Just moments before the NBA Finals kick off, I’d like to share this with everybody reading. It’s pretty eye-opening and a groundbreaking phenomenon. I saw it used hours before games to get the full hormonal influence ideally in the latter half of games. I question whether the Spurs or the Heat have been exposed to it and if they’ve implemented it for the game today. Considering Lebron's athletic ability, perhaps he knew something well before we did.
Well… It is pretty common medical as well as general knowledge that blood is responsible for the transport of oxygen, nutrients, and many other molecules crucial for sustained life. Most bodybuilders will also tell you that blood is important for gaining muscle, blood flow to be more specific. Not surprisingly, an entire category of supplements has emerged in the past decade (for good or bad – I’m yet to conclude), focused on increasing blood flow and thus purporting to enhance anabolism. But what if I told you that the opposite may be true? What would you say if I told you that occluding blood flow to muscles can have an anabolic effect? You would probably tell me I’m not getting enough blood flow to my brain but you would be wrong. Most recently, I was exposed to this form of training, whilst over in the USA and it intrigued me enough to start to research further into its origins and possible uses. I’ve seen it first hand have incredible results in a sports medicine setting, returning athletes in ridiculously fast times and have set about to further my understanding to this phenomenon.
Blood Flow Restriction (BFR) or sometimes referred to as Occlusion training has years of research to support its effectiveness and in this article I will explain what it is and how to use it to augment your training.
Quite simply, BFR training involves restricting the venous return of blood flow from the muscle. The goal is not to restrict blood flow to the muscle, but instead prevent blood flow return from the muscle, i.e. you do NOT want to restrict the arterial blood flow to the muscle, only the venous return from the muscle, causing the blood to pool in the muscle. The purpose of this technique is to increase the accumulation of local metabolic byproducts. These compounds include lactate, IL-6, IL-15, and other “muscle molecules”. They are not simply waste material, but are now understood to be potent stimulators of muscle growth and fat loss through intracellular and hormonal mechanism. This is accomplished by use of some form of constriction around the limbs from theraband to compression sleeves and some literature also describes blood pressure cuffs.
This form of occlusion when performed properly, allows you to use much lower weights than normal training protocols and still achieve sizable anabolic training responses. In fact, studies have shown that occlusion training can increase muscle size and strength using training loads as light as 20% of a 1 rep max. This is especially useful for individuals who are injured and can only use very light weights or for trainers who are undergoing a de-load phase in their training cycle – highly recommended in any sport. Blood Flow Restriction training allows you to still make gains using light weights while giving your joints, ligaments, and tendons a break from heavy lifting. In a high impact and high load sport like basketball – I will discuss tendons and loading in a future article, I see it as ground breaking that we can utilise such a technique. Following NBA games is the only suitable time to lift weights with their heavy schedule. Due to the high frequency of games and very few nights off, it was often the only practical time to lift, as we are all aware of the following day soreness heavy lifting sessions has, and don’t want to risk this impact on performance as well as risk it may place to injury.
Suitably, BFR training induces an anabolic response through various pathways perhaps the most important of which is by preferentially targeting the large fast twitch muscle fibers. Fast twitch fibers are the biggest muscle fibers and have the most potential for growth. These fibers are recruited last during contractions and are mostly anaerobic (don’t use oxygen) whereas the smaller slow twitch fibers are recruited first during contractions and are aerobic (use oxygen). Slow twitch fibers have a much smaller potential for growth compared to fast twitch fibers. By restricting blood flow to muscles, pre-fatiguing the slow twitch fibers and forcing the anaerobic fast twitch fibers to handle the load even at low intensities your muscle is getting a similar effect to lifting heavy loads but using much lighter weights. Not only does occlusion training preferentially activate fast twitch muscle fibers, it has been shown to cause a fiber type shift from slow to fast, thus increasing the potential for muscular growth and size which should inevitably increase power output.
Metabolic by-product accumulation is the primary mechanism by which occlusion training produces hypertrophy and other questionable sports medicine benefits. These metabolic by-products would normally be ‘washed out’ by normal blood flow, but occlusion allows them to accumulate near the muscle. Lactate accumulation in particular seems to have an effect, presumably by increasing growth hormone concentrations. In fact, one study found that BFR training caused a growth hormone increase 290 times above baseline! This is a twofold greater increase in growth hormone than what is produced by normal heavy resistance training. It is here where there is no further research into sports medicine or rehabilitation, but where we can logically conclude that additional growth hormone would result in faster recovery and remodeling of damaged tissue.
If those reasons weren’t convincing enough to try occlusion training, consider that it has also been shown to increase muscle protein synthesis, mTOR signaling, and the expression of NOS-1 that has been shown to increase muscle growth through increased satellite cell activation. Perhaps even more impressive, forms of this training has been demonstrated to reduce myostatin concentrations. For those of you who aren’t familiar with these cellular names, myostatin is considered to be a big time inhibitor of muscle growth and is thought to limit the muscle potential of muscle gain. Perhaps occlusion training may be able to increase the overall potential of muscle gain through slow to fast fiber shifts and reductions in myostatin.
It is important to realize this form of training isn’t a replacement for heavy gym sessions, it is a supplement to all your hard work. It is also very useful for people who can’t train heavy due to injury or de-loading and where I have included it into my rehabilitation and prehabilitation of athletes. However, occlusion provides several long-term benefits that regular heavy training doesn’t, including slow to fast fiber transitions and a greater hormonal response. It would be nice to think these hormonal responses are building sturdier, more resilient tissue in these athletes, making them less prone to injury because of stronger structures. Unfortunately there is no research that has explored such avenues of use but what’s not gained is lost when we are always looking for that competitive edge.
Before proceeding further, and occluding all blood supply to every part of your body, all day every day, please keep in mind that this form of training is very difficult even though the loads are very light, and it has not been researched extensively to be fully aware of medical risks. It is easily the most painful form of training I have ever performed. As always, before starting any kind of new training protocol, you should talk with a medical professional but remember it’s an area poorly understood by most general practitioners. Blood Flow Restriction can be performed for the thighs, calves, upper arms, and forearms using a blood pressure cuff, theraband or tightly wrapped knee wraps (more practical). To occlude the thighs and upper arms, wrap at approximately 70% of maximum tightness around the uppermost part of the muscles. To occlude the calves or forearms wrap at approximately 70% of maximum tightness just below the knee or elbow.
Perform 3-5 sets to muscular failure with 20-50% of your 1 rep max on a given exercise with the muscle occluded the entire time. Rest periods should be 30-60 seconds between sets. After the final set remove the wraps and restore blood flow to the muscle. It is important to never exceed 15-20mins of any form of occlusion.
A word of advice, be prepared for a lot of pain and if you do not find yourself in excruciating pain, the odds are the wraps are not tight enough. Try blood flow restriction training and take your training to another hypertrophic dimension!
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