What is Blood Flow Restriction Training and How Can it Help Me?

 At Liam Newton Physiotherapy we are delighted to bring some some of the latest technology in rehabilitation, using Blood Flow Restriction Training (BFR) cuffs to help maximise your recovery. 

What Is Blood Flow Restriction (BFR) Exercise?

• BFR exercise is a newly emerging approach to strength training and rehabilitation.
• BFR involves exercising at a low intensity with restriction of arterial inflow and venous outflow in the working muscles during exercise.
• This is achieved by applying an external pressure, typically using a cuff, to the most proximal (closest to the centre of the body) region of the upper and/or lower limbs.
• When the cuff is inflated, there is gradual compression of the blood vessels underneath the cuff, resulting in partial restriction of blood flow.
• Compression of the vasculature proximal to the skeletal muscle results in inadequate oxygen supply (hypoxia) within the muscle tissue.
• Also, the reduction of venous blood flow results in blood pooling within the vessels of the constricted limbs.
• Alongside this, when muscle contractions are performed under conditions of BFR, there is an increase in intramuscular pressure beneath the cuff which further restricts blood flow.

What Are The Mechanisms Behind Blood Flow Restriction Training?

• The aim of BFR training is to mimic the effects of high intensity exercise through the creation of a hypoxic environment using the cuff.
• Due to the reduction of outflow of blood, the same physiological muscle adaptations take place during BFR training at lower intensity exercise that would occur with high intensity resistance exercise.

1. Muscle Fibre Recruitment

• Normally, low-intensity exercises primarily engage slow twitch muscle fibres (slow contraction speed, responsible for endurance movements).
• However, due to restricted blood flow and the hypoxic environment, the body recruits fast-twitch muscle fibres (responsible for quick, powerful movements) quickly, although the intensity is low. These fibres have a greater potential for muscle growth and strength gains.
• Additionally, the recruitment of both slow and fast-twitch fibres during BFR exercise leads to more significant muscle activation, which is key for muscle hypertrophy and strength development.

• Also, BFR causes the nervous system to adapt by recruiting a larger number of motor units. This enhanced neural drive causes greater muscle activation during BFR training, assisting to generate greater force output and enhances muscle strength.

2. Metabolic Stress

• BFR exercise significantly increases the production and accumulation of metabolic byproducts such as lactate and hydrogen ions within the muscle tissues due to the restricted blood flow.
• This heightened cellular stress triggers This heightened cellular stress triggers the release of growth factors and hormones that stimulate muscle repair and growth.
• As a result more muscle fibres are engaged during BFR training, leading to greater muscle activation.

3. Cellular Responses

• Additionally, BFR training causes an accumulation of fluid within the muscle cells, this creates mechanical tension within the muscle fibres further stimulates muscle activation. This alongside the metabolic stress from reduced blood flow, contributes to increase motor unit recruitment and muscle growth.

4. Hormonal Responses

• BFR exercise significantly elevates the production of a growth hormone. Also, the accumulation of metabolites such as lactate during BFR creates stimulates the production of greater growth hormone.
• This promotes muscle protein synthesis (production), stimulates the growth of muscle tissue, and aids in the repair of damaged tissues. This leads to greater muscle mass and strength.

What Are The Blood Flow Restriction Training Benefits?

1.  Enhanced Muscle Hypertrophy and Strength Gains

• BFR training allows significant muscle growth and strength gains using low-intensity loads (20-30% of one repetition maximum).
• The restricted blood flow and hypoxic environment promotes the recruitment of fast-twitch muscle fibres which are primarily responsible for muscle hypertrophy and strength.
• This makes it accessible to individuals who may not be able to perform high-intensity resistance training due to injury or other limitations.

2. Reduced Joint and Connective Tissue Stress

• By using lighter weights, BFR training minimises the stress on joints, tendons, and ligaments, reducing the risk of overuse injuries and allowing safer training for individuals with joint conditions or during post-surgical rehabilitation.
• Individuals recovering from musculoskeletal injuries can benefit from muscle strengthening without the risk of exacerbating their condition, accelerating the rehabilitation process.

3. Ageing & Sarcopenia

• Ageing often brings about changes in muscle mass and function, leading to a condition called sarcopenia. Sarcopenia is characterised by a gradual decline in muscle mass and strength.
• However, BFR has emerged as a potential strategy to counteract the effects of ageing and mitigate the progression of sarcopenia, therefore improving age-related muscle loss and improving functional capacity.

Who Is Blood Flow Restriction Training Appropriate For?

• When an individual is limited to low intensity exercise (resistance or aerobic), BFE induces blood flow restriction which increases muscle strength and size, similar to adaptations gained from high intensity exercise.
• Athletic Population

• Athletes recovering from injuries can use BFR training to maintain muscle mass and strength.
• BFR can enhance muscle hypertrophy and strength in athletes without the risks associated with heavy weight lifting, allowing improved performance and recovery.
• BFR has applications in the athletic population when used in conjunction with conventional strength and conditioning programs.

• Postoperative Patients

• BFR training helps maintain and build muscle mass during periods of limited mobility, preventing muscle atrophy and facilitating quicker rehabilitation.
• Individuals recovering from surgeries such as ACL reconstructions, or joint replacements can benefit from BFR training.
• BFR exercise facilitates muscle strengthening and hypertrophy without placing excessive stress on the healing tissues and surgical sites.

• Elderly Individuals

• BFR training can counteract decline in age-related loss of muscle mass and strength by promoting muscle hypertrophy and improving strength with low-intensity exercise, which is safer for joints and bones.

• Individuals With Joint Issues Or Chronic Pain

• Patients with rheumatoid arthritis, other inflammatory joint conditions, or chronic pain can benefit from BFR training as it allows muscle strengthening with minimal joint stress, potentially reducing pain and improving joint function.

What Is The Safety Of Blood Flow Restriction Training?

• BFR has been shown to be very safe in varying clinical populations including athletes and the elderly.
• There is no robust evidence that exists to show that BFR carries a greater safety risk than an equivalent form of exercise at a higher intensity
• However, there are a list of conditions that need to be considered before participating in BFR training, so a medical history should always be taken by a healthcare professional before beginning BFR.

So if you want to take your rehabilitation to the next level, supercharge your adaptations and utilise the power of blood flow restriction training then please do get in touch. We are seeing some fantastic results with our ACL rehabilitation, tendon and muscle injury clients.

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