Using blood flow restriction training during rehab

Why did you turn to blood flow restriction during the rehab process?

As rehab professionals, we are always looking for that little edge, especially when working with elite athletes. If you can intelligently and safely shave time off of recovery, then that is a huge advantage.

I initially encountered blood flow restriction (BFR) in the National Football League over a decade ago. Since then, it has exploded in usage. The ability to safely apply load earlier and more often has been an enormous benefit to the athletes’ recovery from both short and long term injuries. 

When you can advance post-surgical patients more quickly out of the sub-acute stage, or take an injury that would normally last a month and reduce it by a week, that is a sizable benefit to both the athlete and the team. Even more so when you consider seasons such as the NFL’s, where there are so few games before meaningful playoffs begin. Those short time frames matter.

What are some situations where you have used BFR during rehab?

I work with a lot of Achilles repair patients. Using BFR with these individuals over the last decade has been pivotal in their quick recovery. What were once career ending injuries are now reduced to a matter of a few months out of the squad. The ability to begin adapt to resistance / load even before weightbearing has allowed them truly to “hit the ground running” better than ever before.

Obviously, surgical techniques have improved, but the advance of early use BFR – sometimes as soon as one month post-surgery – has been a game changer for us. 

I also work with a lot of throwers and have used BFR to advance their recovery after throwing sessions or on off days. They have benefited from great reductions in soreness and reduced down time, so they can train sooner with more load post-competition.

Are there any nuances that you have found when using BFR for different injuries? Upper versus lower body, for example?

Anecdotally, lower body injuries benefit more from the strengthening side of things, while upper body does better with recovery. That makes sense to me, as the larger, more dynamic movement and stability muscles that produce the larger levels of force through our lower bodies should benefit more. That’s not to say the inverse isn’t true (upper strengthening, lower recovery). However, it obviously depends on your goal for usage and the individual athlete in front of you. 

I see the biggest gains with BFR in the sub-acute / median stages of post-surgical rehab, while the more maintenance and smaller percentage gains come on a day to day basis post-competition and when returning from short term injuries. They all add up to improved performance. 

What protocols do you use?

Million dollar question, right? Everyone seems to have different protocols and schemes, and I feel like have I tried them all at different times and stages of rehab, recovery, or training cycle.

When it comes to strengthening, I initially worked on a 30-20-10-failure rep structure with one minute off between sets, for a total of about 15 minutes for 2-3 different exercises. I enjoyed that for a while as I worked with some pretty intense athletes who felt that if they were not working to failure that they were not gaining anything from the session.

As I have advanced further down the road with BFR technology, I have adopted the more common 30-15-15-15 rep structure. It fits a wider band of athletes’ needs, and I would rather adjust the resistance and have something standard there. It’s our responsibility to choose the appropriate resistance and control that, as opposed to the subjective experiences of failure or “burnout,” which are tougher to quantify and assess externally.

I always start strengthening with lighter pressure until the athlete is comfortable with the experience. Then we can tailor it to them. I’ve had the most successes in the 325 -350 mmHg range for those purposes. 

For recovery, depending on the athlete’s needs and sport requirements, I use lighter resistance and a time based protocol of minutes on / off with lighter activity. Essentially, cutting down resistance and using time as the deciding factor. Hockey players, for example, will do a series of three bouts of two minutes on with lighter pressure, mixed with one minute off, all while riding a bike after practice or competition.

Another, similar protocol for throwers employs just upper extremity BFR and an upper body ergometer or wading / rowing in the pool – just something broad with large ranges of movement. 

What has been athlete feedback like when using BFR? Have there been any athletes who weren’t comfortable with it and had to be won over?

When the technology first came out and was being introduced into training environments, it took quite a bit of convincing and education about what, why, and how. Slowly, athletes began to see the results that it produced and how they could benefit from the sessions, even though it was something that most had never done before. I demonstrated on myself to help many of my athletes to buy in.

It mostly comes back to education and how we present why it is beneficial for them to do it. Especially in a team setting, when one athlete sees something that benefits another, they are all more willing to get in on it. When they see people coming back sooner – and, in many cases, better – from injury, that proof leads them to get on board the next time. 

Obviously, there are always some that are not interested in the experience due to the comfort, but that is the case with anything we do.

What BFR technology have you used and why do you use your current choice?

I feel like I have tried them all. I was initially introduced to BFR with KAATSU’s original system in 2014-15. Slowly, as more and more companies were developing different versions, I have tried and purchased many, including Delfi, AirBands, Smart Cuffs, and B-Strong.

It depends on the usual factors: your athletes’ needs, price, purpose, convenience.

Since I own a mobile practice – I have no physical office, I travel daily both regionally and nationally – I require very portable and efficient systems no matter what my usage or purpose. I am currently using two different sets: B-Strong, primarily for strengthening, and Hytro primarily for recovery. I highly recommend both of them for different reasons.

The convenience and portability of both is what I am looking for with my equipment. I especially appreciate the wide usage and range, as well as the affordability of both products. With more and more athletes on the move, I find that to be at a premium.

Hytro, in particular, has greatly impressed me in the recovery and portability aspects, and the ease of usage by both athlete and practitioner. They are a really nice addition to the space, and I feel that more practitioners will see them as a great addition for their athletes. They are so easy to use on a plane or bus ride home immediately from competition – truly a game changer.

If you want to learn more about how to use BFR during rehab, be sure to see us at this year’s Sportsmith Rehab Conference, or email us at teamsales@hytro.com to talk sooner.