What is blood flow restriction training?
Blood flow restriction training (BFRT) refers to resistance training performed with a reduction of blood flow in the exercising muscles with the use of a compression device. The compression device used can either be a belt, an inflated air cuff (pneumatic cuff), a sleeve (elastic wrap) or a specific tape. Contrary to common resistance training routines, the intensity of BFRT is very low, performed with a load between 20 to 40% of an individual’s 1-RM .
The compression device reduces the level of oxygen circulating through the exercising muscles, and in doing so, muscle adaptation occurring after working at low intensity is greater than the benefits of low intensity with a normal level of oxygen in the working muscle . However, it is unclear whether low load BFRT reaches the same benefits as high load training or not [1,3].
BFRT is a relatively new type of resistance training, inspired from KAATSU, a Japanese strengthening method invented in 1966. Over the last years, studies have been conducted to understand the benefits of BFRT, how it is best to be implemented for different conditions and its safety .
Benefits of BFRT
Most studies found that BFRT brings physiological and functional benefits for the general population as well as people with various conditions, such as knee osteoarthritis, tendon injuries and ACL reconstruction. Physiologically, BFRT has been found to increase muscle size (hypertrophy) and muscle strength in the general population. Functionally, the use of BFRT may reduce pain and recovery time in people with specific conditions [1,2,3].
The authors of a systematic review compared low load BFRT to low and high load training without BFR, for population presenting with various musculoskeletal conditions (ACL reconstruction, knee osteoarthritis, and older adults at risk of sarcopenia). Low load BFRT showed a greater increase in strength compared to low load training without BFR, whereas it was found to be less effective than heavy-load training . However, another study focusing on women with knee osteoarthritis found that low load BFRT provided the same increase in lower limb strength than high load training . This study also looked at muscle size, function and pain. The authors found that (1) low load BFRT and high load training provided a greater increase in lower limb muscle size compared to low load training; (2) low load BFRT and high load training led a greater improvement in function compared to low load training; (3) low load BFRT and low load training provided a greater reduction in pain compared to high load training .
People with patellofemoral pain may also benefit from BFRT. Compared to standard rehabilitation, the use of BFRT provided a greater increase in knee extensors strength and a greater reduction in pain in daily activities .
Safety, precautions, contra-indications
The safety of BFRT is a common and legitimate question as blood flow is voluntarily restricted within the exercising muscles. A study conducted in Japan in 2006 indicated that KAATSU training (original name given to BFRT) is a safe method for training athletes and healthy persons, and it can also be applied to persons with various physical conditions . The most common side effects are subcutaneous hemorrhage (13.1%) and temporary numbness (1.3%), while serious complications are rare (venous thrombus (0.055%), pulmonary embolism (0.008%) and rhabdomyolysis (0.008%)) .
Take home message
BFRT is an effective way to increase strength and muscle size while only working at low intensity. Thus, it appears to be a good clinical rehabilitation tool, especially for people suffering from knee osteoarthritis, tendon injuries, and ligament injuries (such as ACL reconstruction). During rehabilitation, the use of BFRT provides greater gain in muscle strength and muscle size than low load training, while avoiding pain caused by high load training.
Due to the potential side effects of BFRT, we recommend you to use this method in the presence of health professionals. They will set it up safely for you and will monitor throughout your training in order to minimise the risks of side effects.
If you have any questions regarding whether you think you could benefit from doing some supervised blood flow restricction training, please give us a call at (02) 8411 2050. At Thornleigh Performance Physiotherapy, we can give you an accurate diagnosis and treatment, to help you get back in action as soon as possible. We are conveniently located near Beecroft, Cherrybrook, Hornsby, Normanhurst, Pennant Hills, Waitara, Wahroonga, Westleigh, West Pennant Hills, and West Pymble.
1. Ferraz RB, Gualano B, Rodrigues R, et al. (2017). Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis. Medicine & Science in Sports & Exercise, 897-905. DOI: 10.1249/MSS.0000000000001530
2. Giles L, Webster KE, McClelland J, et al. (2017). Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med, 51, 1688–1694.
3. Hughes L, Paton B, Rosenblatt B, et al. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med, 51, 1003–1011.
4. Nakajima T, Kurano M, Iida H, et al. (2006). Use and safety of KAATSU training: Results of a national survey. Int. J. KAATSU Training Res., 2, 5-13
5. British Journal of Sport Medicine (blog) (2018). Bood flow restriction: miracle return to play adjunct or therapy fad? Retrieved on 18/01/2018 from https://blogs.bmj.com/bjsm/2018/11/07/blood-flow-restriction-miracle-return-to-play-adjunct-or-therapy-fad/?utm_source=hootsuite&utm_medium=social&utm_term=&utm_content=&utm_campaign=