A Quick and Dirty Guide to using Blood Flow Restriction in your Training!


   Blood Flow Restriction training is called a million different things like “B-F-R”, “occlusion,” “tourniquet training,” etc., but it’s all based on the same premise. Blood Flow Restriction training is the process of taking some mechanism, such as a cuff, wrap, or anything  suitable and creating a tourniquet at the proximal joint (shoulder or hip) so that the arms or legs receive less blood flow while performing the exercise. The amount of blood flow restricted in clinical settings will be set at the exact point of diastolic occlusion; meaning that during diastole or when the heart is filling with blood after a contraction, blood will not pass through the veins of the occluded limbs. However, in the systolic phase of the cardiac cycle, when the heart contracts, the increased pressure will allow for blood to circulate in the occluded limb. The tourniquet on the occluded limb results in a pooling effect where blood accumulates because the pressure in the veins is less than the arteries. An analogy for the pooling effect would be the kitchen sink. Imagine the arteries represent the faucet where water turned all the way up will fill the sink. The veins taking blood away from the muscles represent the drain, but this drain is slightly clogged (occluded) resulting in an accumulation of water.  For the “Bro’s,” implementing this in the gym, a general 7 out of 10 tightness for the shoulders and an 8 out of 10 tightness for the legs on a scale of perceived discomfort/exertion is recommended.

An aside: In grad school, one of my colleagues was working on an occlusion study comparing the consistency of proper pressure applied among recreational lifters after feeling the clinician set the exact pressure needed. The study also compared between groups to see differences from wraps vs cuffs. In their opinion, I was informed that there was an overwhelming consistency among lifters who were able to accurately re-occlude themselves after a clinician showed them proper tightness. This means that I have full faith that the average lifter can benefit from the implementation of BFR training which is now backed by a body of literature.

     There is a myriad of benefits that come along with BFR training like the ability to use lighter weights, giving your joints a break, and creating metabolic damage within the muscle. I’ll briefly touch on them and get straight to the implementation of BFR. Reducing blood flow by occlusion training should be done with extremely low load (around 30% of a 1 rep max). This, in it of itself, is the basis for its helpfulness and utility. BFR is primarily used in a clinical rehab setting while working to maintain strength and size of an injured limb. Without occlusion, these low loads do not provide enough stimulus to yield any meaningful adaptation from the muscle. Occlusion paired with low loads allows for the accumulation of metabolic damage cursers and slightly acidic pH (acutely post exercise) which have been shown to stimulate the release growth hormone (GH) and muscle growth. BFR training allows for the athlete or lifter to give their joints, tissues, and muscles a break from the heavy load training they should be implementing while still sustaining and generating benefits* from the implementation of occluded training. BFR is something that should not always be in a program but can definitely supplement some phases where the athlete is either: A. going through injury and can’t perform heavily loaded training, or B. in the middle of some intense fatigue accumulation (they may be a little banged up, and need to substitute in some BFR work as accessory work to take it easier on the joints. BFR can promote recovery in the arms and legs and can be great way to get some active recovery in). With all this talk about lower loads being lifted and this protocol or type of training being used for recovery, It would be easy to get the idea  that BFR training would be something an athlete could mail in and just go through the motions; however, BFR training is not something to take lightly. The performance of BFR training is stressful and can be uncomfortable and is accompanied by an enormous “pump.”

Implementation:

     Generally, BFR training applies to those in rehab who are trying to return from injury. Since, many athletes returning from injury require a strict and tightly controlled environment, BFR training for these athletes is occurs on the leg extension machine and leg curl. Assuming the lifter or athlete is not coming back from injury and does not have to navigate the murky exercise selection waters that accompany that, there are multiple options available. There is nothing wrong with sticking to the leg extension or leg curl, but the lifter can be more adventurous with exercise selection. Starting out, they should start with 3-5 working sets at around 30% to volitional failure. If they can accomplish over 30 reps easily, they are not using a heavy enough load. If they are doing upper body, they should superset their biceps and triceps and for lower body their quads and hamstrings. The cuffs should be worn during the entire duration of the BFR portion part of the workout. Your rest should be around 30-45 seconds and no more than a minute. Personally, I would implement BFR for 2-4 weeks at a time.

 

Beginner

2 weeks duration

30-45 seconds rest

 

Lower Body:

Sets

Reps

Weight

1a. Leg Extension

5

15-30

30%

1b. Leg Curl

5

15-30

30%

Upper Body:

 

 

 

1a. EZ Bar Curl

5

15-30

30%

1b. EZ Bar Skullcrusher

5

15+30

30%

 

 

 

 

Intermediate

2-4 weeks duration

~45 seconds rest

 

Lower Body:

Sets

Reps

Weight

1. Walking Lunges

5

20-30 (Per leg)

30%

Upper Body:

 

 

 

1a. Close Grip Bench Press

5

15-30

30%

2b. Dumbbell Curl

5

15-30

30%

 

 

 

 

Advanced

2-4 weeks duration

~45 Seconds rest

 

Lower Body:

Sets

Reps

Weight

1a. Barbell Box Squat

3-5

20-30

30-40%

1b. Banded Leg Curl

3-5

15-30

30%

Upper Body:

 

 

 

1a. Bench Press

3-5

20-30

30-40%

1b. Barbell Rows

3-5

20-30

30-40%

 

Closing thoughts:

     It would be interesting for me to see what kind of results an athlete would get with pairing a BFR protocol with banded Terminal Knee Extensions (TKE) in a clinical setting, and to see what the ramifications for the knee would be. The combination of proper tracking of the knee and stabilizing of the knee cap a la vastus medialis oblique (VMO) with the hypertrophic and strength wielding results of occluded training could be a one-two power punch for knee health and function. I am sure there are many other interesting exercise selections that BFR could be coupled with to make for some game changing results.

     BFR training possesses some real benefits that athletes should be looking to capitalize on. Whether its supplementing regular training schedule or looking to stay on top of things when dealing with an injury, athletes and lifters can continue to grow muscle and get stronger while implementing what they’ve learned in this article.

     You can pick up some BFR cuffs from Amazon here for a fair price, these are the ones that I own. If you're looking to dive off the deep end, you can get a more clinical feel by using these which you work with a pump, similar to getting your blood pressure taken. I am not convinced that the pricier ones are worth it or result in greater benefits but might provide more comfort and a better tactile experience.

If you have any questions feel free to contact me at connorcocklin@gmail.com

**** There was a study reviewed by Greg Nuckols from strongerbyscience in MASS that showed Type I muscle fibers hypertrophy after powerlifters implemented BFR into their training. I’m not endorsed/paid/whatever but you should check it out for a deeper dive.


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