Blood flow restriction (BFR) training involves exercising while restricting arterial inflow into the muscle, and occluding venous return from the muscle1. Although the exact mechanism is not fully understood, many studies have shown that BFR therapy results in beneficial effects on skeletal muscle form and function, and preliminary evidence suggests it may also promote bone formation 2, 3. Researchers have found that the low oxygen state caused by BFR makes the body use muscle fibers typically reserved for the most strenuous tasks, such as sprinting and heavy lifting4. This causes the brain to release anabolic substances such as human growth hormone (HGH), as much as 290 times greater than baseline4.
Typically, a person needs to lift weights at around 70% of their one repetition maximum to have noticeable increase in muscular strength and size2. However, heavy resistance training has risk of injuries and may not be used for many at risk population such as the elderly, and patients undergoing rehabilitation. Studies have shown that BFR training at low resistance can increase both muscle mass and strength, and is beneficial for the recovery of wounded soldiers, injured athletes and patients requiring muscle gain 2,4,5,6.
For an example, at the Centre for the Intrepid (CFI) in San Antonio, low-resistance BFR training was introduced to help rehabilitate wounded soldiers4. Many of these patients have severely damaged limbs which prevent them from participating in traditional weight training. BFR training has allowed them to gain muscle strength and function without compromising vulnerable soft tissues and joints. Researchers at CFI have observed an average increase of 50%-80% strength gains in a little as a few weeks.
While BFR training appears to hold promise in increasing muscle strength and size, it must be done in a controlled, supervised environment with trained staff, and with specialized surgical tourniquet systems adapted for BFR training4. Furthermore, since the applied pressure should be high enough to stop venous return but low enough to allow for consistently restricted arterial flow, the optimal pressure applied will be different for each individual, and should be personalized to maximize the safety, consistency, and effectiveness of the BFR training. Personalization of the BFR training can be achieved by applying a specialized pneumatic tourniquet cuff and setting a cuff pressure based on the individual’s limb occlusion pressure (LOP) [http://www.tourniquets.org/lop.php]. It has been suggested that applying a cuff pressure at a predetermined percentage of the LOP can maximize the anabolic response to skeletal muscle without increasing the possible negative consequences of higher pressures1. The use of a specialized surgical tourniquet system adapted for BFR training improves BFR training by maintaining, controlling and applying evenly distributed pressure, based on personalized limb occlusion pressure, through an adapted surgical tourniquet cuff, applied around the limb proximal to the targeted muscle group.
 Loenneke JP, Thiebaud RS, Abe T, Remben MG. “Blood flow restriction pressure recommendations: the hormesis hypothesis.” Med Hypothesis. 2014 May; 82(5): 623-6.
 Loenneke JP, Abe T, Wilson JM, Thiebaud RS, Fahs CA, Rossow LM, Bemben MG. “Blood flow restriction: an evidence based progressive model (Review).” Acta Physiologica Hungarica. 2012 Sep; 99(3): 235-250.
 Loenneke JP, Young KC, Wilson JM, Andersen JC. “Rehabilitation of an osteochondral fracture using blood flow restricted exercise: a Case review.” J of Bodywork and Movement Therapies. 2013 Jan; 17(1): 42-45.
 Bell, Stephanie. “New method may benefit athletes.” ESPN. ESPN Internet Ventures, 11 Nov 2014. Web. 26 Nov 2014. <http://espn.go.com/nfl/story/_/id/11858977/tourniquet-training-change-way-athletes-recover-injuries>.
 Martin-Hernandez J, Marin PJ, Menendez H, Ferrero C, Loenneke JP, Herrero AJ. “Muscular adaptations from two different volumes of blood flow-restricted training.” Scand J Med Sci Sports. 2013 Mar; 23(2): e114-20.
 Hylden C, Burns T, Stinner D, Owens J. “Blood flow restriction rehabilitation for extremity weakness: a case series.” JSOM. JSOM Online, 15 Jul 2014. Web. 28 Nov 2014. <https://www.jsomonline.org/Newsletter/140715.html#2>.
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