As we previously covered in Parts I and II, blood flow restriction training has emerged as a game-changing rehab and performance tools. While traditional resistance exercise strength & hypertrophy must be done with heavy loads, blood flow restriction is the opposite. With blood flow restriction strength and hypertrophy gains have been shown in research at loads as low as 20% of an individual’s one rep maximum.

For a quick recap of the research, blood flow restriction training doesn’t break down the muscle like traditional resistance exercise because the loads are so light. Instead, BFR creates huge amounts of protein synthesis due to the hormonal responses the body has to BFR training.

While the majority of research has focused on rehab implications of blood flow restriction training, there are also lots of potential performance enhancement results for athletes wanting to perform at their best. blood flow restriction strength

Blood Flow Restriction for Strength & Performance Protocols

Cuff Placement

There are only two places that a blood flow restriction device should be placed: the upper arm and at the upper thigh. Frequently, recommendations of cuff placement at the upper calf or forearms are made. There are very superficial nerves in these areas. The amount of compression from a blood flow restriction cuff can cause serious damage resulting in medical conditions such as foot drop.

So I’ll say it again, there are only two places that a blood flow restriction device should be placed: the upper arm and at the upper thigh.

Cuff Pressure

If using a blood flow restriction training device that allows you to precisely measure the amount of blood flow occlusion, we suggest using 50% occlusion for the upper body and 80% for the lower body. This means that all venous blood flow is restricted, and only a portion of arterial blood flow comes into the leg.

blood flow restriction strength

For those using compression bands, wraps, or other non-objective devices, I suggest using a pressure of 4-5 out of 10 for the upper body and 6-7 / 10 for the lower body.

Exercise Selection

Almost any exercise used to build strength and hypertrophy can be used with blood flow restriction. From bodyweight to weighted, from open kinetic chain to closed. Power, speed, and jumping exercises should not be used.

Amazingly, several studies have looked at the effects of blood flow restriction training while cycling and walking. With both of these, gains in muscle mass, strength, and VO2 max have been seen. These changes have been as crazy a college basketball players. One study found an 11.6% increase in VO2 max after walking twice a day with BFR for two weeks!

Sets and Reps

The 30/15/15/15 protocol is what appears the most in the literature and from a clinical and practical application. Here’s the breakdown:

30 reps with a 2 second concentric and 2-second eccentric contraction
30 seconds rest
15 reps
30 seconds rest
15 reps
30 seconds rest
15 reps
30 seconds rest

If the total of 75 reps cannot be completed, repeat the weight next workout. But, if less than 50 reps were completed, then lower the weight. If completing the 75 reps isn’t SIGNIFICANTLY hard, increase the resistance next time.

Other than that, general rules of weight and exercise progression are in play.

BFR training should be performed after other weight lifting exercises.

Here are some more specific examples of how we could use Blood Flow Restriction training for specific athletes.

CrossFit Athlete

CrossFit requires the practice of a wide variety of exercises and skills. To be competitive at the highest level, most athletes have had to take to performing multiple workouts per day. If an athlete knows that a particular body part is weak, it is very difficult to add more training volume to his or her weekly schedule. blood flow restriction strength

Blood Flow Restriction Strength Athletes

The same applies to Olympic lifters, and I’ve been implementing BFR with my elite lifters for some time now. These elite lifters are already working out 6-10 times per week. Adding heavy resistance training volume isn’t an option. BFR is a great option to improve strength & hypertrophy without interfering with their already high training load.

A great program for adding lower body size can see below in Olympic lifter Lindsey Stroker who is performing BFR split squats to improve lower body strength.

https://www.instagram.com/p/BJN4cRhhPoa/?taken-by=thebarbellphysio

Bodybuilders

Bodybuilders care about muscle hypertrophy above all else, and BFR is an amazing tool for them to add to their arsenal.

BFR can be used as a metabolic finisher after a workout of heavy resistance exercises. They might perform close grip bench press, tricep pushdowns, and finish off with BFR dumbbell tricep extensions.

Secondly, blood flow restriction can be a great way to add a second daily workout into their training schedule without impeding recovery.

Finally, it can also be a great way to still get a significant training effect during a deload week.

The following chart outlines a suggested utilization of BFR for physique athletes from a 2020 research-based guide.

In Season Athlete

For athletes like basketball or baseball players with multiple games per week, BFR can be used as their strength work. Especially when the athlete has a short turnaround between games but needs to continue building strength. Then when they have a gap in their schedule, they can do a traditional high-intensity workout.

NBA Super Star Dwight Howard was recently featured on ESPN for using BFR as part of his training program in season.

Endurance Athlete

Implement twice-weekly blood flow restriction training for maintenance of strength as your endurance training volume increases and reap the potential VO2max benefits. Cycle at 40% of your VO2max for 15 minutes.

https://www.instagram.com/p/BDD64XCBE7S/?taken-by=thebarbellphysio

Deload Weeks

Do you need a break from the heavy lifts? BFR on deload weeks is the perfect way to keep strength and hypertrophy progressing while allowing your body to recover.

Weak Body Parts

While research on traditional resistance exercise suggests 12 weeks of work must be put in before seeing significant improvements, studies on BFR have shown significant hypertrophy gains in 2 weeks!

Thus, it’s a great tool to rapidly bring up weak body parts.

Recovery & Prehab

As we discussed in Part II, blood flow restriction training results in a huge release of growth hormone. GH is a key hormone for protecting tendons and muscle structure. BFR can thus be used as a recovery tool or prehab tool. So, I have some athletes prone to injuries in certain areas regularly perform BFR as a way to augment their body’s regeneration to avoid recurring injuries. blood flow restriction strength

Blood Flow Restriction Strength Training for Rehab

Finally, BFR has huge implications for rehab. Injured individuals often cannot load a muscle, or joint with maximal loads need to build strength and hypertrophy. BFR solves this problem, and because of those great growth hormone responses, we’ve seen rapid changes in many injuries such as tennis elbow, patellar tendonitis, and muscle strains.

During periods of non-weight bearing after surgeries, BFR is highly effective at minimizing the loss of strength and muscle mass. When post-surgical patients can’t perform heavy loaded exercises, BFR solves the strength problem. And does so without using any exercises outside the surgeon’s protocol. Now those low level “strength” moves you are limited to during early rehab can create strength and hypertrophy gains.

NOTE: Tourniquets are FDA regulated medical devices. If using blood flow restriction in the rehab setting, please use an FDA approved device. I suggest looking at those offered at OwensRecoveryScience.com. blood flow restriction strength

A great example can be seen in the following video of Jared Fleming. Jared is an elite Olympic lifters who he the American record in the snatch. So, we used blood flow restriction training as part of his ACL reconstruction rehab. Many studies show quad weakness and atrophy long after ACL reconstructions. But in Jared’s surgical leg was 1 inch larger than his non-surgical only three months out!