How Blood Flow Restriction Training Is Making Gains in Sports Rehab and Performance

blood flow restriction training athlete daily

My right leg is on fire. Not a injured feeling, but the kind of screaming and aching that usually accompanies the end of a Hero WOD or some heavy weightlifting schemes.

But today I am just doing air squats, sets of 25 with a minute rest in between. By the end of set three it’s downright excruciating. How can training at bodyweight be this painful for someone who spends upwards of two hours a day powerlifting?

Welcome to the world of blood flow restriction training, a phenomenon that’s sweeping through the sports rehab and performance world.

If you’re injured, deloading or searching for a way to ramp up muscle growth, blood flow restriction training can be a game-changer. It already is in the rehab world with tons of research backing up a modality that encourages hypertrophy (muscle growth) while lifting just 20-30 percent of your max load.

What’s even more impressive is the speed at which blood flow restriction (BFR) training works- with muscle girth increases in as little as two weeks at those lighter loads. But is it safe? How does it work? And, most importantly, can it benefit you? Read on for the details.

What is blood flow restriction training?

Essentially, BFR training involves doing resistance exercises with decreased blood flow to the limb or muscles.

It typically involves using a tourniquet to measure occlusion, which is completely stopping blood flow to the limb. You take that pressure and calculate 70-80 percent occlusion to keep the blood flow restricted to 20-30 percent of your regular blood flow.

How is that a good thing?

“The benefit is received by the muscle working very hard to accomplish what would be simple with regular blood flow,” said Dr. Yoni Rosenblatt, who uses BFR training regularly in his practice, at True Sports Physical Therapy.

“You are not letting the blood in. And blood brings with it, not just healing factors but energy. It allows you to turn over your muscle cycle. So, when you are fatigued all of these toxins are sitting in the muscle and the blood flushes it out and brings new energy sources in. When you block that the muscle has to work much harder.”

So those air squats I was doing? They were equivalent of loading up a heavy barbell, forcing my leg muscles to work incredibly hard with none of the next day soreness or injury risk.

“It’s doesn’t cause as much muscle soreness because you aren’t actually ripping apart the [muscle] fibers you are just effecting the chemicals of the fibers,” Rosenblatt said.

“A lot of times people come in [the next day] expecting to be much more sore. It mimics the heavy weight in terms of muscle growth, but doesn’t damage the tissue as much.”

Who does it benefit?

Patients who have trouble with activation. Maybe your quads don’t turn on or your glutes don’t fire properly, leading to chronic knee pain. BRF training has also had success with rotator cuffs, another pesky injury in an area strength athletes struggle to “turn on.”

The cool thing about BFR is once the machine is on, it increases how many muscle fibers are doing the work in the affected muscle as well as increased the ability for that muscle to grow and shortens the time it takes for it to grow.

People who are coming out of surgery or have other issues prohibiting them from lifting heavy weights can also utilizing BFR training to help avoid losing muscle.

“We put a centimeter of thigh girth on an athlete recently in two weeks. The only thing we changed was blood flow. We didn’t teach him new exercises or graduate him to anything different in his rehab.” Rosenblatt said.

“He had a meniscus tear he was recovering from. We did blood flow restriction training three times a week for two weeks and he started to show growth. That doesn’t happen for six weeks without blood flow restricting training.”

blood flow restriction training athlete daily

I’m not hurt. Would it still help me?

Yes. Theoretically, BFR training would help anyone looking to grow muscle and get stronger while giving your joints, ligaments and tendons a break from heavy lifting.

It’s important to note that, if you’re healthy, this isn’t a replacement for your heavy training. It’s a supplement to go along with it.

“Absolutely, a healthy athlete can benefit from it,” Rosenblatt said. “It’s not typically used as much because it can be cumbersome, you have to take measurements get a system to use. and also-these systems can be cost prohibitive. If you’re using the FDA-approved system, it’s expensive.”

While there are cheaper devices on the market, such as arm bands or voodoo bands, it’s tough to get an accurate read on occlusion and someone administering restrictions with no formal training can risk nerve damage.

Still, the growing interest in BFR could change that.

Devices such as the Occlusion Cuff have received favorable reviews for the recreational athlete and strength coach. If you are seeking out BFR training for rehab purposes, you want to make sure they’re using the Delphi system, says Rosenblatt, as it’s the only device that’s currently FDA approved.

How do I get this done?

The good news is, the list of providers is growing. The bad news is, it’s still not common enough for you to expect most PTs to offer BFR.

When Rosenblatt first started implementing the modality, his office was the only private practice in Baltimore to do so for the first year or so.

“You want to find a provider that has been doing it for a while, that knows how to do the science,” he said. “Also, how long is your therapist spending with you? If you’re in a standard therapy setting, you get 15, 20, maybe 30 minutes one-on-one. You want a provider that knows your sport, in this case knows BFR and is going to spend 45 minutes to an hour with you.”

What else do I need to know?

It’s not fun. Lack of blood flow is uncomfortable stuff and you are often going to failure. The cuff is for arms and legs only, so it’s not ideal for people rehabbing back injuries (thought it can help keep you somewhat strong).

It’s also still considered somewhat controversial though there’s been a ton of research to back up BFR trainings claims.

“When it was brought to me by co-workers that said, ‘Hey, let’s invest in this’, one of my hesitations was, it’s great to want to hypertrophy someone’s leg, but if you’re getting a lot of athletes having activation issues, if they cant turn the muscle on, how can we force it to grow,?” Rosenblatt said.

“And then they started showing me newer literature about increased activation [with BFR]. Your muscle is working more efficiently and more effectively. Then I’m all in. We do so much to try to trick the muscle to work properly, if this is such a known tool to do that —and we are starting to see the science to back it up— you’re going to start to see this really grow because of that.”