Blood Flow Restriction Training

What is Blood Flow Restriction Training? (BFR)

BFR training is when inflatable pressurised cuffs around a limb (proximal to the muscle being trained) are used which limits blood delivery to and from the contracting muscles.

Why Would You Use It?

When high intensity/high load training is not possible or not indicated

Examples:

After An Injury
After Surgery
Joint Doesn’t Tolerate High Load/Exercise (Arthritic Joint or Cartilage Damage etc.)
Pain Relief
Nerve Related Injuries/Radiculopathy
Patients over 40 yrs old who wish to supplement their current workouts without irritating their joints

Why Can BFR Help?

Enhances muscle hypertrophy
Increases Strength
Improves Aerobic Capacity
Attenuates Atrophy
Less Stress on Joints Due to Lower Load

(Scott ’15, Heitkamp ’15, Patterson ’19, Bowman ’19, Hughes ’19, Korkmaz ’20, Head ’20)

What Is Our Clinic’s Experience/Results and Who Do We Use It For? Most Common Conditions:

Post Knee Surgery
Arthritic Knee (Allows you to strengthen the thigh without irritating the joint and reduces pain)
Tennis Elbow
Muscle Injury of arm or leg muscles
Lumbar Radiculopathy (If used in the correct stage of rehab, can work really well)

Common Results and Use:

If successful with a trial in the clinic, patients are given a take home device for 2-6 weeks
Several patients use the device longer than 6 weeks as they are still making improvements, and some will buy the device for long term benefits
We use this often in the clinic each week, but not for every patient
One if the most effective rehabilitation strategies we use when indicated

What Are The Basics Of How It Is Used?

20-40% 1RM (one Repetition Max effort), which is usually light resistance for the patient
Frequency: 2-3 times per week
30 second rest breaks between sets
First set of exercise 30 reps followed by 3 sets of 15 reps for first exercise
Following exercises 2-3 sets of 15 reps
The application of BFR should be limited to less than 20 minutes for lower limb, and 15 minutes for upper limb, before allowing adequate time for reperfusion of tissues (3 min).

When Did BFR Start and How Much Research Is Available?

Yoshiaki Sato originated the idea in the late 1960’s
1970’s body builders used it
Mid 1990’s rehabilitation started using it
Early 2000’s increased use by the medical field]
2010’s pro athletes started using it
2017 89 articles published on BFR
2020 160 plus articles published on BFR
Now over 1,300 research articles related to BFR on pubmed

So How Does BFR Really Work?

It basically accelerated fatigue and tricks the muscle into thinking it is lifting heavier loads than what it is wheihc can lead to hypertrophy (muscle growth) response. You only need 20-40% of 1RM load to achieve the desired results! 40-80% limb occlusion pressure if often used

Several Possibilities:
- Low Oxygen
- Metabolite Accumulation
- Increased Hormone Response
- Cellular Swelling (lack of venous return)
- Activation of Anabolic Pathways (Pearson ’15, Loenneke ’11)
- Markers damage markers are not increased with BFR (Loenneke ’12)
- It doesn’t appear to stimulate greatly neural, high loads most likely needed for this (Duchateau ’06, ’11)

What About Pain Relief and Using BFR?

Reduction in pain in all tasks when compared with not using BFR (Hughes ’85, Kirakais ’18, Giles ’17, VanCant ’20).

Want To Know Even More About BFR? Watch This Video Below

Ways To Measure The Correct Pressure For Your Cuffs

Option 1:

Use the below calculator for the most accurate reading.

Blood Flow Restriction Calculator For Pressure

Measure Blood Pressure in Supine (safest and on the side of caution for positioning)

Option 2:

Additional Measures To Check Your Pressure Is Correct:

When pumping up your cuffs, the perceived pressure should be no more than 7/10 (patient ranks the pressure, 10 is the most pressure, 0/10 is no pressure)
1. Patient should be close to 7/10 pressure, but not more than 7.
Capillary refill ( <0:03 seconds)
1. Push on finger nail for 1-2 seconds, the whiteness should return to pink within 3 seconds. If not, you may have too much pressure.
Check Pulse with Pulse Oximeter
1. Pulse needs to be present when checking with Pulse Oximeter. If it is not, you likely have enough pressure for full occlusion. You should work out with no more than 50% of this pressure.