BLOOD FLOW RESTRICTION TRAINING

Blood flow restriction training (BFR) is a resistance training variant shown to be effective in improving muscle mass and strength, while using very light weights (30% of 1RM), therefore reducing stress on the joints.

BFR involves occluding the limb being trained, allowing blood to flow to the muscle (arterial blood flow), but not to return (venous return) causing blood to pool in the area below the occlusion. This causes fast twitch muscle fibre activation, metabolic by product accumulation, improved post exercise muscle protein synthesis and higher growth hormone elevation.

How is it performed?

In research, a specialised cuff or torniquet is generally used, occluding the limb at a specific pressure. This equipment can be costly and inconvenient for general use, so research has been performed on “Practical Blood Flow Restriction Training (PBFR)”, which involves using weightlifting knee wraps wrapped at a perceived tightness of 7/10. Studies have found that PBFR using knee wraps is sufficient to get the same response as using medical cuffs or torniquets.

The wraps are placed on the most proximal part of the limb and are kept on for the duration of all sets and reps of the exercise being performed. BFR has been used in research and practice and shown to be effective with isotonic exercises.

How is it programmed?

For hypertrophy and muscular strength, the evidence supports:

• Isotonic exercise
• ~30% of 1RM
• 3-4 sets of 15-30 repetitions
• 30 seconds rest
• 2-3 x per week

Is BFR training safe?

A survey of 12,462 people who had received an occlusion cuff for BFR training. 

The incidence of side effects: venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%).

A pre screening questionnaire has been compiled by the British Olympic Medical Institute to screen for risk factors:

British Olympic Medical Institute pre training screening questionnaire -

Absolute contraindications: deep-vein thrombosis, pregnancy, varicose veins, high blood pressure, and cardiac disease.

1. Do you have a personal or family history of clotting disorders (e.g. SLE (lupus), haemophilia high platelets)?
2. Do you have a past history of DVT or pulmonary embolus?
3. Do you smoke?
4. Are you on any medication including the contraceptive pill?
5. Do you have a history of injury to your arteries or veins?
6. Do you have a history of injury to any of your nerves (including back or neck injury)?
7. Do you have diabetes? Does anyone in your family have diabetes?
8. Does your current or previous training include resistance training?
9. Do you have any history of high blood pressure?

If any risk factors are identified from the questionnaire or table below or if unsure, medical clearance is advised. BFR is generally safe for those without any risk factors.

American College of Sports Medicine. Guidelines for Exercise Testing and Prescription (8th ed). Philadelphia, PA: Lippincott Williams & Wilkins, 2009. 65–66. Loenneke JP, Wilson JM, Marín PJ, Zourdos MC, Bemben MG. Low intensity blood flow restriction training: a meta-analysis. Eur J Appl Physiol, 2012. 112(5): 1849-59. Loenneke JP, Wilson GJ, Wilson JM. A  mechanistic approach to blood flow occlusion. Int J Sports Med, 2010. 31:1–4. Loenneke JP, Fahs CA, Rossow LM, Abe T, Bemben MG. The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Medical Hypotheses, 2012. 78: 151–154. Yamanaka T, Farley RS, Caputo JL. Occlusion training increases muscular strength in division IA football players. The Journal of Strength and Conditioning Research, 2012. 26: 2523 2529. Luebbers PE, Fry AC, Kriley LM, Butler MS. The Effects of a Seven-week Practical Blood Flow Restriction Program on Well-trained Collegiate Athletes. J Strength Cond Res, 2014. 28(8): 2270–2280. Wilson JM, Lowery RP, Joy JM, Loenneke JP, Walters JA, Amsden CE. Practical blood flow restriction training increases acute determinants of hypertrophy without increasing indices of muscle damage. J Strength Cond Res, 2013. 27(11): 3068 3075. Lowery RP, Joy JM, Loenneke JP et al. Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme. Clin Physiol Funct Imaging, 2014. 34(4): 317-21. Scott BR, Loenneke JP, Slattery KM, Dascombe BJ. Exercise with Blood Flow Restriction: An Updated Evidence-Based Approach for Enhanced Muscular Development. Sports Med, 2014 (epub ahead of print). Nakajima T, Kurano M, Iida H. Use and safety of KAATSU training: results of a national survey. Int J KAATSU Train Res. 2006. 2 (1): 5–13. Loenneke JP, Wilson JM, Wilson GJ, Pujol TJ, Bemben MG. Potential safety issues with blood flow restriction training. Scand J Med Sci Sports, 2011. 21: 510-518. Loenneke JP, Thiebaud RS, Abe T. Does blood flow restriction result in skeletal muscle damage? A critical review of available evidence. Scand J Med Sci Sports, 2014. 25(4): 521-534. Libardi, C., Chacon-Mikahil, M., Cavaglieri, C., Tricoli, V., Roschel, H., & Vechin, F. et al. (2015). Effect of Concurrent Training with Blood Flow Restriction in the Elderly. International Journal Of Sports Medicine, 36(05), 395-399. http://dx.doi.org/10.1055/s-0034-1390496

Research has shown that foam rollers can do four things:

1. Decrease post exercise soreness up to 3 days after an exercise bout
2. Decrease tenderness to touch (mechanical sensitivity)
3. Improve range of motion at the joint in the short term 
4. Small changes in vertical leap post foam rolling

Overall, foam rolling increases blood flow to your muscles, improving delivery of oxygen during your workout.  It also helps to relieve muscle tension, especially after a hard workout.   

What doesn’t foam rolling do?

Foam rolling does not change muscle or fascia length or destroy ‘trigger points’ - the change in range of motion seen after foam rolling is due to increased tolerance to stretch due to nervous system desensitisation rather than a change in structure.

How do I use a foam roller?

The foam roller can be used on a wide range of muscles, simply by rolling back and forth over the length of the muscle itself. 

It is often uncomfortable, especially over a particularly tight area however it is best to not push in to too much pain as this could be counterproductive. 

The good news is, research has shown no difference in 30 seconds of foam rolling versus 5 minutes so don’t spend all day on it!

What do Team8 Physio recommend when it comes to foam rolling?

Foam rolling can be applied before a workout, in conjunction with a dynamic warm up to take advantage of the short term changes in joint range of motion and performance.

Foam rolling can also be used as needed after a workout, particularly if experiencing delayed onset muscle soreness. Test/retest yourself and see the changes yourself, for example try rolling your legs before a leg workout and see how it affects your mobility and performance.

Balance push and pull exercises

The volume of upper body pull exercises (rows, pulldowns) should be equal to, or slightly greater than push (bench press, shoulder press). This will keep the muscular balance of the torque producing and stabilising muscles of the shoulder girdle.

Rotator cuff activation work

Activate the rotator cuff before an upper body workout, a good activation exercise is called a ‘Sharapova’. Face a wall and place a loop band around the wrists, place the little finger on the wall and slide it up and down the wall keeping tension on the band at all times.

Be careful, or avoid...

Dips and upright rows are very sensitive movements for the rotator cuff, as they can get the shoulder into loaded positions of impingement. Unless absolutely necessary for their sport, goals or activity it would be best to use an alternative exercise that achieves the same purpose. 

INGREDIENTS

1 onion, chopped

1 leek, sliced

1 potato, chopped

1.5L chicken/vegetable stock

2 small broccoli head, chopped

80g Stilton cheese, crumbled

Olive oil and toasted baguette to serve

METHOD

Heat some oil in a pot, add onion, leek and potato and stir until starts to soften. Add stock and cover, allowing to simmer for approximately 8 minutes. Add broccoli and simmer for another 3 minutes.

Remove pot from heat and with a handheld blender, process until smooth. Add the Stilton to the soup and season to taste.

Serve the soup in bowls with drizzled olive oil and toasted baguette. Enjoy!

Note - if you don't enjoy the strong flavour of blue cheeses, substitute the Stilton for a tasty cheese instead. And of course if you can't find Stilton in your supermarket, you can simply use a different type of blue cheese.

1) Lower back pain is the most common type of back pain experienced. This is due to the lower back twisting and bending more than any other part of the back. It also bears the weight of the upper body.

2) Back pain is not always caused by an injury – in many cases, strains, fractures and disc problems are to blame, but a large number of back conditions are due to less obvious causes such as stress, low mood, anxiety and lack of sleep

3) It used to be thought that bed rest was the only way for people experiencing back pain to recover. It is now known that bed rest actually delays the healing process and that most damaged tissues repair faster when they’re used. You may not be able to do everything that you normally do without the pain but it is recommended that you try to remain as active as possible.

4) Scans like x-rays and MRIs don’t usually help in determining what’s causing back pain. Scans can be expensive and in most cases will not leave you any better off than someone who takes simple steps like applying heat, staying active and seeing a physio. However, if there are concerning symptoms such as unexplained weight loss, loss of feeling in the legs or if the pain gets worse, imaging may be appropriate.

5) Painkillers and anti-inflammatories can help to reduce back pain, but they only mask the symptoms and do not address the cause of pain.