Blood Flow Restriction Training
Blood Flow Restriction (BFR) training in London
Blood Flow Restriction Training
Blood Flow Restriction (BFR) training is an increasingly popular method that mechanically restricts blood flow to the muscles being trained to boost muscle growth and strength.
How does BFR training work:
BFR training involves using special cuffs or bands on the arms or legs to restrict blood flow to the muscles partially. This creates low oxygen levels within the muscle, which is thought to help stimulate muscle growth and strengthening even at much lower intensities.
By restricting blood flow to the muscle tissue, you can mimic the effects of high-intensity training (i.e., 70-85% of your one-rep max) while training at only 20-30% of your one-rep max.
This is because BFR training causes several key physiological responses:
Metabolic stress:
Restricted blood flow increases lactate and other metabolite levels, which promote muscle growth by triggering anabolic signalling pathways and stimulating muscle protein synthesis.
Muscle fibre recruitment:
Our largest and most powerful muscle fibres (fast-twitch fibres) are usually only recruited during high-intensity exercise. In BFR training, these fibres are recruited at much lower intensities.
Growth hormone production:
Low-oxygen conditions increase growth hormone levels, which are vital for building and repairing muscle tissue.
Earlier return to activity:
As BFR training utilises lower intensity and lighter weights, you may be able to start performing targeted exercises sooner than you’d be able to do if they required greater intensity.
What the research shows:
As BFR grows in popularity, numerous research studies and reviews have sought to establish its effectiveness as a training and rehabilitation tool. A meta-analysis by Lixandrao et al. (2018) showed that BFR training (at 20-30% of one rep max) elicits hypertrophic responses similar to those of traditional high-intensity resistance training (at 70-85% of one rep max).
Hughes et al. (2017) demonstrated that BFR training significantly increased muscle strength and size in various groups and was an effective rehabilitation tool for patients with ACL injuries, knee osteoarthritis and those at risk of age-related sarcopenia (muscle loss). Wortman et al. (2021) concluded that BFR can improve strength, muscle size, and markers of sports performance in healthy athletes. Additionally, combining traditional resistance training with BFR may allow athletes to maximise athletic performance and remain healthy.
A systematic review and meta-analysis by Jørgensen et al. (2023) demonstrated that knee extensor strength, leg press strength, quadriceps muscle size, and self-reported pain and function improved similarly in groups undergoing BFR or high-intensity training. Their findings applied to both healthy individuals and those suffering from musculoskeletal conditions.
Conditions we use BFR for
Osteoarthritis and rheumatoid arthritis:
Multiple studies have shown that BFR training at low intensity produces similar improvements in strength, muscle gain, and physical function as regular high-intensity training, but with far fewer adverse events, such as injuries or joint flare-ups, due to the reduced load and stress on the arthritic joint.
Tendinopathy:
Tendinopathy rehabilitation usually requires heavy controlled loads to generate regeneration and repair the tendon. However, some patients find this unsuitable or too painful. BFR training can help facilitate the necessary physiological changes in the tendon at much lower loads than traditional training, thereby putting less stress on the tissues. BFR training is particularly effective at improving pain and function in patients with patella tendinopathy and tennis elbow.
Post-surgical rehabilitation:
Patients recovering from surgical repair of their ligaments (such as the ACL, collateral ligaments, and ATFL), menisci, or tendons can benefit from BFR training. By training at a lower intensity, you will reduce the load and stress on your ligaments, tendons, and joints while still increasing the strength of the surrounding muscle tissue, which will help support the injured muscle.
Chronic pain syndromes:
BFR training has been shown to reduce pain following exercise via an exercise-induced hypo-analgesic effect and provide longer-term pain reductions when completed regularly. It is thought that this pain-relieving effect is due to muscle contractions, which increase endorphin release. The BFR allows this endorphin release process to occur when working at much lower intensities.
Muscle Strength & Hypertrophy:
BFR training can help you gain significant strength with minimal joint stress. The reduced oxygen flow to your muscles helps activate your high threshold motor units faster- these are the ones most responsible for muscle growth. Elite teams and athletes are using it now as a hack for hypertrophy training sessions.
Endurance:
Training with BFR can significantly increase lactate accumulation and hypoxia (low oxygen in the working muscle), leading to greater-than-average improvements in endurance.
Recovery:
With the reduced training load needed, it spares your overall fatigue, letting you work with weights much less than your max, allowing for fast recovery.
How BFR training can help with your rehabilitation:
Reduced injury risk:
BFR allows you to train at lower intensities and with lighter weights, reducing the amount of stress placed on your ligaments, joints and other tissues, helping minimise the risk of re-injury.
Accelerated muscle hypertrophy:
The physiological effects of BFR training may lead to faster muscle and strength gains, getting you back to full fitness quicker.
Time efficiency:
By restricting blood flow to the muscles, you’ll fatigue your muscles much sooner, thereby stimulating the positive effects of training much faster, too.
Earlier return to activity:
As BFR training utilises lower intensity and lighter weights, you may be able to start performing targeted exercises sooner than you’d be able to do if they required greater intensity.
What to expect during your session?
After this, specialist cuffs will be placed around your limbs (usually the upper arms or upper thighs, depending on what muscles you will be training). The cuffs will then assess your blood pressure to calibrate and deliver the appropriate level of pressure (blood flow restriction) for you.
Your workout will then begin with a weight or weights that are 20-30% of your one-rep maximum. So, if your one-rep max is 60kg, then you will use 12-18kg during the BFR training session.
You will perform 15-30 repetitions per set, with approximately 30 seconds of rest in between sets.
During BFR training, you should expect to experience muscle fatigue far sooner than you would normally. You may even feel a burning sensation in the muscles due to the build-up of lactate and other metabolites. You may also notice a bigger ‘pump’ in your muscles than usual.
Some discomfort is expected during BFR training, but it should not be painful. If you experience pain, inform your trainer and ensure the cuff pressure is adjusted
accordingly.
Precautions and considerations:
Always consult with a qualified medical professional before starting any new exercise routine. Individuals with high blood pressure, a history of DVT, cardiovascular disease, or nerve damage should avoid BFR training. Consult a relevant health professional before incorporating BFR training into your exercise routine.
Conclusion:
Blood Flow restriction training can be a practical addition to your training and rehabilitation. It enables you to increase muscle strength, size, and function to a level similar to high-intensity training but with much lower intensities and weights. This means you can return to exercising sooner, put less stress on your tissues, minimise your risk of injury, and save precious time.
Feel free to call us on +44 7516 421 230 and speak to one of our clinicians about whether Blood flow restriction training is right for you.
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Many insurance providers cover physiotherapy appointments at MSK Clinic Physiotherapy. Please contact us to confirm whether your healthcare insurance provider is included.
Your Clinician
Rick Evans
Rehab Trainer, Strength & Conditioning Coach, Massage Therapist, Shockwave Therapist
Alice Southwood
