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Some exercise trends are hard to ignore, and very few have impacted the therapy and sports medicine communities like blood flow restriction training. But what exactly is BFR, and why does it matter?
Blood flow restriction training (BFR) involves using a cuff or band to stop blood flow from a limb while limiting blood flow into the limb.
This method is then paired with a specific exercise routine (sometimes called occlusion training). This reduced blood flow with exercise causes a number of benefits in the limb that’s being trained. (1)
Blood flow restriction training is used in multiple settings, including physical therapy and other fitness settings:
In physical therapy, BFR enhances the recovery of injuries that limit the amount of exercise or weight that can be tolerated.
In the fitness world, BFR can increase muscle mass and strength in addition to a regular resistance training program.
While BFR is used for many purposes, research is ongoing. Refining a training protocol that seems to work across the board for physical therapy and fitness is important.
In the past, BFR has been done using blood flow restriction bands to limit blood flow while exercising. Unfortunately, elastic bands and belts don’t provide specific or reliable pressure to achieve the best results.
Modern BFR uses a pressurized blood flow restriction cuff. It detects blood pressure and adjusts in real-time to maintain steady occlusion pressure and limit blood flow appropriately.
The goal of BFR training is very straightforward: reduce blood flow to make exercise harder, since your muscles require blood flow to function.
However blood flow restriction therapy is fascinating because of its effects on the body. This explains why many patients see it in their recent care plans.
During BFR training, unique stress is placed on the area being exercised that stimulates a number of hormonal effects.
One major effect is that specialized muscle cell signals stimulate increased protein building. This reaction promotes muscle hypertrophy – an increase in muscle size. At the same time, myostatin, a protein that limits muscle growth, seems to be reduced after blood flow restriction training. (2)
One of the most interesting effects of BFR training is the high activation of type II muscle (or fast twitch) fibers with very low resistance. Under normal circumstances, type II muscle fibers are only used to such a degree during higher intensity work.
This leads to increased muscle hypertrophy— or greater muscle growth. Increased muscle mass has a number of benefits for just about everyone, young or old.
Research shows that these effects are seen in the area below the blood pressure cuff and in the entire limb. If you practice BFR with a cuff just above your knee and exercise your calf muscle, you also get the same benefits for your thigh and hip.
Blood flow restriction training can be used for various purposes. However, it’s especially helpful in treating conditions like soft tissue injuries, fractures, and deconditioning.
Soft tissue describes parts of your body like muscles, tendons, and ligaments. When you experience an injury to one of these structures, it can limit your ability to participate in rehab exercises. In turn, your injury limits your potential for recovery.
Using BFR as a means to exercise allows you to stimulate muscle growth and soft tissue recovery without putting a ton of load on your injury site.
Fractures are difficult injuries that can completely halt your ability to exercise. If you experience a fracture, the traditional first line of treatment would be to avoid exercise and other forms of loading or pressure on the area.
However, blood flow restriction training creates a unique workaround that allows for the benefits of exercise without directly stressing the injured area.
For example: if you are healing from an ankle fracture that stops you from putting weight on your ankle or performing strengthening exercises, your therapist can use BFR to stimulate strengthening and healing throughout your entire leg.
Deconditioning refers to the weakening of soft tissues and a reduced tolerance for exercise. Many people experience deconditioning after a long bout of bedrest or chronically living a sedentary lifestyle.
If you are significantly deconditioned while starting your exercise program, you may not have enough endurance to get the benefits from exercise before fatigue sets in. By adding BFR to their training program, deconditioned patients can gain more from exercise without needing significant weight or complicated workouts.
Although blood flow restriction training is generally very safe, research is still being done to map out specific safety protocols for various situations. For this reason, it’s important to know the current dos and don’ts of safe and effective exercise with BFR.
Blood flow restriction training can be used by adults who:
Are recovering from a soft tissue injury, fracture, or surgery
Are attempting to recover from significant deconditioning
Seek to increase muscle strength and size
Adults should not use blood flow restriction training:
With a history of deep vein thrombosis (DVT) or blood clotting disorder
With a heart condition, history of blood clots or poor circulation in their limbs
With cancer, active infection, or kidney problems
Who are pregnant (3)
As with other forms of exercise, consult your primary care doctor before starting a new exercise program.
Many benefits of blood flow restriction training, including increased muscle strength and size, can be seen by older adults, which can greatly affect their everyday lives. (4)
For an older adult, everyday activities like getting up from bed or crossing the street can be seriously impacted by a lack of muscle strength. In addition to traditional strength training, blood flow restriction training can improve performance in daily life – but strength isn’t just important during everyday activities.
Fall prevention and recovery both require a considerable amount of strength. This means that BFR training can have an important role in preventing falls and maintaining safety for older adults.
Strength is important for daily activities and safety, but should also be trained regularly to help you participate in your favorite hobbies.
As you age, activities like throwing a ball or dancing can become harder with each passing year. Luckily, regular exercise can help you to maintain and improve the strength you need to keep up with your grandkids and your favorite activities.
Blood flow restriction training is a great addition to a strength training program because it allows you to continue working on your strength when other factors, such as an injury or illness, limit you.
Blood Flow Restriction (BFR) training complements, rather than replaces, traditional strength training. For those with certain injuries or conditions preventing heavy lifting, BFR offers an alternative to promote muscle growth with less resistance. Still, a combination of both traditional and BFR methods can offer the best muscle growth and strength benefits for healthy individuals.
The ideal frequency of BFR training varies based on individual needs and goals. Generally, incorporating BFR 2-4 times a week, akin to regular resistance training, is effective. However, it’s crucial to allow for adequate recovery between sessions.
For safe and optimal outcomes, it’s best to use specialized equipment. Traditional elastic bands and belts might not ensure accurate pressure. Modern BFR employs a pressurized cuff that adjusts in real time, providing consistent and safe occlusion pressure.
The timeframe for noticeable results from BFR varies, depending on an individual’s starting point, training frequency, and goals. Some might see muscle strength and size improvements within a few weeks of consistent BFR training. However, diet, rest, and overall health influence results.
BFR stands out in rehabilitation since it fosters muscle growth and strength without stressing injured areas. Traditional rehab can sometimes be too strenuous for severe injuries. With BFR, even light exercises can activate and grow muscles. However, it’s essential to consult a healthcare professional to decide between BFR and other rehab methods, based on the injury and individual requirements.
Patterson SD, Hughes L, Warmington S, Burr J, Scott BR, Owens J, Abe T, Nielsen JL, Libardi CA, Laurentino G, Neto GR, Brandner C, Martin-Hernandez J, Loenneke J. Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety. Front Physiol. 2019 May 15;10:533. doi: 10.3389/fphys.2019.00533. Erratum in: Front Physiol. 2019 Oct 22;10:1332. PMID: 31156448; PMCID: PMC6530612. https://doi.org/10.3389%2Ffphys.2019.00533
Cognetti DJ, Sheean AJ, Owens JG. Blood Flow Restriction Therapy and Its Use for Rehabilitation and Return to Sport: Physiology, Application, and Guidelines for Implementation. Arthrosc Sports Med Rehabil. 2022 Jan 28;4(1):e71-e76. doi: 10.1016/j.asmr.2021.09.025. PMID: 35141538; PMCID: PMC8811521. https://doi.org/10.1016%2Fj.asmr.2021.09.025
Lorenz DS, Bailey L, Wilk KE, Mangine RE, Head P, Grindstaff TL, Morrison S. Blood Flow Restriction Training. J Athl Train. 2021 Sep 1;56(9):937-944. doi: 10.4085/418-20. PMID: 34530434; PMCID: PMC8448465. https://doi.org/10.4085%2F418-20
Centner, C., Wiegel, P., Gollhofer, A. et al. Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Med 49, 95–108 (2019). https://doi.org/10.1007/s40279-018-0994-1
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