Suji Newsroom

[{"id":565172764726,"title":"BFR Training - Benefits without lifting a finger.","created_at":"2024-02-22T01:27:22-05:00","body_html":"\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eBlood flow restriction (BFR) training is rapidly becoming a common training modality in exercise rehabilitation programmes. The appeal of BFR training is that the user can achieve improvements in muscle strength, muscle mass and cardiovascular function using relatively low training intensities, adaptations more typically reserved for strenuous exercise. BFR training evolved as a strategy to increase muscle mass and rehabilitate injury (\u003c\/span\u003e\u003ca data-sanitized-data-mce-href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\" data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\"\u003eWhat is blood flow restriction training?\u003c\/a\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e), however we are now beginning to understand that the benefits of BFR are likely to also impact bone, tendons and blood vessels among other systems in the body. While there remains valid concerns about the safety of BFR training techniques, in a research setting BFR has been applied to a wide range of clinical subjects including those with hypertension, kidney disease, osteoporosis and Parkinson's disease. BFR researcher Professor Jeremy Loenekke recently described BFR in three separate phases \u003c\/span\u003e\u003ca data-sanitized-data-mce-href=\"https:\/\/barcainnovationhub.com\/blood-flow-restriction-training-from-science-to-practice\/\" data-mce-href=\"https:\/\/barcainnovationhub.com\/blood-flow-restriction-training-from-science-to-practice\/\" data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" href=\"https:\/\/barcainnovationhub.com\/blood-flow-restriction-training-from-science-to-practice\/\"\u003e(Loenekke, 2019)\u003c\/a\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e:\u003c\/span\u003e\n\u003col data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e\n\u003cli data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eBFR applied in the absence of muscle contraction\u003c\/li\u003e\n\u003cli data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eBFR in combination with low-intensity cardiovascular exercise\u003c\/li\u003e\n\u003cli data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eBFR in combination with low-load resistance exercise\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cp\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eThe first of these phases suggests that the application of BFR can be used as a standalone treatment strategy and has been demonstrated effective at maintaining muscle mass and strength.\u003c\/span\u003e\u003c\/p\u003e\n\u003cdiv data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" class=\"image_break_sec\"\u003e\u003cimg data-sanitized-data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/IMG-20201014-WA0025-600x750.jpg\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/IMG-20201014-WA0025-600x750.jpg\" data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" height=\"400\" width=\"100%\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/IMG-20201014-WA0025-600x750.jpg\" class=\"size-medium wp-image-864\"\u003e\u003c\/div\u003e\n\u003cdiv data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" class=\"image_break_sec\"\u003eBlood flow restriction training involves partially occluding blood flow to the working muscles during physical activity.\u003c\/div\u003e\n\u003ch2 data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eBFR in the absence of muscle contraction:\u003c\/h2\u003e\n\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eThe concept of using BFR as a passive strategy was first described in a research paper by Takarada et al. (2000) over 20 years ago. This study was conducted in post-operative ACL reconstruction patients and BFR was trialled as a strategy to minimize quadriceps wastage post-surgery. In ACL rehabilitation quadriceps dysfunction has the potential to create abnormal movement patterns, impair activities of daily living and increase the likelihood of re-injury. In this study, participants wore BFR training cuffs for 5 x 5min intervals with 3mins of rest between. The cuffs were inflated from 180-240mmHg and the pressure progressed from day 3-14 post ACL reconstructive surgery. During this period the experimental group who wore the cuffs reported a 9.4% decrease in quadriceps muscle mass, while the control group (who followed the same protocol in the absence of BFR) reported a 20.7% decrease in quadriceps mass. While these findings have important clinical implications, it is important to note that this line of research remains in its infancy and further research is required to understand the clinical significance of these findings. More recently Barbalho et al (2019) used a similarly passive BFR protocol with intensive care patients. Within this study, subjects were taken through passive mobilization exercise that is common to intensive care. Throughout, one limb was subject to BFR using a tourniquet, while the other limb served as a control. Within this study BFR appeared as valid and effective strategy to reduce muscle wasting in intensive care patients. The mechanisms by which BFR may prevent muscle wastage remain unclear. However, if we are to re-consider the different ways in which BFR in combination with resistance exercise may trigger muscle growth, some popular theories have been hypothesized (\u003c\/span\u003e\u003ca data-sanitized-data-mce-href=\"https:\/\/sujibfr.com\/blog\/bfr-training-and-muscle-growth\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/bfr-training-and-muscle-growth\" data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" href=\"https:\/\/sujibfr.com\/blog\/bfr-training-and-muscle-growth\"\u003eBFR training and muscle growth\u003c\/a\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e). Perhaps the most common theory is the concept of cellular swelling. BFR training completely occludes blood flow \u003c\/span\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e\u003cstrong data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eaway\u003c\/strong\u003e\u003c\/span\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e from the muscles, however typically only partially occludes blood flow \u003c\/span\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e\u003cstrong data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eto\u003c\/strong\u003e\u003c\/span\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e the muscles. This causes an accumulation of fluid that can transfer in to the muscle cells and presents as an important stimulus for muscle growth. This concept remains speculative and further research in this area is required.\u003c\/span\u003e\n\u003ch2 data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eBFR and neuromuscular electrical stimulation:\u003c\/h2\u003e\n\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eNeuromuscular electrical stimulation is commonly used as a rehabilitation strategy to prevent muscle atrophy during periods of immobilization, by delivering an electrical impulse to the nerves to trigger a series of involuntary muscle contractions. Given that BFR training is based on the premise that a muscle growth stimulus can be achieved with low-intensity training, it is plausible that muscle contractions evoked by NMES may induce muscle hypertrophy when combined with BFR. This concept was first explored by Natsume et al. (2015) who exposed subjects to 2x sessions per day, 5x days per week, for 2 weeks of NMES either with or without additional BFR. When combined with BFR, NMES led to a 3.9% increase in muscle thickness, a 14.2% increase in isometric strength and a ~8% increase in isokinetic strength. No noticeable changes were observed when NMES was used as a standalone intervention. These findings have recently received support within the literature (Slysz et al., 2020), however this line of research is still very young. Remarkably, BFR combined with NMES has also been shown to have implications for people suffering from spinal cord injuries. Incomplete tetraplegia is a form of spinal cord injury commonly associated with atrophy of the wrist-extensor muscles leading to limited upper body extremity function, impaired fine motor control and increased dependency. Research from Gorgey et al. (2016) demonstrated a 15% increase in the cross-sectional area of the extensor carpi radialis longus muscle (a key wrist extensor muscle) following 6 weeks of BFR combined with NMES training. This change was coupled with an increase in wrist strength and hand function that was observed in both experimental groups. This findings exemplify the capacity for BFR training to be a crucial tool in clinical individuals who are contraindicated to traditional strength training methods.\u003c\/span\u003e\n\u003ch2 data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eFinal word:\u003c\/h2\u003e\n\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eThe use of BFR training in the absence of physical exercise is a relatively new concept. To date only a handful of research papers have explored its clinical effectiveness as a rehabilitation strategy, however the results are thus far encouraging. The capacity to limit muscle wastage in those physically unable to exercise has significant and important clinical implications and the capacity to improve rehabilitation and quality of life outcomes.\u003c\/span\u003e\n\u003ch2 data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eReferences:\u003c\/h2\u003e\n\u003cul data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e\n\u003cli data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eTakarada, Y., et al.,\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eApplications of vascular occlusion diminish disuse atrophy of knee extensor muscles.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eMedicine and Science in Sport and Exercise, 2000. pp. 2035-2039.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-sanitized-data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/11128848\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/11128848\/\" data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/11128848\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/11128848\/\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eNatsume, T., et al.,\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eEffects of Electrostimulation with Blood Flow Restriction on Muscle Size and Strength.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eMedicine and Science in Sport and Exercise, 2015. pp. 2621-2627.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-sanitized-data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26110693\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26110693\" data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26110693\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/26110693\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eSlysz, J. T., et al.,\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eThe Effects of Blood Flow Restricted Electrostimulation on Strength and Hypertrophy.\u003c\/em\u003e\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003eJournal of Sport Rehabilitation, 2018.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e27\u003c\/strong\u003e: pp. 257-262.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-sanitized-data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28513326\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28513326\/\" data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28513326\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/28513326\/\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eGorgey, A. S., et al.,\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003eElectrical stimulation and blood flow restriction increase wrist extensor cross-sectional area and flow mediated dilation following spinal cord injury.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eEuropean Journal of Applied Physiology, 2016.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e116\u003c\/strong\u003e: pp. 1231-1244.\u003cspan data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-sanitized-data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27155846\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27155846\/\" data-sanitized-data-mce-fragment=\"1\" data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27155846\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/27155846\/\u003c\/a\u003e\n\u003c\/li\u003e\n\u003c\/ul\u003e","blog_id":81818452022,"author":"Ali Cianciulli","user_id":79137341494,"published_at":"2021-02-28T01:00:00-05:00","updated_at":"2024-04-23T02:08:15-04:00","summary_html":"","template_suffix":"","handle":"bfr-training-benefits-without-lifting-a-finger","tags":"","image":{"created_at":"2024-02-22T01:27:22-05:00","alt":"","width":520,"height":293,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Suji-BFR-Blog-Image-4_520x500_6052cb4c-e601-47b9-b865-5adbfce0cb6f.webp?v=1708583243"}},{"id":565172731958,"title":"BFR Training - Above or below the cuff?","created_at":"2024-02-22T01:22:29-05:00","body_html":"\u003cp\u003e\u003cspan data-mce-fragment=\"1\"\u003eBlood flow restriction training (BFR) has recently gained popularity as a method for increasing muscle mass and strength using resistance training loads as low as 20% 1RM (\u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\"\u003eWhat is blood flow restriction training?\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e). Traditional resistance exercise methods demand loads greater than 70% 1RM be used in order to trigger a muscle hypertrophy response, making BFR an appealing alternative. Adaptations to resistance training are typically localised to the working muscle, however less pronounced gains in strength are also observed in the contralateral (opposite) limb due to a phenomenon known as \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003ecross-education\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e. This concept dictates that if you train one side of your body, the other side has the potential to get stronger. These strength gains are attributed to changes in the central and peripheral nervous system, resulting in a more co-ordinated movement pattern on both sides of the body. Further still, there is some evidence to support the concept of a \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003eremote-transfer\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e effect, which suggests that if you train one part of your body, for example your legs, the strength gains you can achieve in another part of your body, your arms, may be amplified. The remote-transfer effect is thought to be driven by changes in hormones that circulate within your bloodstream and have the potential to impact all areas of your body. BFR training causes an increase in both neural drive and circulating muscle growth hormones (\u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/sujibfr.com\/blog\/bfr-training-and-muscle-growth\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/bfr-training-and-muscle-growth\"\u003eBFR training and muscle growth\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e), making it plausible that the benefits of BFR training are not necessarily confined to the muscles directly beneath the cuff.\u003c\/span\u003e\u003c\/p\u003e\n\u003cdiv data-mce-fragment=\"1\" class=\"image_break_sec\"\u003e\u003cimg data-mce-fragment=\"1\" height=\"300\" width=\"100%\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/WhatsApp-Image-2020-10-30-at-11_04_57-600x747.jpeg\" class=\"size-medium wp-image-936\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/WhatsApp-Image-2020-10-30-at-11_04_57-600x747.jpeg\"\u003e\u003c\/div\u003e\n\u003cdiv data-mce-fragment=\"1\" class=\"image_break_sec\"\u003eBFR training involves training with a pneumatic cuff device that partially restricts blood flow to the working muscle.\u003c\/div\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe majority of research surrounding the use of BFR training has targeted the muscles directly beneath the cuff. For example, the application of BFR cuffs to the most proximal part of the thigh has consistently been shown to increase quadriceps muscle mass and strength when training the lower limb. However, as we learn more about BFR, we discover that the benefits of this form of training may be pertinent to other areas of the body.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003e\u003c\/h2\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eAbove the cuff:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eRecent research from Eric Bowman has demonstrated an increase in muscle strength and endurance capacity in muscles located above the cuff in both the lower (2019) and upper (2020) limb. In the lower limb this research demonstrated increase in muscle strength in hip extension and abduction with the cuff placement at the top of the thigh. In the upper limb BFR training caused an increase in muscle strength in shoulder flexion, abduction, and internal and external rotation. While there is mixed evidence regarding the effects of BFR training in muscles proximal to the cuff, these findings have considerable implications for the use of BFR in clinical populations. The potential to increase muscle strength above the cuff would benefit post-operative hip and shoulder pathologies, and suggest that the benefits of BFR training is not localized to the extremities where BFR can be directly applied.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eBelow the cuff:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eWhen considering muscles below the cuff, we are referring to those muscles that lie at least one joint away from the site of the cuff. For example, when training the lower limb, the cuff is typically applied to the most proximal part of the thigh. The muscles below the cuff would be those that function about the ankle, most prominently the calf muscles. There is considerable research supporting the use of BFR training in muscles distal to the cuff placement. A recent case study by Yow et al (2018) demonstrated the effectiveness of BFR training in two post-Achilles tendon rupture patients in regaining calf strength and endurance capacity. These findings were supported by Centner et al (2019) who was able to show the calf strength training combined with BFR was able to cause structural changes in the Achilles tendon similar to what is typically observed with high intensity exercise. In the upper limb, blood flow restriction training has been shown to be more effective than traditional resistance training methods in developing hand grip strength (Fernandes et al 2020).\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eRemote transfer and Cross-education:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe concept of using BFR training to target remote transfer improvements in strength was first explored by Madarame et al (2008). This study compared two groups, both of whom completed upper and lower limb based resistance exercise. The experimental group applied BFR cuffs to the lower limb. Their findings demonstrated an increase in muscle mass and isometric strength in the muscles of the forearm, only when combined with BFR resistance exercise for the leg muscles. While the underlying mechanisms explaining the remote transfer effect requires further examination, these initial findings have since been supported by May et al (2018). The potential for a cross-education effect of BFR was first explored by Bowman et al (2019). Within this research two groups completed unilaterally loaded resistance exercise in both limbs, with the experimental group having blood flow to one of their limbs occluded with a BFR cuff. These finding demonstrated a superior strength and hypertrophy response in the occluded limb when compared to the exercise-matched control group. However they also found a greater increase in muscle mass and muscle strength in the non-occluded limb within the experimental group, when compared to the control. These findings were since replicated in a comparable study in the upper limb (Bowman et al 2020).\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eFinal word:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe clinical uses for BFR training are continuing to be discovered. BFR training has the capacity to influence muscle strength above and below the cuff, as well the potential to trigger a cross-education and remote transfer effect. Although direct application of blood flow restriction is limited to the extremities, the training benefits are potentially applicable to all areas of the body. These increases in strength are likely driven by changes in circulating systemic hormones and neuromuscular adaptations.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eReferences:\u003c\/h2\u003e\n\u003cul data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003eBowman, E. N., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eProximal, Distal, and Contralateral Effects of Blood Flow Restriction Training on the Lower Extremities: A Randomized Controlled Trial.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eSports Health, 2020.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e11\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e(2): p. 149-156.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30638439\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30638439\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/30638439\/\u003c\/a\u003e.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eBowman, E. N., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eUpper-extremity blood flow restriction: the proximal, distal and contralateral effects - a randomized controlled trial.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eJournal of Shoulder and Elbow Surgery, 2019.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e29\u003c\/strong\u003e: p. 1267-1274.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32423577\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/32423577\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/32423577\/\u003c\/a\u003e.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eYow, B. G., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eBlood Flow Restriction Training After Achilles Tendon Rupture.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eThe Journal of Foot \u0026amp; Ankle Surgery, 2018.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e57\u003c\/strong\u003e: p. 635-638.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29477554\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29477554\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/29477554\/\u003c\/a\u003e.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eCentner, C., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eLow-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eJournal of Applied Physiology, 2019.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e127\u003c\/strong\u003e: p. 1660-1667.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31725362\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/31725362\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/31725362\/\u003c\/a\u003e.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eFernandes, D. Z., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eEffects of blood flow restriction training on handgrip strength and muscular volume of young women.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eInternational Journal of Sports Physical Therapy, 2020.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e15\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e(6): p. 901-909.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eMadarame, H., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eCross-Transfer Effects of Resistance Training with Blood Flow Restriction.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eMedicine and Science in Sport and Exercise, 2008. p. 258-263.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18202577\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/18202577\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/18202577\/\u003c\/a\u003e.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eMay, A. K., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eLower body blood flow restriction training may induce remote muscle strength adaptations in an active unrestricted arm.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eEuropean Journal of Applied Physiology, 2018.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e118\u003c\/strong\u003e: p. 617-627.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29350278\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29350278\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/29350278\/\u003c\/a\u003e.\u003c\/li\u003e\n\u003c\/ul\u003e","blog_id":81818452022,"author":"Ali Cianciulli","user_id":79137341494,"published_at":"2021-01-29T10:00:00-05:00","updated_at":"2024-04-23T02:09:27-04:00","summary_html":"","template_suffix":"","handle":"bfr-training-above-or-below-the-cuff","tags":"","image":{"created_at":"2024-02-22T01:22:29-05:00","alt":"","width":520,"height":293,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Suji-BFR-Blog-Image-5_520x500_1c0bf96e-338d-4b0e-a40d-1b1f53b33836.webp?v=1708582949"}},{"id":565172699190,"title":"How is Suji improving the standard of BFR training?","created_at":"2024-02-22T01:20:05-05:00","body_html":"\u003ch2 data-mce-fragment=\"1\"\u003eIntroduction:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eBlood flow restriction training (BFR) has emerged as a popular training strategy to achieve improvements in muscle mass and strength using low training intensities (\u003c\/span\u003e\u003ca href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\"\u003eWhat is blood flow restriction training?\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e). This type of training has been shown to result in similar muscle adaptation as high load training via a variety of different mechanisms. While BFR has received significant attention within the scientific literature, consensus as to the safety and the optimal use of BFR to improve performance outcomes remains speculative. A variety of different devices have been used to restrict blood flow, including pneumatic and non-pneumatic nylon cuffs, traditional blood pressure cuffs, elastic straps and elastic knee wraps. Likewise, different strategies have been used to determine the restrictive pressure to safely optimize training adaptations. Occlusion pressures have been determined based off ratings of perceived discomfort, relative systolic blood pressure, relative limb circumference and previous research findings. Within the literature a range of restrictive pressures have been used from 60mmHg through to over 250mmHg. It appears as though the occlusion pressure required to restrict blood flow is highly individual and determined by several intrinsic (limb circumference, limb composition and haemodynamic variable) and extrinsic factors (cuff width and cuff material). The restrictive pressure required to restrict an individuals arterial blood flow is referred to as their limb occlusion pressure (LOP) or arterial occlusion pressure (AOP) and prescribing BFR training based off personalized LOP is fast evolving as the gold standard. Innovative performance company \u003c\/span\u003e\u003ca href=\"https:\/\/sujibfr.com\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/sujibfr.com\/\"\u003eSujiBFR\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e has developed a BFR cuff system that can automatically calculate users LOP and provide bespoke exercise programming solutions that ensure the safe and effective implementation of BFR training.\u003c\/span\u003e\n\u003cdiv class=\"image_break_sec\" data-mce-fragment=\"1\"\u003e\n\u003cimg height=\"157\" width=\"300\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/landing-page-feature-image-layers-600x314.jpg\" class=\"size-medium wp-image-799\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/landing-page-feature-image-layers-600x314.jpg\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eSujiBFR has developed a BFR training cuff that can automatically detect LOP and optimise the safety and effectiveness of BFR training.\u003c\/div\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eLimb occlusion pressure:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe purpose of BFR is to occlude venous outflow and restrict arterial blood flow to the muscle. Because of the way blood is transported through arteries and veins differently, a higher restrictive pressure is required to occlude arterial blood flow (venous occlusion ~60mmHg, arterial occlusion ~150mmHg) (Kacin et al 2015). LOP is typically determined via Doppler ultrasonography. This technology bounces high frequency sound waves off circulating blood cells to determine to estimate blood flow and is often used to diagnose vascular health disorders. Several factors can influence LOP. The dynamics of the cuff used to restrict blood flow appears to have a significant impact on the pressure exerted on the vasculature. Wider cuffs occlude arterial blood flow at a much lower overall intensity than narrow cuffs, which may have implications for training adaptations and user safety. Likewise the material of the cuff (elastic vs. nylon) may also have implications for how force is transmitted across the limb. It is therefore considered that identifying each individuals LOP relative to the restrictive device they are using, is currently best practice in safely and effectively administering a BFR training protocol.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eSafety:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThere is strong evidence that BFR training is a safe and effective method of training (\u003c\/span\u003e\u003ca href=\"https:\/\/sujibfr.com\/blog\/is-blood-flow-restriction-training-safe\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/is-blood-flow-restriction-training-safe\"\u003eIs Blood Flow Restriction Training Safe?\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e). However, there remains some concerns over its use should BFR be used inappropriately. The primary safety concerns surrounding BFR are: mechanical injury to the skin, muscle or peripheral nerves, venous thrombosis due to vascular damage and disturbed haemodynamics, and augmented arterial blood pressure responses due to high level of exertion couple with increased vascular resistance (Kacin et al, 2015). Each of these risk factors can be associated with high restrictive pressures. Excessively high cuff pressures result in high levels of compression and shear stress to the structures beneath the cuff and increase the risk of soft-tissue damage, compression of the peripheral nerve and vasculature disruption. Personalized occlusion pressure ensures users avoid pressures that are too high relative to cuff dynamics, limb circumference or blood pressure, and minimize risk of complication.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003ePerformance:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eBFR training is typically used to trigger increases in muscle mass and strength. There are been considerable research exploring the optimal restrictive pressure to optimize changes in muscle adaptation using BFR training. Kacin and Stazar (2011) found that using a wider cuff during knee extension exercise reduced muscle hypertrophy at the site of the cuff. As discussed above, the use of a wider cuff transmits pressure through soft-tissue more effectively than a narrow cuff, thus requiring a lower pressure to occlude blood flow. The author hypothesized that the wide cuff, coupe with high occlusion pressures, may have caused excessive compressive forces to the soft-tissues beneath the cuff and impaired muscle growth. More recently, Counts et al (2016) demonstrated that relative pressures as low as 40% LOP may be all that is required to optimize skeletal muscle adaptation. Further research is required to better understand how different relative pressures are implicated in other beneficial responses of BFR training such bone mineral density, vascular adaptations and tendon remodelling. Using relative LOP to prescribe restriction pressure allows users to adopt a system of progressive overload when prescribing restriction pressures alongside exercise intensity, permitting users to continually evolve their BFR training to target continued improvements in performance.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eAdherence:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe occlusion pressure used during BFR training can have implications for the perceptual responses to exercise. Hollander et al (2003) suggested that ischaemic pain, metabolite accumulation and artery deformation could create enhanced perceptions of pain associated with high occlusion pressures. While the research surrounding BFR and pain remains inconclusive, several papers have since supported to concept that high occlusive pressures can increase user discomfort. Changes in perceptual responses are important as they may ultimately dictate whether a user adheres to the chosen form of exercise. Prescribing exercise sessions based of individual LOP enables users to progressively increase the stimulus of BFR within safe ranges in a way that is safe, effective and limits pain.\u003c\/span\u003e\n\u003cdiv class=\"image_break_sec\" data-mce-fragment=\"1\"\u003e\n\u003cimg height=\"300\" width=\"240\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/WhatsApp-Image-2020-10-30-at-11_05_19-600x751.jpeg\" class=\"wp-image-809 size-medium\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/WhatsApp-Image-2020-10-30-at-11_05_19-600x751.jpeg\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eUsing the SujiBFR system, users can safely and effectively prescribe BFR training session based of relative LOP and research backed training programmes.\u003c\/div\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003e\u003c\/h2\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eSujiBFR device:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe SujiBFR device is in the industries first artificial intelligence powered BFR training system. Prior to training with the system, users must complete a calibration process that will determine resting LOP in both the upper and lower limb. Internal testing has shown the Suji device to be accurate within 12mmHg, which compares to an automated surgical tourniquet which demonstrates accuracy within 15mmHg. The calibration process takes no longer than 3-5 minutes per limb and is a simple on-screen and step-by-step process via the mobile application controlling the Suji device. Once the calibration is completed users have the option of selecting from a wide variety of pre-programmed training sessions specifically targeted at muscle hypertrophy, cardiovascular fitness and pain mitigation. The programmes have been developed by industry leading strength and conditioning professionals and guide users through a safe and progressive training regime. Unlike other BFR equipment, the Suji device automatically stores the users safe working pressure zones and exercise programmes to allow users track their progress and achieve continued and sustained success in their BFR training journey.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eReferences:\u003c\/h2\u003e\n\u003col data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003eKacin, A., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eSafety considerations with blood flow restricted exercise.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eAnnales Kinesiologiae, 2015.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e6\u003c\/strong\u003e(1): 3-26.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca href=\"https:\/\/www.researchgate.net\/publication\/293767736\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.researchgate.net\/publication\/293767736\"\u003ehttps:\/\/www.researchgate.net\/publication\/293767736\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eKacin, A. \u0026amp; Strazar, K.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eFrequent low-load ischemic resistance exercise to failure enhances muscle oxygen delivery and endurance capacity.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eScandinavian Journal of Medicine and Science, 2011.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e21\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e(6): 231-241.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/j.1600-0838.2010.01260.x\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/j.1600-0838.2010.01260.x\"\u003ehttps:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1111\/j.1600-0838.2010.01260.x\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eCounts, B. R., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eInfluence of relative blood flow restriction pressure on muscle activation and muscle adaptation.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eMuscle and Nerve, 2016.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e53\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e(3): 438-445.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1002\/mus.24756\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1002\/mus.24756\"\u003ehttps:\/\/onlinelibrary.wiley.com\/doi\/abs\/10.1002\/mus.24756\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eHollander, D. B., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eRPE, pain, and physiological adjustment to concentric and eccentric contractions.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eMedicine \u0026amp; Science in Sport \u0026amp; Exercise, 2003.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e35\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e(6): 1017-1025.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/12783051\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/12783051\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/12783051\/\u003c\/a\u003e\n\u003c\/li\u003e\n\u003c\/ol\u003e","blog_id":81818452022,"author":"Ali Cianciulli","user_id":79137341494,"published_at":"2021-01-10T10:00:00-05:00","updated_at":"2024-04-23T01:40:42-04:00","summary_html":"","template_suffix":"","handle":"how-is-suji-improving-the-standard-of-bfr-training","tags":"","image":{"created_at":"2024-02-22T01:20:05-05:00","alt":"","width":520,"height":293,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Suji-BFR-Blog-Image-3_520x500_3ee82d85-8fd3-4e90-9fa8-48120507f780.webp?v=1708582806"}},{"id":565172666422,"title":"Case Study - BFR Training and Eccentric Hamstring Strength","created_at":"2024-02-22T01:16:28-05:00","body_html":"\u003ch2 data-mce-fragment=\"1\"\u003eIntroduction:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eEccentric (ECC) hamstring strength is a key physical quality in mitigating soft tissue injury risk and improving physical performance. The most effective way to develop ECC hamstring strength is via supramaximal ECC strength training. This form of training leads to very specific neuromuscular adaptations that collectively increase the strength of the muscle during the eccentric phase of movement (for a comprehensive review see \u003c\/span\u003e\u003ca href=\"https:\/\/www.researchgate.net\/publication\/308338367_Chronic_Adaptations_to_Eccentric_Training_A_Systematic_Review\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.researchgate.net\/publication\/308338367_Chronic_Adaptations_to_Eccentric_Training_A_Systematic_Review\"\u003eDouglas et al., 2017\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e). However, ECC training often requires high mechanical loads and certain individuals will be contraindicated to this form of high-intensity exercise. Blood flow restriction (BFR) training has evolved as a useful training method to achieve increases in muscle mass and muscle strength using low intensity training alternatives (\u003c\/span\u003e\u003ca href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\"\u003eWhat is blood flow restriction training?\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e). To the authors knowledge, there is currently no research exploring the potential of BFR training to increase ECC muscle strength. The purpose of this case study was to explore whether 6-weeks of submaximal ECC strength training could improve maximal ECC strength of the hamstring muscles in a highly trained professional athlete.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eMethods:\u003c\/h2\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eSubject characteristics:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe subject was a 23-year old professional rugby union athlete. He has a history of high grade strain injuries to his posterior cruciate (PCL), and medial collateral ligaments (MCL) in both of his knees. The PCL functions primarily to prevent posterior translation of the tibia relative to the femur, and as such, is often put under strain during many common hamstring strength exercises. These injuries have caused the subject persistent discomfort during heavily loaded open-kinetic chain (OKC) hamstring strength exercises, such as a Nordic hamstring curl, and compromised his ability to complete supramaximal eccentric hamstring loading.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eIntervention:\u003c\/h3\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eWeeks 1-3: Concentric\/Eccentric loading\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eOcclusion pressure:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e70% limb occlusion pressure (LOP)\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eExercises:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003eSeated banded hamstring curls\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eSets x Reps:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e30, 15, 15, AMAP (Target 15-25 reps)\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eTempo:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e1-0-1-0\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e(Eccentric phase - Transition - Concentric phase - Transition)\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eRest:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e60 sec\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eWeeks 4-6: Eccentric loading\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eOcclusion pressure:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e70% limb occlusion pressure (LOP)\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eExercises:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003eDouble leg eccentric hamstring slides\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eSets x Reps:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e4x20\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eTempo:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e3-0-0-0\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e(Eccentric phase - Transition - Concentric phase - Transition)\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eRest:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e60 sec\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e*Eccentric hamstring slides were completed in addition to seated banded hamstring curls during week 4-6.\u003c\/p\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe athlete has previous experience using BFR training as this was one of the training strategies implemented throughout his rehabilitation from the original injury. As such, no acclimatization period was required for this case study. BFR training was completed alongside a full pre-season training load and in conjunction with a structured strength and conditioning programme. These exercises were used as a substitute for any heavily loaded OKC hamstring exercises and were completed in the evening once all squad sessions were completed.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eEccentric strength testing:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe subject completed a Nordic hamstring strength assessment as part of a routine monitoring process with the main training squad. This test was completed at the beginning of pre-season, and at the end of week 3 and 6 of the training block. Testing was completed on the Hamstring Solo - ELITE. The subject completed 3x repetitions and the maximum score was taken from each trial. The Hamstring Solo - ELITE provides unilateral force data and the maximum score was taken as the highest combined force output from both left and right legs.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003e\u003c\/h2\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eResults:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eOver the course of the 6-week training intervention the subject achieved a 31% increase in ECC hamstring strength (Figure 1). The results observed in the present case study are similar in magnitude to those observed after 10-weeks of ECC strength training using a Nordic hamstring exercise (Bourne et al., 2017). While this case study research provides preliminary support for the use of BFR training to develop ECC hamstring strength, future research should consider the mechanisms through which we observe these changes. For example, many of the benefits of ECC training are brought about by favourable changes in muscle architecture such as an increase in muscle fascicle length. Understanding, how and why BFR training may be effective at improving performance in this particular test of ECC hamstring strength would provide useful information in dictating its application in athletic populations.\u003c\/span\u003e\n\u003cdiv class=\"image_break_sec\" data-mce-fragment=\"1\"\u003e\n\u003cimg class=\"wp-image-888\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Presentation2-1-e1608238800729-600x407.jpg\" alt=\"\" width=\"488\" height=\"331\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Presentation2-1-e1608238800729-600x407.jpg\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eFigure 1: Eccentric hamstring strength following 6 weeks of BFR training.\u003c\/div\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003e\u003c\/h2\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eDisclaimer:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe SujiBFR training system was provided to the subject for use throughout the duration of the intervention. The subject has given verbal permission for his training programme and results to be published within this forum.\u003c\/span\u003e","blog_id":81818452022,"author":"Ali Cianciulli","user_id":79137341494,"published_at":"2020-12-20T10:00:00-05:00","updated_at":"2024-04-23T01:40:49-04:00","summary_html":"","template_suffix":"","handle":"case-study-bfr-training-and-eccentric-hamstring-strength","tags":"","image":{"created_at":"2024-02-22T01:16:28-05:00","alt":"","width":520,"height":293,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Suji-BFR-Blog-Image-1_520x500_ecf14b72-a44d-4a5c-a231-b09be7fde6e7.webp?v=1708582588"}},{"id":565172633654,"title":"BFR Training and Muscle Growth","created_at":"2024-02-22T01:01:12-05:00","body_html":"\u003cspan data-mce-fragment=\"1\"\u003eBFR training has evolved as an effective training tool to increase muscle mass and muscle strength (\u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\"\u003eWhat is BFR\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e). To enhance muscle mass high-intensity resistance training (HI-RT) with loads between 70-85% 1RM are typically recommended. However recent evidence has shown that low-intensity exercise, when combined with BFR, can be effective in promoting increases in muscle mass. In a recent interview with FC Barcelona, Professor Jeremy Loenekke, renowned BFR researcher, identified 3 key phases of BFR (\u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/barcainnovationhub.com\/blood-flow-restriction-training-from-science-to-practice\/\" data-mce-href=\"https:\/\/barcainnovationhub.com\/blood-flow-restriction-training-from-science-to-practice\/\"\u003eLoenekke, 2019\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e).\u003c\/span\u003e\n\u003col data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003ePassive BFR:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eThis involves BFR applied in the absence of an exercise stimulus. Passive BFR has been shown to be effective at attenuating muscle loss associated with disuse atrophy commonly seen in people who are immobilized such as post-surgical patients.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eBFR aerobic exercise:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eAerobic exercise is not typically associated with improvements in muscle mass. In-fact aerobic exercise is known to inhibit increases in muscle mass when combined with a resistance training programme. However, when combined with BFR, aerobic training interventions such as cycling, walking and running have been shown to be effective at increasing muscle mass by up to 5-7% over 3 weeks (Abe et al. 2006).\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eBFR resistance exercise:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eThe largest increase in muscle mass is observed when BFR is combined with low-intensity resistance exercise. Improvements in muscle mass have been observed with training intensities as low as 15%. Increases in muscle mass are often compared to more traditional resistance exercise, with much of the research producing encouraging findings.\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cdiv data-mce-fragment=\"1\" class=\"image_break_sec\"\u003e\u003cimg data-mce-fragment=\"1\" class=\"size-medium wp-image-789\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/suji-landing-page-600x750.jpg\" alt=\"\" width=\"340\" height=\"300\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/suji-landing-page-600x750.jpg\"\u003e\u003c\/div\u003e\n\u003cdiv data-mce-fragment=\"1\" class=\"image_break_sec\"\u003eFigure 1: BFR training is an effective stimulus for muscle growth.\u003c\/div\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eBFR training vs. traditional exercise:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eWhen compared to traditional training methods, most research will use one of two potential comparisons; an exercise-matched control where subjects complete the same low-intensity exercise without BFR, or a high-intensity resistance training method typically used to increase muscle mass (~70-80% 1RM). When compared to an exercise-matched control BFR training produces a superior hypertrophy effect when using both aerobic and resistance training methods (Slysz et al. 2015). However, when compared to HI-RT, BFR training produced comparable results (Lixandrao et al 2016). These are important findings because the potential to achieve similar training results using a much lower training intensity has considerable implications for certain populations (\u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/sujibfr.com\/blog\/who-should-use-bfr-training\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/who-should-use-bfr-training\"\u003eWho should use BFR training?\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e).\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003e\u003c\/h2\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eMechanisms of action:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThere are several physiological mechanisms that appear to facilitate adaptations to BFR training.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eCell swelling:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe application of a BFR training cuff will partially restrict arterial blood flow while fully restricting venous return, promoting blood to pool in the capillary bed of the target musculature. Often referred to as \"the muscle pump\" this process of cellular swelling has been shown to increase muscle protein synthesis and decrease protein degradation. These responses are essential components in triggering muscle hypertrophy and is often presented as a key mechanism through which BFR may contribute to enhanced muscle growth.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003ePreferential recruitment of fast-twitch muscle fibres:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eBFR training will create an artificial state of hypoxia within the working muscle, similar to that experienced during high-intensity exercise. Fast-twitch muscle fibres are anatomically designed to function in low-oxygen conditions and are hence typically only recruited during high-intensity exercise. These fibres posses the most potential to grow and produce force when stimulated, partially explaining why HI-RT is typically required to trigger hypertrophy. BFR training has been shown to preferentially recruit fast-twitch muscle fibres during low-intensity resistance exercise (Yasuda et al. 2009).\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eAnabolic hormone production:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eIt has been suggested that acute increases in anabolic hormones such as testosterone and growth hormone (GH) play a key role in regulating the muscle growth response to HI-RT. BFR combined with low-intensity resistance exercise has been shown to increase GH, testosterone, insulin-like growth factor-1 and cortisol in response to a range of different protocols. This increase is superior to that achieved with an exercise-matched control and appears comparable to that achieved with HI-RT.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eHypertrophy signalling pathways:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThere are many gene signalling pathways that control the process of hypertrophy. These pathways are typically activated by multiple variables common to high intensity exercise such as mechanical stress, hypoxia and metabolic waste among others. Perhaps the most well researched pathway is the mTOR pathway. BFR restriction training when combined with resistance exercise has been shown to upregulate various components of the mTOR pathway to stimulate muscle hypertrophy (Fujita et al. 2007). Further, myostatin is a gene responsible for inhibiting muscle growth, and is essential to maintain the balance of muscle turnover within the body. BFR training has been shown to diminish myostatin gene expression providing another potential pathway through which BFR may increase hypertrophy (Laurentino et al. 2012).\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eAccumulation of metabolites:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eBFR training causes the accumulation of metabolites such as lactate, inorganic phosphate and hydrogen ions, common to anaerobic metabolism. This metabolic stress has an important impact on cellular swelling, hormonal release and the formation of reactive oxygen species. All of these responses can initiate anabolic signalling pathways responsible for muscle growth.\u003c\/span\u003e\n\u003cdiv data-mce-fragment=\"1\" class=\"image_break_sec\"\u003e\u003cimg data-mce-fragment=\"1\" class=\"size-medium wp-image-795\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/suji-600x750.jpg\" alt=\"\" width=\"240\" height=\"300\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/suji-600x750.jpg\"\u003e\u003c\/div\u003e\n\u003cdiv data-mce-fragment=\"1\" class=\"image_break_sec\"\u003eFigure 2: Training with BFR can increase the biochemical response to resistance training.\u003c\/div\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eTraining considerations:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eTo effectively optimize muscle hypertrophy using BFR training techniques there are several potential moderators that need to be considered. While the research surrounding the optimal BFR training regiment remains a topic for debate, adaptations to BFR appear to adhere to basic training principles of progressive overload. Four key variables appear to be \u003c\/span\u003e\u003cspan data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003epotentially\u003c\/strong\u003e\u003c\/span\u003e\u003cspan data-mce-fragment=\"1\"\u003e important when considering a BFR training programme:\u003c\/span\u003e\n\u003col data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eTraining duration:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eBFR training programmes of \u0026gt;6-8 weeks appear to be the most effective at achieving a muscle hypertrophy response. However, significant increases in muscle size have been achieved in as little as 8 days during an intensive resistance training protocol consisting of 2x BFR training sessions per day (Abe et al. 2005).\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eTraining intensity:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003ePerhaps the most appealing part of BFR training is the capacity to achieve training results with a low-intensity training stimulus. While increases in muscle mass have been achieved with as little as 5x2min bouts of walking completed 6x per week for 3 weeks, it appears that training intensity \u0026gt;20% 1RM when resistance training and \u0026gt;70m.min when walking achieved greater hypertrophy responses (Slysz et al. 2015). Training intensity should be progressed gradually alongside improvements in strength during BFR training, similar to more traditional training methods.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eTraining frequency:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eThere is a range of training protocols implemented within the research using a training frequency from 2x per week through to 14x per week. There appears to be no adverse reactions to high frequency BFR training, however there is no research to suggest a superior training response. Meta-analytic evidence shows us that training with BFR 3x per week yielded a greater training response than training 2x per week (Slysz et al. 2015).\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eCuff pressure:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eOptimizing cuff pressure is a topic of much contention. Some research tells us that pressures as low as 40% limb occlusion pressure may be all that is necessary to improve muscle hypertrophy (Lixandro et al. 2015). Likewise, there is meta-analytic evidence to suggest that cuff pressure has no impact on muscle hypertrophy (Lixandro et al. 2016). Alternatively, a separate meta-analysis suggests greater adaptations are achieved with an absolute cuff pressure \u0026gt;150mmHg. As with other modifiable variables, cuff pressure can be progressively overloaded as you continue to advance in your training. With advances in technology, cuff pressure can, and should be personalized to ensure a safe and appropriate training stimulus can be delivered.\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eFinal word:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eBFR training is an effective strategy to improve muscle mass. Training with BFR, you can achieve comparable training results using 20% of your 1RM as you otherwise could using more traditional training methods at 70-80% 1RM. Effective BFR training prescription should adhere to general concepts of progressive overload with several different training variable progressed concomitantly.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eReferences:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eAbe, T., et al. \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eMuscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Applied Physiology, 2006. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e100:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003ep 1406-1466. \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16339340\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16339340\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/16339340\/\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e Slysz, J., et al. \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eThe efficacy of blood flow restricted exercise: A systematic review and meta-analysis.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Science and Medicine in Sport, 2015. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e19\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e: p 669-675. \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26463594\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26463594\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/26463594\/\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e Lixandrao, M. E., et al. \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eMagnitude of Muscle Strength and Mass Adaptations Between High-Load Resistance Training Versus Low-Load Resistance Training Associated with Blood Flow Restriction: A Systematic Review and Meta-Analysis.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003eSports Medicine, 2016. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e48\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e: p 361-378. \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29043659\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29043659\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/29043659\/\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e Yasuda, T., et al. \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eMuscle activation during low-intensity muscle contractions with restricted blood flow.\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003e Journal of Sports Science, 2009. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e27\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e: p 479-489. \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19253083\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/19253083\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/19253083\/\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e Fujita, S., et al. \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eBlood flow restriction during low-intensity resistance exercise increases S6k1 phosphorylation and muscle protein synthesis.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Applied Physiology, 2007. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e103\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e(3): p 903-910. \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17569770\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/17569770\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/17569770\/\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e Laurentino, G. C., et al. \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eStrength Training with Blood Flow Restriction Diminishes Myostatin Gene Expression.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003eMedicine \u0026amp; Science in Sport \u0026amp; Exercise, 2011. p 406-412. \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/21900845\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/21900845\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/21900845\/\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e Abe, T., et al., \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eEight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003eInternational Journal of Kaatsu Training Research. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e1\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e(1): p 19-23. \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/www.jstage.jst.go.jp\/article\/ijktr\/1\/1\/1_1_19\/_article\" data-mce-href=\"https:\/\/www.jstage.jst.go.jp\/article\/ijktr\/1\/1\/1_1_19\/_article\"\u003ehttps:\/\/www.jstage.jst.go.jp\/article\/ijktr\/1\/1\/1_1_19\/_article\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e Lixandrao, M. E., et al. \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eEffect of exercise intensity and occlusion pressure after 12 weeks of resistance training with blood-flow restriction.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003eEuropean Journal of Applied Physiology, 2015. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e115\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e(12): p 2471-2480. \u003c\/span\u003e\u003ca data-mce-fragment=\"1\" href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26323350\/\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26323350\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/26323350\/\u003c\/a\u003e","blog_id":81818452022,"author":"Ali Cianciulli","user_id":79137341494,"published_at":"2020-11-29T10:00:00-05:00","updated_at":"2024-04-23T02:11:24-04:00","summary_html":"","template_suffix":"","handle":"bfr-training-and-muscle-growth","tags":"","image":{"created_at":"2024-02-22T01:01:12-05:00","alt":"","width":1600,"height":900,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Suji-BFR-Blog-Image-4_1600x_02d1ebde-1dc6-4d2c-b583-e85b2bdfad84.webp?v=1708581673"}},{"id":565172600886,"title":"Blood Flow Restriction Exercise and Pain.","created_at":"2024-02-22T00:57:40-05:00","body_html":"\u003cspan data-mce-fragment=\"1\"\u003eExercise has the capacity to relieve, and decrease sensitivity to muscle and joint pain. This is called exercise-induced hypoalgesia (EIH) and is common in many clinical conditions. Experimental pain studies have demonstrated that localized joint pain leads to a decrease in muscle function, impaired motor control and fear avoidance behavioural patterns (avoiding painful activities). Collectively, this can trigger a vicious cycle of spiralling physical function that can increase the risk of developing chronic and degenerative conditions such as osteoarthritis (Figure 1). Exercise interventions that can appropriately load the injured area, relieve pain and increase muscle strength, presents as an effective management system to target the multiple factors of these complex conditions.\u003c\/span\u003e\n\u003cdiv class=\"image_break_sec\" data-mce-fragment=\"1\"\u003e\n\u003cimg class=\"size-medium wp-image-849\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Presentation1-e1605907029579-600x597.jpg\" alt=\"\" width=\"300\" height=\"300\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Presentation1-e1605907029579-600x597.jpg\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eFigure 1: Pain can trigger a cycle of fear avoidance behaviours and impaired physical function.\u003c\/div\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eBFR exercise and hypoalgesia:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eWhile traditional resistance exercise has the capacity to relieve pain and increase muscle strength, this form of training may also increase load through the injured area and potentially aggravate symptoms. The American College of Sports Medicine \u003c\/span\u003e\u003ca href=\"https:\/\/www.acsm.org\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.acsm.org\/\"\u003e(ACSM)\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e recommends training loads of 60-70% of a 1-repetition maximum (1RM) to increase muscle strength. Blood flow restriction training has the capacity to increase muscle strength and hypertrophy using much lower training loads, as little as 20% 1RM (\u003c\/span\u003e\u003ca href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/sujibfr.com\/blog\/what-is-blood-flow-restriction-training-2\"\u003eWhat is blood flow restriction training?\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e). For this reason, BFR has been utilised as an exercise strategy in several clinical musculoskeletal conditions including; patellofemoral pain, Achilles tendinopathy, ACL reconstruction, polymyositis and osteoporosis.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eDoes it work?\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe majority of research exploring the BFR and hypoalgesia has been conducted in knee pain. A land mark study by Korakakis et al. (2018) explored the use of BFR in 30 male patients suffering from anterior knee pain. In response to BFR, pain scores were significantly reduced while performing 3 common functional tasks; a shallow single leg squat, a deep single let squat and a step down task. These findings suggest BFR may have 2 key benefits for this population:\u003c\/span\u003e\n\u003col data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003eThe BFR intervention caused a reduction in pain symptoms for 45 minutes. Used as a pre-exercise strategy this may permit the completion of a traditional resistance exercise training program to increase muscle mass and strength.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eBFR is a potent stimulus for muscle hypertrophy and muscle strength, and has the potential to break the cycle of pain, fear avoidance and decreased function.\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eWhile the research exploring BFR and hypoalgesia is in its infancy, these results have been replicated in various studies and within multiple pain states.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eMechanisms of action:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eWhile there is growing evidence supporting the use of BFR in pain management, how and why it is effective remains speculative. A recent review by Hughes and Patterson (2019) explored some of the potential mechanisms by which BFR may influence pain, which are described below.\u003c\/span\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003eConditioned pain modulation:\u003c\/h4\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe simplest way to describe conditioned pain modulation is with the expression 'pain cures pain'. The old wives tale suggesting to pinch your ear before receiving an injection to distract yourself likely rings true. Within the conditioned pain modulation paradigm, a painful conditioning stimulus, may inhibit the perceived pain of a secondary stimulus. Conditioned pain modulation has been shown to be a key component of EIH, with the concept of a painful exercise intervention being a vital component dictating its effectiveness. While BFR is characterised by low-intensity training, perceptions of pain and discomfort comparable to high intensity exercise are consistently reported in the literature.\u003c\/span\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003eRecruitment of fast twitch muscle fibres:\u003c\/h4\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe recruitment of fast twitch muscle fibres is a key characteristic of high intensity exercise. It also appears to be an essential component of EIH. This may provide a rational as to why high intensity exercise is more effective at triggering a hypoalgesia response than low intensity exercise. BFR creates a hypoxic environment within the muscle, simulating the conditions of high intensity exercise at lower working thresholds. This causes the preferential recruitment of fast twitch muscle fibres during low intensity exercise, which may be both an important mechanism behind BFR and hypoalgesia, and an important component of BFR and hypertrophy.\u003c\/span\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003eOpioid and endocannabinoid systems:\u003c\/h4\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eBFR exercise causes an increase in metabolites such as lactate within the muscle. These metabolites stimulate the production of opioids and endocannabinoids. Opioids are a family neuropeptides produced within the nervous system. Specifically beta-endorphine is thought to play a key role in EIH. Endocannabinoids are derived from lipids, specifically arachidonic acid, a polyunsaturated omega-6 fatty acid. Several endocannabinoids increase in response to high intensity exercise and likely have an important analgesic effect.\u003c\/span\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003eIncreased heart rate and blood pressure:\u003c\/h4\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eRegions of the brain controlling the cardiovascular system (heart rate and blood pressure) overlap with regions contributing to pain sensitivity. Interestingly, elevated blood pressure and heart rate is often associated with a reduction in pain sensitivity. BFR increases the stress on the cardiovascular system compared to exercise-matched controls, and is comparable to high intensity exercise.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eBFR exercise protocols:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eTo the authors knowledge, there is currently no literature exploring the effectiveness of different BFR protocols on pain perception. Anecdotally there are several things to consider when deciding upon a protocol:\u003c\/span\u003e\n\u003col data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003ePurpose of the session:\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eBFR is currently being used in a wide range of settings. It is currently being used in clinical populations to alleviate pain to allow for optimal rehabilitation, equally, it is being used in elite level sport as a warm up strategy for training and competition for athletes managing pain. While pain and exercise intensity appear to be key components of BFR and hypoalgesia, if preparing for competition, the implications of fatigue post-BFR training need to be considered. Warm up protocols should be performed with longer and more frequent reperfusions (deflate the cuff) to permit adequate recovery.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eGood pain vs. bad pain:\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003eManaging pain, particularly chronic pain, is incredibly complex and often requires a highly refined exercise regiment. As mentioned above, pain appears to be a key component of many of the mechanisms that lead to EIH. However, inappropriate loading of muscle and joint injuries is also likely to exacerbate pain. If the discomfort that you experience during the exercise does not immediately subside post the session, you may need to consider reducing the intensity of your session to a more tolerable level.\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eThe final word:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eBFR exercise presents a promising training strategy to manage both acute and chronic pain states. It is widely viewed as an effective strategy in musculoskeletal rehabilitation and there is growing evidence for its value in reducing pain. While there remains much to learn around how and why it may be effective, there is sufficient evidence to get your cuffs on and see if it can be a valuable addition to your training or rehabilitation.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eReferences:\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eKorakakis, V., et al., \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eBlood Flow Restriction induces hypoalgesia in recreationally active adult male anterior knee pain patients allowing therapeutic exercise loading.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003ePhysical Therapy in Sport, 2018. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e32\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e: 235-243. \u003c\/span\u003e\u003ca href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29879638\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/29879638\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/29879638\/\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e Hughes, L., and Patterson, S. D., \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eLow intensity blood flow restriction exercise: Rationale for a hypoalgesia effect.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003eMedical Hypotheses, 2019. \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e132\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e: 1-7. \u003c\/span\u003e\u003ca href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0306987719307364\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0306987719307364\"\u003ehttps:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0306987719307364\u003c\/a\u003e","blog_id":81818452022,"author":"Ali Cianciulli","user_id":79137341494,"published_at":"2020-11-23T10:00:00-05:00","updated_at":"2024-04-23T02:03:09-04:00","summary_html":"","template_suffix":"","handle":"blood-flow-restriction-exercise-and-pain","tags":"","image":{"created_at":"2024-04-23T02:03:09-04:00","alt":"","width":2000,"height":1125,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Blood_Flow_Restriction_Exercise_and_Pain.jpg?v=1713852189"}}]