Origin:
Blood
Flow Restriction Training (BFRT), or occlusion training began in the 1960’s,
coined by Dr. Yoshiaki Sato as KAATSU (or “additional pressure,” “ka” + “atsu”
in Japanese). This initial process began with Sato rehabilitating himself after
a ski injury resulting in a fractured ankle and ligamentous knee injury. While
in the plaster cast for his ankle, he experimented applying various tubes and
bands to his upper leg and performing isometric exercises resulting in minimal
atrophy as well as an improved recovery compared to what he expected to be
normal. Fifty years later, the United States military began to adopt Sato’s
methods as a means of improving endogenous production of Growth Hormone to assist
in healing of skin and tissue grafts. Further experimentation and research
protocols were then subsequently developed to aid in the strengthening of
residual limbs to prepare for prosthetics. To date, over 800 published articles
have been dedicated to this topic since its initial hypothesis, consequently
resulting in the clinical application of BFRT in exercise physiology and
rehabilitation settings. The use of BFRT
is currently implemented in professional/collegiate sports teams and hospitals
all around the world.
Physiology:
BFRT is
the brief and intermittent occlusion or restriction of arterial and venous
blood flow that is performed by applying a tourniquet to the upper or lower
extremity while at rest or exercising. Using this technique, one can exercise
using significantly less weight, and still achieve significant gains in muscle
strength and size. With BFRT, restriction
of blood flow results in reduction of oxygen supply to a working muscle to result
in a change from aerobic to anaerobic metabolism. At the cellular level, the
current evidence shows that BFRT increases lactate by-product within the muscle,
resulting in Growth Hormone release, stimulated Insulin-like Growth Factor
(IGF-1) and cell swelling. All of these physiologic
changes have influence on:
Ø Rehabilitation/prehabilitation of injuries
Ø Increasing strength
Ø Attenuating muscular atrophy
Ø Creating muscle hypertrophy
Ø Aiding in recovery
Ø Improving bone density and function
Ø Improving cardiovascular function
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Protocol:
There
are multiple protocols established by the current research: protocol chosen will be based the clinical
goal to be achieved. See below for an example:
Hypertrophy
Protocol:
Volume:
1 cluster set of 4 sets: 30/15/15/15 repetitions (at 2 seconds concentric and 2
seconds eccentric) with 30 second rest breaks between each set.
Frequency:
2-3x per week (mixed in with normal strength and endurance training)
Load:
15-30% of 1RM
Limb Occlusion Pressure (LOP): 80% of max for lower extremity and 50% of max
for upper extremity
*Disclaimer: Do not apply BFR or
tourniquets without the supervision of a licensed professional.
Please note the contraindications and
risk categories for BFRT
CONTRAINDICATIONS
‣Acidosis
‣Cancer
‣Extremities with dialysis port
‣Excessive swelling in post-surgical limb,
often UE (i.e. lymphedema)
‣Infection within extremity
‣Increased intracranial pressure
‣Impaired circulation
‣Lymphedema (on limb)
‣Open fracture/open wound
‣Pregnancy
‣Previous revascularization of limb
RISK
CATEGORIES
‣Sickle cell anemia
‣Severe hypertension
‣Severe crush injury
‣Vascular graft
‣Venous thromboembolism
‣Women who have had a mastectomy with
or without radiation and/or an axillary node dissection- avoid BFRT on the affected
arm.
‣People in hemodialysis who have
arterial venous fistulas- avoid BFRT exercise on the affected limb
MEDICATIONS
‣Known clotting risk
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Personal
Experience & Application of BFRT
My
first exposure to BFRT was about 5 years ago, where I experimented on myself
for personal use at the gym. That later evolved to the clinical setting, using
BFRT in a sports setting for both rehabilitation and active recovery.
I
recently attended Smart Tools’ Blood Flow Restriction course, instructed by Ed Le Cara, DC, AT,PhD. This course dove deep into the
physiology and demonstrated that the benefits transcend across the entire
rehabilitation continuum from bedridden to professional athletes. Dr. Le Cara’s energetic style in combination
with our eager participation in the lab portion created an amazing atmosphere
to the very last minute. Dr. Le Cara did
a wonderful job explaining that BFRT is a tool, and when applied to the correct
context, can be beneficial to better serve our patients. After this course, my understanding of the
clinical application expanded way beyond my initial narrow vantage point. In addition, what made this course very
special and highly conducive to learning, was nearly everyone already knew each
other. Thank you to Movement Links, Dr. Clare Frank, and Dr. Ed Le Cara for
putting this course together and providing a great experience to learn and
provide the best possible care.
Nicholas Smith is a Physiotherapist
with Casa Colina in Azusa California. He is a Movement Links Certified
Clinician, a graduate of the Azusa Pacific University Movement & Performance
and owner of Smith Forged Strength & Conditioning (@smithforgedsc). Nick
has a passion for movement and hopes to help more people participate in the
activities they love.
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References
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the Preoperative Practice Setting. In: Preoperative Standards and Recommended
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Abe, T., Fujita, S., Nakajima, T., Sakamaki, M., Ozaki, H.,
Ogasawara, R., Ishii, N. (2010). Effects of Low-Intensity Cycle Training with
Restricted Leg Blood Flow on Thigh Muscle Volume and VO2MAX in Young Men. J
Sports Sci Med, 9(3), 452-458.
Abe, T., Sakamaki, M., Fujita, S., Ozaki, H., Sugaya, M., Sato,
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