What is BFR?
Blood flow restriction (BFR) training is rapidly gaining in popularity in the rehab setting, but what exactly is BFR and how can it benefit you? Consider these two simple concepts: (1) to maintain muscles, we must use them and (2) to gain muscle strength, we must train them.
Traditionally, muscle training to gain strength was done by progressively lifting heavier weights over time. During heavy lifting, there is a reduction of oxygen delivery to the muscles that stimulates the body to respond in ways that ultimately lead to muscle growth. Weight training by heavy lifting may not be an option to many different groups of people: the injured, those having undergone recent surgery, those with medical conditions that put them at risk for injury, the elderly, and the list goes on and on.
In BFR training, blood flow to specific muscles is restricted by pressure, which recreates the same environment caused by heavy lifting. When light lifting is combined wit blood flow restriction, the body responds with similar muscle growth and strength gains as seen with heavy weight lifting.
The Evolution of BFR
This unique discovery was made by Dr. Yoshiaki Sato in Japan in the 1960s. At the age of 18 years, Dr. Sato spent a prolonged amount of time sitting in a traditional Japanese posture and noticed his lower leg muscles were swollen as if he had done a hard workout.
After years of investigation and experiments to develop this pressurization technique, Dr. Sato eventually patented the technology, termed “KAATSU” (“additional pressure”) training. The Department of Defense later had success using it on military personnel after limb salvage procedures, traumatic blast injuries and general orthopedic surgeries such as ACL reconstruction. It has since become popular with professional athletes, Jadeveon Clowney being the first NFL player to use it in 2015 after a lower leg injury. Now BFR is found in general orthopedic rehab facilities and hospital settings due to the undeniable benefits established through extensive research.
During BFR training a tourniquet is placed on the upper thigh or arm that is set at an individualized pressure to mimic the hypoxic (reduced oxygen) environment that occurs with exercise. What makes BFR so unique is that using a light load or even body weight is all that is needed to have similar effects as lifting a heavy load. Research has also shown significant improvements of lower extremity strength, muscle volume, and functional outcome measures when used during a BFR walking program.
Gaining muscle by just walking with a BFR tourniquet on is something to be excited about! During the workout the tourniquet causes a blood pooling effect and increases muscle fiber recruitment that stimulates beneficial growth factors and hormones to the area. This slows down muscle loss and promotes muscle growth and strength.
Who Can Benefit From BFR Training?
BFR training experts are in agreement that whenever possible, traditional heavy weight training is best to optimize muscular development and BFR should be introduced when loading heavy is not ideal. Activity reduction is common after a spine injury or surgery, which opens the door for muscle loss to occur. Using BFR with light weight training while an injury heals or before and after surgery can be very effective and complies with post surgical lifting precautions while preventing muscle loss and even building strength.
Muscle loss is one of the biggest problems a physical therapist faces when treating patients, which is a common problem in the geriatric population.
The old adage, “if you don’t use it, you lose it” holds true for our muscles; if we don’t give them a reason to stay, they will quickly leave. Muscle wasting has been linked to a loss of independence and increased mortality. Lifting heavier weights has been shown to be safe in the geriatric population but for some it may not be the best option. BFR bridges that gap by allowing the muscles to be appropriately worked without heaving lifting at all.
BFR Safety and Efficacy
Safety is a top priority during rehabilitation. Risks concerning blood clots and muscle damage have been studied extensively with BFR training. These studies have shown that BFR does not increase the process of blood clot formation and the risk of developing a blood clot is the same when compared to the risk during traditional exercise training. The risk of muscle damage using light weights with BFR is less than the risk compared to heavy weight training. Although BFR is not for everyone and is safest when directly guided by a physical therapist with BFR training, the technique is generally considered to be safe. This innovative technology has allowed a wide variety of patients to maintain or regain strength and return to a satisfactory quality of life faster than traditional rehab. At Virginia Therapy and Fitness Center we have seen great success with BFR training for many patients during their rehab journeys. BFR training has evolved since its discovery and it is definitely here to stay.
by Justin Geisler, PT, DPT at Virginia Therapy and Fitness Center