Ever wonder if there is a way to improve strength and muscle size while recovering from an injury? Enter blood flow restriction training (BFR). Never heard of it? We're going to cover the basics of BFR training and how you can implement it when recovering from an injury.
To stimulate muscle growth and size, higher levels of strength training intensities are required. Strength training at 60-80% of your 1 repetition maximum (1RM) is the recommended intensity for muscle hypertrophy (growth) to occur. However, if you are dealing with an injury, it's unlikely you'll initially be able to lift at that intensity.
Blood flow restriction training can elicit muscular strength and growth with efforts as low as 20-30% of your 1RM. How? Let's discuss the mechanism of blood flow restriction training and why it can be a game changer for recovery.
Types of Blood Flow Restriction Training
The two methods that most people will use to perform BFR are either using a band or wrap, or they will use a pneumatic device to monitor pressure. Here are three examples:
These are compression bands that we use from our good friend Dr. John Rusin. We'll use these for the upper extremities if the limb is smaller and the occlusion cuff elite shown below is too bulky.
These bands provide effective blood flow restriction, but we like to monitor blood flow with a device called a handheld doppler ultrasound. This allows us to measure precise blood flow, which is ideal for recovery situations.
If you don't have this device, you should tighten the cuffs to about a 7 on a scale from 1-10.
The occlusion cuff utilizes a BP cuff to monitor circulation levels which helps makes training more objective.
The Delphi unit is the only unit currently on the market that has a doppler built into the device that constantly measures blood flow while you train.
- When it comes to rehab and returning from injury, we want to ensure safety and recovery is being maximized throughout treatments. We use a combination of the occlusion cuff elite, with a handheld ultrasound doppler to help give us objective numbers for precise pressures to be monitored.
The premise of BFR involves restricting the blood circulation to the targeted area using one of the methods discussed above. In your body, you basically have two muscle fiber types, fast-twitch and slow-twitch. The slow-twitch muscle fibers require oxygen to perform optimally. Because the compression from the BFR cuff leads to a low oxygen environment, the slow-twitch fibers aren't the primary target. The focus is on the fast twitch muscle fibers, which are responsible for muscle size and strength, to work harder during low intensity exercise.
Pump Up The Tissues!
The low oxygen environment from BFR leads to an overcompensation of the body. This causes a cascade of cellular events to occur. Increased lactic acid buildup further stimulates increased fast-twitch muscle fiber recruitment, increased growth hormone is released (more on this in a bit), and increased cell swelling (otherwise known as the pump) all contribute to improvements in muscle strength and size.
There are a number of other cellular changes that occur during blood flow restriction training, but these are the important concepts we'll focus on when recovering from an injury. Another important element of BFR when it comes to recovery is that BFR also inhibits the production of myostatin. Myostatin is responsible for slowing and inhibiting muscle growth. When it comes to injury, myostatin is increased in the local area of injury, making it more difficult to regenerate and improve muscle size.
The Role of Growth Hormone in Recovery
Growth hormone is a naturally occurring hormone in the body. Strength training can bring about increases in growth hormone in blood circulation, which can be beneficial for injuries. However, the problem when dealing with an injury is the inability to train at higher levels of intensity. Lack of strength training at higher levels reduces the stimulation of lactic acid buildup, which thus limits the ability for growth hormone to be produced at higher rates in the body.
Although the perception is growth hormone is responsible for improving muscle growth, its main role is to help in collagen synthesis. Your muscles, tendons and ligaments are all made up of collagen fibers. Increased levels of growth hormone can aid in quicker tissue recovery and also protect them from further stress. BFR training expedites the healing process through increased growth hormone levels, but also improves strength at the same time. The best part about this? Because you are training at 20-30% of your 1 rep max, there is very little to no muscular breakdown or damage, which is crucial when recovering from an injury!
A disclaimer I should note is that BFR training DOES NOT completely obstruct limb circulation. We always monitor circulation below the level of restriction to ensure safety throughout its use. Blood flow restriction training is not a new phenomenon. Although it has been around for a while, it is being utilized more in rehab and recovery lately with promising results. Implementing this type of training can not only help you recover from an injury faster, it can also be used as an adjunct to strength training for continued muscle growth once you are healthy again.
Have questions about BFR? Feel free to email us or reach us on our social media channels! And make sure you check out the video above to see BFR in action.
Doessing S, Heinemeier KM, Holm L, et al. "Growth hormone stimulates the collagen synthesis in human tendon and skeletal muscle without affecting myofibrillar protein synthesis." J Physiol. 2010;588(Pt 2):341–51.
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