligament (MCL) injuries.

Stages of Healing for Soft Tissue Injuries

The amount of time it takes for a soft tissue injury to heal depends on many factors and is specific to each person and their circumstances. Those factors include a person’s age, fitness level, chronic conditions, and other medical issues. It also depends on how severe the injury is and what tissue or body part is injured. 

Soft tissue healing occurs in three phases: inflammatory, proliferation, and remodeling. Because of the nature of soft tissue healing, these phases often overlap to some degree.

Inflammatory Phase: 0 – 6 days

This first phase begins on the day the injury occurs and can last up to six days. Swelling around the injury is extremely common in this phase. Healing cells start their work of cleaning up and removing the dead tissue.

Proliferation Phase: Day 6 – Day 24

Swelling will subside as the dead tissue is removed, and type III collagen is introduced to produce new tissue. During this phase, the injured area will be quite weak because this newer tissue does not possess the same qualities and strength as normal tissue.

Remodeling Phase: Day 21 – 2 years

Finally, that type III collagen is converted into type I collagen, which is present in scar tissue. As soft tissue goes through the healing process, the body creates scar tissue to replace the damaged tissue. This last phase can take up to two years for the injury to completely heal, depending on its type and severity.

With the loss of muscle mass and strength from a soft tissue injury, many people need the help of physical therapy to regain strength and mobility in the affected body part. This is important so that the person can use that body part normally again. 

How BFR Can Help with Soft Tissue Injury Healing

Blood Flow Restriction (BFR) training offers significant benefits for physical therapy and soft tissue injury rehabilitation. 

When blood flow is restricted, the injured area recruits muscle fibers. These fibers help facilitate an increase in muscle mass. Furthermore, the results take less time than traditional training modalities and rehabilitation programs. 

By understanding soft tissue and the phases of healing, we can better determine the sense of the time it takes for specific injuries to heal. 

 

How to Use BFR Bands for Legs & More

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How to Use BFR Bands | Crucial Tips for First Timers

If you’re visiting this blog, you’ve likely heard of BFR, or Blood Flow Restriction training. It’s also likely that you’re interested in learning more about BFR and how to use BFR bands or cuffs for training and rehabilitation for the first time. 

BFR training is when you place cuffs or bands around a limb during exercise to maintain arterial inflow to the muscle while at the same time preventing venous return of the blood to the heart. 

Guide to Using BFR for the First Time

As a beginner, you need to decide what type of cuff or band to use. BFR cuffs allow you to precisely control the amount of pressure and the restriction to blood flow, making them not only consistent but also much safer than bands. 

Before beginning a training session, perform a light warmup such as walking or light cycling. Follow that five-minute warmup with roughly 15 un-cuffed reps with whatever weight you plan to use for your first set of BFR. To find the best weight, start on the lighter side and experiment with what works best for you. 

Now that you’re ready to train, wrap the BFR cuff around the top portion of your legs or arms. Depending on whether you’re using cuffs or bands, remember to not wrap too tightly to avoid numbness or tingling. 

Dos and Don’ts of BFR

Do lift much lighter weights than you think you need. One of the primary advantages of BFR training is that you can train by lifting lighter loads at a lower intensity. However, when lifting lighter weights at a lower intensity, you do want to perform more reps and longer sets with shorter rest periods in between. 

Don’t be afraid to start slow. In other words, don’t overdo it. This is a very real temptation when beginning a new training program or strategy. Most patients or athletes get excited and want to go all-in and see results immediately. Those results will come soon enough. But as a beginner, it’s critical to listen to your body, take it slow, and take breaks if needed. Work your way up to longer sets. 

How Do You Know If BFR Is for You?

BFR training benefits a wide range of people. Those who have mobility issues, such as those who are in a cast, bed-ridden, elderly, or post-op, will benefit.

As you begin your BFR training, it’s important to consult with your physician before starting a new exercise program. Invest in the proper equipment and start off slow and deliberate. Build up your training from there and you’ll discover BFR is a game-changer when it comes to seeing results and reducing the risk of injury to your muscles, joints, and tissue.

 

Comparing Occlusion Training Bands vs. Cuffs

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Occlusion Training Bands | Bands vs. Cuffs 

Blood Flow Restriction (BFR) training has become quite popular with athletes and fitness professionals, as well as those with mobility issues and those who are rehabbing from an injury or surgery. 

But just what is BFR training and how does it work? The term “blood flow restriction” can sound a bit intimidating, but it is part of an effective training strategy that produces results.

How Does BFR Work?

BFR training works by placing cuffs or bands around a limb of your body during exercise. The band or cuff helps maintain arterial inflow to the muscle while simultaneously preventing venous return. In other words, blood can flow to the muscles but not out of them. 

Since this training is achieved through low-intensity exercise with a decrease in stress to tissue and joints, the benefits are ideal for mobility-challenged patients going through rehabilitation or for athletes looking to isolate and strengthen weaker regions of the body.

Using a Band for BFR

A variety of tools can be used to perform BFR. The two most common are bands or cuffs, since they are the least expensive options. You can search your favorite online store and find most options well under $50. 

The downside to bands is that they offer little in the way of consistency. It’s extremely difficult to achieve any level of accuracy over multiple workouts because there’s no way to apply a consistent level of pressure. Your workout on Monday may feel very challenging, while Wednesday’s workout may seem too easy. 

Using a Cuff

A cuff, which has the ability to accurately measure a personalized pressure, provides a much more consistent training method, as well as enhanced safety to help reduce risk of injury when training. 

Accurately measuring a personalized pressure is important because it allows you to take the guesswork out of the amount of blood flow restriction you’re applying to a limb on an individual basis. This is a crucial safety feature. 

A cuff system which offers an electronic pump system that lets you set your personalized pressure, can make the entire process quick and easy. 

Some cuffs  also feature built-in safety mechanisms like “Manual Mode,” which allows the user to inflate the cuff to the desired pressure. 

Pros and Cons of Bands vs. Cuffs

As you can see, there are key differences between these two methods of BFR training. 

Bands

Pros:

  • Inexpensive and the most affordable

Cons:

  • Inconsistent pressure and accuracy
  • Pose a greater risk of injury

Cuffs

Pros:

  • Extremely safe and easy to use
  • Ability to measure a personalized pressure for enhanced safety and accuracy
  • Built-in safety mechanisms
  • Least risk of injury

Cons:

  • More expensive than bands

What Is The Difference Between BFR and Traditional Physical Therapy?

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What Is The Difference Between BFR and Traditional Physical Therapy?

Blood Flow Restriction (BFR) has changed the game of rehab as we know it. 

By using BFR with rehab patients, we are able to stress tissue earlier while still protecting it. This allows patients to rehab faster with better results.

How Does Traditional Physical Therapy Work? 

Traditional physical therapy is designed to restore and improve functional capacity typically after an injury or surgery. 

In simpler terms, functional capacity is what your body is physically capable of doing.

Regular physical exercise and training are designed to improve functional capacity. Physical therapy is similar, but extra attention and detail are required to respect the injured/recovering body part to fully rehab it. To better understand why traditional physical therapy has limitations, we need to better understand injuries.

How do Injuries Occur? 

The simplest way to understand injuries is to look at the relationship between external demand and functional capacity. When the external demand is greater than the body’s functional capacity, tissue failure can occur. 

When tissues fail, they’re exposed to excessive amounts of mechanical stress that can cause injuries such as muscle tears, tendon/ligament ruptures, bone fractures, you name it. 

And unfortunately, when an injury occurs, the functional capacity of the tissue significantly drops. 

This is where physical rehab comes into play. During physical therapy, we want to protect the injured tissue — that’s why the extra attention and details matter— while we carefully and gradually stress the tissue to increase its functional capacity. The ultimate goal is to improve the tissue’s functional capacity to get it back (at least) to baseline, but ideally even greater than baseline so that there is less risk of the same injury (or others) happening again.

Why Are Injuries Challenging to Treat As Is? Mechanical Stress Issues

With most injuries, there is always a component of rehab that focuses on improving muscle. From research, we know that muscle hypertrophy (increase in muscle size) occurs in response to stress. There are two main types of stress, mechanical and metabolic stress. 

Traditional rehab typically involves therapeutic exercises with resistance bands or weights, which is a mechanical load imposing a demand on the tissue. However, rehab can be really hard and challenging because injured tissue is really sensitive to mechanical load.

If the mechanical load is too much or the exercise volume is too high (too many sets and reps), patients can end up dealing with excessive pain and may have a hard time going about their life outside of rehab. If patients can’t tolerate rehab exercises that truly challenge the injured tissue or the total exercise volume necessary, then there may be not enough optimal stress to increase the injured tissue capacity. This ultimately leads to poor rehab results, frustrated patients, and the next thing patients know they out of available physical therapy visits according to their insurance company even when they still need help.

So, the question is how do we challenge injured tissue without excessive mechanical load or exercise volume? 

Treating Injuries With BFR – Maximizing Metabolic Stress

When mechanical stress is not tolerated, we can turn to metabolic stress to improve muscle. 

So, what is metabolic stress? It’s that terrible muscle burn you feel when you’re working really hard for long periods of time. But again, a common issue with treating injuries is that patients cannot tolerate excessive exercise volume, which is typically needed to cause metabolic stress. So that’s where BFR excels compared to traditional physical therapy because it can initiate metabolic stress with minimal exercise volume.

According to an article by Ozaki et al. 2015, the hypertrophic effect on muscle via metabolic stress is significantly exaggerated when you combine exercise with BFR. 

The true beauty of BFR is that you can exercise with really low mechanical loads (as low as 20% 1RM) and still elicit muscle hypertrophy. The best part is, it doesn’t take much exercise volume as BFR induces metabolic stress relatively fast due to the restricted blood flow increasing muscle oxygen demand, so muscles end up having to work really hard in a short time period leading to earlier onset of fatigue. Earlier onset of fatigue means less total exercise volume, which can mean happy patients with faster results.

References

  1. Ozaki H, Loenneke JP, Buckner SL, Abe T (2016) Muscle growth across a variety of exercise modalities and intensities: contributions of mechanical and metabolic stimuli. Med Hypotheses 88:22–26. doi:10.1016/j.mehy.2015.12.026
  2. Fry CS, Glynn EL, Drummond MJ, Timmerman KL, Fujita S, et al. Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. J Appl Physiol.
  3. Centner C, Lauber B, Seynnes OR, et al. Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared to high-load resistance training. J Appl Physiol. November 2019. doi:10.1152/japplphysiol.00602.2019
  4. Bittar ST, Pfeifer PS, Santos HH, Cirilo-Sousa MS (2018) Efects of blood fow restriction exercises on bone metabolism: a systematic review. Clin Physiol Funct Imaging. https://doi.org/10.1111/ cpf.12512

 

The Benefits of Blood Flow Restriction Training for Your Patients

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Simply put, it is efficient and attainable since it allows patients to see significant results while using much lighter weights.

What Can BFR Do for Your Patients

BFR training typically requires some form of easily doable but effective exercise personalized to the patient’s rehabilitation needs.

Through BFR, patients are better able to move actively, improve function, and improve independence and quality of life.

BFR Compared to Other Methodologies

For many patients, the psychological buy-in of BFR is more immediate compared to other modalities used in rehabilitation (e.g., STM, electrical stimulation, ultrasound, joint mobilization, etc.).

Too often, after 4-6 weeks of repetition with other methods and little to show for it, patients tend to question the results and whether anything is actually happening. They can’t see a  tendon being restructured, tissue being laid down, or their brain’s neural network labeling sensations as safe or threatening every time they do a squat. So, patient compliance can become challenging.

How Does BFR Work?

BFR training uses specifically designed cuffs to control the amount of oxygen available to a limb, replicating a high-intensity environment. If a patient lifts light weights combined with BFR, they will get similar results seen with heavy lifting. BFR is even more beneficial during rehabilitation because it enables a patient to exercise effectively, which is key to triggering tissue adaptation and recovery.

What Types of Injuries Can BFR Be Used On?

The low threshold required to use BFR combined with the potential benefits makes it a definite go-to for rehab. It offers enormous benefits for many musculoskeletal injuries, including bone fractures, muscle strains, post-surgical tendinous or ligamentous interventions, meniscus repair, Achilles or Patellar tendon repairs, and total joint replacement. If a patient needs simple but effective rehabilitation, BFR is an excellent first step.

 

[1]Loenneke J.P., Wilson J.M., Marin P.J., Zourdos M.C., Bemben M.G. (2012). Low intensity blood flow restriction training: a meta-analysis. European Journal of Applied Physiology 112, 1849-1859

[2]Ferraz, RB, Gualano, B, Rodrigues, R. Benefits of resistance training with blood flow restriction in knee osteoarthritis. Med Sci Sports Exerc. 2018;50:897-905.

Giles L, Webster K, McClelland J, Cook J., Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain. A double blind randomized trial, Journal of Science and Medicine in Sport 20S (2017 e67-e105)

[3]Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, Ishii N (2000b). Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. J Appl Physiol 88:2097–2106

Blood Flow Restriction Training

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Author: Ed Le Cara, DC, PhD, MBA, ATC, CSCS
Board Certified in Rehabilitation
Board Certified in Chiropractic Sports Medicine

“Blood Flow Restriction” (BFR) training involves wrapping an elastic band or cuff around your limbs to partially block blood flow during a workout. The technique has been growing in popularity among bodybuilders in recent years. Proper education and effective application for efficacy and patient safety is the key.

The goal of BFR training is to increase the metabolic stress on your muscles without doing intense work that causes muscle breakdown. To accomplish the goal, one wraps a tourniquet-like cuff around the top of the arm and/or leg. The cuff is tight enough to block the veins returning blood from the muscles to the heart, but loose enough to allow fresh arterial blood into the muscles.

Under normal conditions, the metabolites produced in your muscles during hard exercise serve as cellular signals that trigger adaptations in your body – bigger muscles after resistance training, for example.

The most robust evidence for BFR training is in increasing strength and muscle mass using relatively light weights. A typical BFR protocol involves lifting between 20% – 40% of your one rep maximum (1RM), with one set of 30 repetitions followed by three sets of 15 repetitions each, with 30 to 60 seconds of rest between.

While the weight will still seem light, you’ll feel the localized burn in your muscles more acutely. With more training sessions, my patients start to tolerate the burn much better.

The main attraction of BFR is you stress the muscles without accumulating as much wear-and-tear as you would with normal training. For a serious athlete, adding a set of BFR lifts after you’ve already maxed out your normal workout could be a way of getting an extra training boost. Healthy individuals can substitute traditional strength training sessions as an, “active recovery day” or when equipment is not available to do heavy-load like during travel or vacations.

BFR training is a novel approach to increase active participation in patients without the need for large amounts of space or resistance equipment.

Look for upcoming articles on how I specifically use BFR with my patients to improve their functional capacity and recover from injuries.

 

About the Author:
Dr. Le Cara, a former Army Combat Medic, has worked as a strength and conditioning coach, athletic trainer, and chiropractor for over 20 years. He holds a PhD in Athletic Training from Rocky Mountain University of Health Professions. His original research on the structure and function of the lumbar multifidus muscle and how it relates to lower back pain was published in 2014. He has authored or co-authored numerous peer reviewed articles and dozens of non-peer reviewed articles. Ed holds an MBA in Transglobal Education from St. Mary’s College of California. In addition to being the director of education for Smart Tools and teaching internationally, he treats patients every day with manual therapy and fitness training.