There has been a lot of discussion about occlusion training within the fitness injury of late. Bodybuilders and weight lifters are always looking for new innovative ideas to increase muscle quality and size. The use of occlusion training has ultimately found its way in to the Physiotherapy and rehabilitation sector either being referred to as blood flow restriction training/therapy (BFR). There is growing supportive evidence for the use of occlusion training within rehabilitation. So what is it?
The pressure placed through the blood flow restriction cuff needs to ensure blood flow restriction pressure is optimal to create a muscular response. If the pressure is too low, adaptive muscular response may not occur (Scott et al, 2014). However, it is important to ensure the cuff is not too tight and anecdotally inhibit skeletal muscle movement but hinder muscle development (Loenneke et al, 2014). “Blood flow restriction pressure should be high enough to occlude venous return, yet low enough to maintain arterial inflow into the muscle”. (Loenneke et al, 2014). Specifically for use by practitioners, when applying a blood flow cuff, restriction pressure should vary relative to each individual. From my own use it is important to listen to what the client is telling you. If the cuff is too tight it may restrict the movement of the muscle and prevent the exercise being completed properly.
BFR must be combined with exercise in order to create a positive muscle adaptation stimulus. Simple walking exercise have been shown to develop muscle strength and adaptation using BFR. Scott et al, demonstrated supportive evidence for the use of exercise and BFR. (See reference below). This is excellent reading as previous to BFR training, the evidence indicated that we needed to lift over 60% of our 1RPM to initiate muscle development. The BFR process looks to increase metabolic accumulation, fast-twitch muscle fiber recruitment, increased protein synthesis and cell swelling (Loenneke et al, 2010).
Experience of using the cuff in clinic:
Of course it is important to critique the latest and most reliable articles doing the rounds. It is what guides us as practitioners and allows use to make informed decisions to practically use the latest tech when doing rehab (It has absolutely nothing to do with the fact new tech gets us Physio’s super excited. What has the cuff been like practically, does it work?
We have been using the cuff now in clinic for 3 months. We decided to invest as we felt as a team that we had some clients that would benefit from the use of BFR. We have been implementing it primarily with knee based pathologies. We were finding that the specific muscle development of the VMO was not occurring as quickly as we would have liked. Having used the cuff in a structured S and C program, we can say that we are fans! We have seen good development particularly with the VMO and the clients have reported that the knee feels more stable.
The general consensus is that using occlusion training is a positive step for rehabilitation. Anecdotally we have seen in clinic good results for its use and patients have reported good results too. Supportive studies on BFR and the current research show substantial increases in muscle strength and growth when low-load lifting (20-30% 1RM) is combined with blood flow restriction (Yamanaka et al, 2012). However, there has not been enough evidence to show its benefits over traditional strength and conditioning training. Due to occlusion training only being researched on body weight/ low weight exercises we are not yet able to compare the difference between traditional strength and conditioning training and occlusion training with increased weight.
As is the case with most new techniques within the rehab world it takes time for rigorous results to conclude its benefit. Therefore more research is needed in this area. However we personally believe it is an excellent tool and will continue to use it in clinic.
Thanks for reading
Loenneke JP, Thiebaud RS, Abe T, et al. Blood flow restriction pressure recommendations: the hormesis hypothesis. Med Hypotheses. 2014;82(5):623–6.
Loenneke JP, Wilson GJ, Wilson JM. A mechanistic approach to blood flow occlusion. Int J Sports Med,2010. 31:1–4.
Loenneke JP, Fahs CA, Rossow LM, Abe T, Bemben MG. The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Medical Hypotheses, 2012. 78: 151–154.
Lowery RP, Joy JM, Loenneke JP et al. Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme. Clin Physiol Funct Imaging, 2014. 34(4): 317-21.
Scott et al., 2014. Exercise with Blood Flow Restriction: An Updated Evidence-Based Approach for Enhanced Muscular Development. Sports Med. DOI 10.1007/s40279-014-0288-1
Yamanaka T, Farley RS, Caputo JL. Occlusion training increases muscular strength in division IA football players. The Journal of Strength and Conditioning Research, 2012. 26: 2523-2529.