What is Blood Flow Restriction Training & How Will it Aid Recovery?
Written by Dr. Michael Tancini
With the increasing presence of blood flow restriction training in conversations surrounding physiotherapists and strength coaches, individuals are beginning to seek out applications for the method of training which may help them reach new levels of athletic performance. In many competitive arenas; an athlete’s training volume is often limited by their ability to recover from their training sessions, not their desire to continue training. With elite athletes there are a handful of factors that influence recovery; sleep, nutrition, training volume, the modality of training, body work…etc. Athletes are looking for everything they can in order to recover faster so they can train harder. Blood Flow Restriction Training is an option and should be included in the conversation of modalities that help you recover faster.
What is Blood Flow Restriction Training (BFR)?
In brief, it is when you use a tourniquet device to restrict blood flow to your extremities while exercising. Faster Recovery + Greater amount of quality training = greater gains over time.
How will this aid recovery?
First let’s start with the idea that BFR does not cause muscle damage. This is a very important aspect of BFR training. Ultimately if we are performing a modality to increase recovery, we do not want to break down muscle fibers in the process.
Think of muscle recovery as an equation of protein balance. Net protein balance = Muscle protein synthesis – muscle protein breakdown. We want our net protein balance to be above 0 (in the positive). A positive net protein balance signifies we are building muscle, not breaking it down.
There are other markers used in research to quantify muscle break down such as CK levels and myoglobin levels. Delayed onset muscle soreness (DOMS) has also been measured in subjects following BFR. The subject showed no significant increase in DOMS following BFR. When looking at the research available there appears to me no direct or indirect measures of muscle damage associated with BFR. So we can conclude that using BFR will not increase muscle breakdown following an athlete’s training session.
But HOW will it actually aid recovery? Just because it does not do further damage to the muscles, does not mean it will help me recovery faster!
The first thing we will look at is the increased release of growth hormone. Studies have shown there to be up to a 290% increase in growth hormone following BFR. Growth hormone is a key component in collagen synthesis. Increased collagen synthesis helps the body restore tendons and ligaments, which are highly reliant on collagen for their structure and strength.
Tendons just like muscles are subject to damage following training. If we have greater tendon (collagen) breakdown when compared to tendon (collagen) synthesis we can ultimately end up with annoying tendon injuries (tendonopathy, tendonitis, tendonosis). Studies have shown there to be increased cross sectional area and increased tendon stiffness when comparing increased GH to a normal control group without increased GH.
What does this mean for the athlete? The increased Growth hormone response with blood flow restriction training may lead to increased tendon strength and durability, thus allowing them to train longer without injury.
Growth hormone is also associated with increased healing in bone (due to the increased collagen synthesis). A common injury seen in high level athletes are stress fractures. A stress fracture is when there is more collagen breakdown when compared to collagen synthesis…refer to the equation once again. Due to the positive effects for bone development, BFR may play a role in helping to prevent or limit stress fractures in highly competitive athletes.
Next let’s look at IGF-1. Insulin like growth factor -1 (IGF-1) is ultimately a protein that is linked to muscle growth. When we look at what’s needed for muscle growth, we can refer back to the equation mentioned before; Net protein balance = Muscle protein synthesis – muscle protein breakdown. If have a positive net protein balance we can conclude that we will achieve muscle growth. More muscle being built than the muscle being destroyed = muscle growth. If we are achieving a net positive protein balance, we can conclude that our muscle fibers are recovering like they should be. Studies have shown there to be an increased number of IGF-1 when using BFR training when comparing to controls. Greater levels of IGF-1 = greater muscle growth, which correlates with greater muscle recovery.
1) No muscle damage from BFR.
2) Increased HGH: Ligament, bone, and tendon recovery
3) Increased protein synthesis: Build more muscle, muscles rebuild better.
4) Increased IGF-1: Increased protein synthesis, muscles rebuild better.
5) Low Volume, low load, low demand not the CNS,lLow demand on the muscle fibers
Now there is a lack of evidence in the literature for BFR for the sole purpose of muscle recovery post exercise/training. However, what we know about the effects of BFR and how they affect the body the arrow points towards a solid recovery modality, which could aid recovery and performance.
How can we put this into practice?
I know you’re wondering, “I have a huge training volume as it is! How am I supposed to fit BRF into my programming?”
Like I mentioned before, it’s low load, low volume, and low demand on the Central Nervous System (CNS).
- The BFR would take place as the last thing you did before leaving the gym. You can do upper or lower body, however if your goal is strictly muscle recovery, I’d recommend doing the lower extremity. The lower extremity has greater muscle mass which will create a greater metabolic response. Because HGH and IGF-1 are carried throughout the blood stream, the effect is systemic (whole body). However, you would be fine doing either the upper or lower extremities. BFR is safe to use on a daily basis, so I would recommend alternating Upper body on your primarily upper body dominant days and the lower body on primarily your lower body dominant days.
- The exercise of choice for the lower extremity would be some kind of deadlift or squat performed at 20-30% of your 1RM. The exercise of choice for the upper body would be some kind of push up, row, or press. Once again you are aiming for 20-30% 1RM. You want the exercises to be simple. It is not a great Idea to perform BFR when doing muscle ups or handstand pushups. That’s a recipe for disaster.
- The protocol is to use 4 sets of 30/15/15/15 reps with a 30 second rest between sets and a 2-second concentric and 2- second eccentric contraction for a metabolic response. The entire protocol would be complete in about 4-5 minutes.
- The placement of the cuffs (see below) would be at the top of your arm, the most proximal segment just before the shoulder, or the top of your leg, the most proximal segment below your hip. We want the limb occlusion pressure to be 80% for the lower extremities and 50% for the upper extremities. IF YOU EXPERIENCE NUMBING AND TINGLING YOU’VE CONSTRICTED TOO MUCH! It will be uncomfortable, and will be the biggest “pump” + “burn” you’ve ever experience. However, there should be zero numbness or tingling when performing BFR.
There are a few ways to perform BFR including:
1) Owens recovery science FDA approved medical tourniquet. This is the gold standard for BFR. It’s the only FDA approved piece of BFR equipment on the market, it’s expensive, and you’re going to need to know a medical professional who has one. You need a medical license in order to buy one.
2) The occlusion cuff. This is your next best option. It cost around $130 online and it works pretty well. It is essentially a blood pressure cuff made for BFR. It’s easy to use and is probably the best answer for the majority of the fitness population.
3) The Voodoo band is better than the BFR straps you can find online. However I wouldn’t recommend it either primarily because there is no way to actually measure the level of occlusion and the potential risk of nerve damage due to the narrow nature of the device you’re using to restrict blood flow.
If you want to dive into the literature there is tons of it out there. Any quick Google Scholar Search will find some articles for you to look into. Before diving into BFR for yourself, make sure you look into the precautions and contraindications to make sure it’s right for you. BFR is safe, but there are a few cases in where you wouldn’t want to use it.
Owens, J. (n.d.). BLOOD FLOW RESTRICTION – REHABILITATION . doi:Copyright ORS, Inc. 2016
Copyright ORS, Inc. 2016
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