Category: Health and Fitness Professionals

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 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 Do You Need to Use BFR in Your Clinic or Gym?

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BFR Tools You Need in Your Clinic or Gym

With the increased popularity of Blood Flow Restriction (BFR) training, you may be considering utilizing it in your clinic or gym. 

BFR provides a great option for rehabilitating patients with mobility issues or injuries or those who have had surgery. 

Everything You Need to Use BFR in Your Clinic

The goal of BFR training is to train at a lower intensity with lighter loads while still achieving the same desired results you would get from training with heavier loads. To get the same high-intensity results from a low-intensity workout, a band or cuff is placed around a limb to allow arterial inflow and limit venous return. 

Your first decision is what method to use for BFR training in your clinic: bands or blood flow restriction cuffs? Bands offer an inexpensive option, but they are inconsistent when training. Results will vary from one workout to the next because it is nearly impossible to achieve the same level of resistance each time. They also don’t possess any built-in safety features like as some cuffs do, so the potential for injury is much higher. 

By choosing a product with features such as an electronic pump that allows you to set a specific personalized pressure, you ensure the greatest consistency and accuracy from workout to workout.

Depending on the size of your clinic and the predicted workload, you may want to hire and train additional staff as well.

 

Everything You Need to Use BFR in Your Gym

When using BFR in your gym, you’ll need a set of Cuffs, resistance like weights and/or resistance bands, and a training/fitness plan. If you’re training an athlete, developing a well-rounded fitness plan that incorporates BFR training can prove extremely beneficial. This is especially true for active recovery or isolating a weaker muscle group. 

Do I Need Training for BFR?

Whether you’re using BFR training in your clinic or the gym, safety is of paramount importance. You should learn and understand how to properly use BFR techniques to achieve the best results in the safest manner possible. 

Training is not required for either non-health pros or health professionals; however, we do recommend training for health professionals as they are likely to see a variety of different types of patients with potentially contraindicating conditions that preclude them from BFR training.

SmartTools offers CEU-approved, evidence-based training courses in BFR training all around the world, including training sessions, classes, and continuing education. 

We pair that evidence-based training with our instructors’ real-world experience to create a dynamic combination. You’ll be able to immediately implement the lessons and knowledge you gain into your training with patients and athletes. 

And for consumers, we offer free consultations with our BFR coaches with each purchase. This way we can ensure they get started safely and in the most effective way possible. 

To learn more and view our list of BFR Training courses across the globe, visit our education page. 

 

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