354 | What is Blood Flow Restriction Training?

[00:00:05] Welcome to The Optimal Body podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical

[00:00:13] therapy pearls of wisdom to help you begin to understand your body, relieve your pains

[00:00:17] and restrictions, and answer your questions. Along with expert guests, our goal of The

[00:00:21] Optimal Body podcast is really to help you discover what optimal means within

[00:00:26] your own body. Let's dive in.

[00:00:28] Okay. So for our PT Pearl today, we're going to be talking about a topic that

[00:00:32] I feel like it's been gaining a lot more popularity, especially in the rehab space in recent

[00:00:37] years. And that's blood flow restriction training and diving in a little bit more to

[00:00:43] what that is when you should be potentially considering using it, how it was

[00:00:48] discovered. And I know that you got a kick out of the story of how the initial guys

[00:00:53] started looking into this and researching it.

[00:00:55] Yeah, it originated in Japan by Dr. Yoshiaki Satto. And he actually came up with what

[00:01:01] is called katsu training. And so what I thought was really funny is that so his legs

[00:01:06] became numb after he was sitting at a Buddhist memorial in an kneeling position.

[00:01:10] And then he started to massage his calf and he noticed the swelling and discomfort

[00:01:14] was similar to like when he was doing calf exercises.

[00:01:16] So he decided, OK, well, what happens if I then kind of restrict the blood flow

[00:01:22] and do low level exercise? Will I get the same kind of effect?

[00:01:25] And that's how he came up with, you know, low intensity exercise.

[00:01:29] So you're looking at like about 20 to 50 percent of your one rep max and you're

[00:01:36] occluding. He had it occlude up to 200 millimeters mercury of the systolic blood

[00:01:41] pressure. And so it's kind of cool how this really originated and what his

[00:01:46] brain was kind of doing when he thought, oh, my goodness, this feels,

[00:01:50] you know, similar to strength training.

[00:01:52] I know it's interesting just like I feel like many people out there are

[00:01:56] like, oh, I sit in a certain position and then my legs get kind of numb or tingly.

[00:01:59] And then when I walk up, you know, stand up and walk around, it feels a lot

[00:02:03] different. And it's interesting that he noticed this massage.

[00:02:07] His calf is like, huh, that kind of feels like exercise.

[00:02:10] And then basically decided to cut the circulation from his legs and

[00:02:15] experiment with this a bit.

[00:02:16] And it's interesting where he started out occluding 200 millimeters

[00:02:21] mercury. So like the systolic blood pressure is the higher one.

[00:02:24] Yeah. So normal or healthy is 120 over 80 ish.

[00:02:30] So 200 millimeters mercury essentially would for most people be occluding

[00:02:35] all blood flow into the legs.

[00:02:37] And that's different than what, you know, most parameters are that are used

[00:02:42] today, especially in the rehab space.

[00:02:45] But what when he started and when other people started researching it,

[00:02:49] what they found was that essentially the body needs to work harder.

[00:02:54] You're not getting as much blood flow.

[00:02:55] You're not getting as much nutrients, oxygen, all the things that your

[00:02:59] muscles need to do exercise.

[00:03:02] So when you're doing a lot lower intensity exercise, your body's

[00:03:06] recruiting muscle fibers sooner.

[00:03:08] It's recruiting larger motor units, which essentially it's recruiting more

[00:03:12] muscle fibers to do the exercise that normally might be very low

[00:03:16] intensity. And they would also notice the body starts creating a lot

[00:03:21] more of what we would call these metabolites or essentially the products

[00:03:25] that are created when you do exercise.

[00:03:27] It's the waste of the muscle.

[00:03:29] So people start to think and realize, oh, wow, when we slightly

[00:03:35] occlude or occlude the blood flow from muscles, they need to work

[00:03:38] harder to do the same amount of work, which kind of makes sense

[00:03:41] when you think about it intuitively.

[00:03:45] Taking a quick pause from the episode to talk about something we can all

[00:03:47] focus on just a little bit more to optimize our overall health.

[00:03:51] And that is our hydration, not just by drinking water, but by making sure

[00:03:55] we're getting back in the electrolytes that we're naturally

[00:03:58] losing throughout the day.

[00:04:00] That's why Jen and I drink element on a daily basis.

[00:04:03] We love it so much one because it tastes so great and keeps us coming

[00:04:06] back to our water bottle, but two because it gets back in the vital

[00:04:10] sodium, potassium and magnesium that our body requires for so many

[00:04:15] cellular processes.

[00:04:16] Just by optimizing our electrolytes, we can help combat things like brain

[00:04:20] fog, fatigue, we can have better bowel movements and better sleep.

[00:04:25] Making sure we have these electrolytes is absolutely vital.

[00:04:28] So if you go down to the link in the show notes, you will get a free

[00:04:31] sample pack with every single order.

[00:04:33] This will help you so you can try every single flavor and know which

[00:04:37] one you like best when you inevitably come back and get more.

[00:04:40] So go down to the link in the show notes, grab yourself a box,

[00:04:43] get that free sample pack and make sure you're keeping yourself

[00:04:46] hydrated on a daily basis.

[00:04:49] Yeah, and I think that's what's cool.

[00:04:50] So we get to see that this low load, you know, blood flow restriction

[00:04:55] with resistance exercise really allows for the ability to train at a

[00:04:59] greater frequency with less mechanical stress on the joints, which allows

[00:05:03] for a broad application of post-operative injured and cardiac

[00:05:07] rehabilitation in patients, even in season athletes and in the elderly

[00:05:12] individuals.

[00:05:12] And so I think that's what's really cool is that you can get, you know,

[00:05:17] you could still train just at a very low intensity, but still get this

[00:05:21] hypertrophy and strength gains happening within the body.

[00:05:25] And the that's where it's being used.

[00:05:27] I feel like so much more in different rehab scenarios.

[00:05:30] Like you said, anywhere from elite, elite athletes to people in nursing

[00:05:34] homes or people who are in very significant cardiac situations or events

[00:05:41] because we can introduce exercise at such a lower load, do it safely in

[00:05:46] a way that their body responds as if they're doing closer to maximal or

[00:05:51] higher intensity training.

[00:05:53] And that's really cool.

[00:05:54] So I think something that we should do is just point out some of

[00:05:56] the stuff that is seen in studies.

[00:06:00] So there was a blood flow training done and with just even a single

[00:06:04] session of resistance exercise and older men, it led to and here's

[00:06:09] where some sciency words come in.

[00:06:11] But increased phosphorylation of proteins involved in skeletal

[00:06:14] muscle anabolism by 30 to 300%.

[00:06:18] So like anywhere from a, you know, mild to a massive increase in what

[00:06:25] that means, the phosphorylation of these proteins is essentially the

[00:06:28] creation of these proteins that help to build skeletal muscle.

[00:06:32] So what this could help with is people who are seeing a

[00:06:36] significant amount of sarcopenia or atrophy, muscle atrophy,

[00:06:41] and wasting as they get older, it could be a way to like go to your

[00:06:45] local blood flow restriction training center and do a couple of sessions

[00:06:49] a week that will give you the similar results to as if you're heavy

[00:06:54] resistance training or Olympic training when you were younger to

[00:06:58] combat some of that muscle wasting.

[00:07:01] Yeah.

[00:07:01] I think that's what's, you know, one of the coolest parts.

[00:07:04] One, you pointed out something very specific that I think we have to

[00:07:08] include right away is that you're going to professionals who work with this,

[00:07:13] who have their certifications that you can get in this now, you know,

[00:07:17] who understand what you're really measuring.

[00:07:20] Because sometimes you see people just like wrapping resistance bands

[00:07:23] around their arms and legs and doing it themselves.

[00:07:25] Yeah.

[00:07:26] Which I've done before.

[00:07:27] Oh my gosh.

[00:07:29] Not great.

[00:07:30] You know, especially if you're somebody who has other comorbidities,

[00:07:36] like has heart conditions, has, you know, that's why it's so important

[00:07:39] because a lot of the, we talked about Dr.

[00:07:42] Yoshiaki who basically occluded all blood flow into the legs.

[00:07:47] Most protocols these days use a pressure that's above the diastolic

[00:07:52] blood pressure, which is the lower number.

[00:07:54] Like, so if it's 120 over 80, you know, they're using a number

[00:07:57] that's more in like the 90 to a hundred range.

[00:08:00] So it's still allowing some blood to get to the muscles, but not as much

[00:08:05] return or get out of the muscles.

[00:08:06] So it still creates that hypoxic environment, but that's why it's important.

[00:08:10] Because how many people know what their blood pressure is at any given moment

[00:08:15] on any given day, you know, you're going with professionals who will

[00:08:18] measure your blood pressure, actually measuring it out, find the correct

[00:08:21] amount and then monitor to see if you're showing any sort of adverse

[00:08:24] reactions as it's going on and using different cuffs like it, you know,

[00:08:27] for the upper extremity, obviously we're going to use a cuff that's

[00:08:30] different than the lower extremity because you have a much thicker and

[00:08:34] bigger, you know, shape that you need to include.

[00:08:38] Might be different in those areas.

[00:08:40] In the lower body than the upper body.

[00:08:41] So, you know, just working with someone and getting that understood is good.

[00:08:45] And, and what I think is also cool, what they've shown with the

[00:08:48] cardiovascular health in older patients is not only is it going to help with

[00:08:52] skeletal muscle and growth, but it's also going to help to reduce blood

[00:08:55] pressure and that's what they were seeing.

[00:08:58] So, you know, combining resistance training, exercise in general, we

[00:09:03] know is going to help to reduce blood pressure, but now-

[00:09:06] I was going to say that's something you see in like resistance training in

[00:09:08] general, you see a reduction in blood pressure.

[00:09:10] So it makes sense that you might see it here as well.

[00:09:13] Well, and giving them the opportunity to be able to exercise in people

[00:09:16] that may not be doing as much.

[00:09:18] So overall, you know, you're going to see a lot of those benefits.

[00:09:22] So another area, you know, other than people who might be older

[00:09:27] dealing with muscle wasting or, you know, be somebody who's having

[00:09:31] heart issues where this could be a beneficial type of training, we're

[00:09:35] seeing it a lot in the rehab space.

[00:09:37] I had a buddy who played in the NFL for five, six, seven years.

[00:09:41] And he said, blood flow restriction is one of the primary things that

[00:09:45] their training staffs use when they have somebody who's injured.

[00:09:48] Because again, say somebody tears their ACL or, and is in their

[00:09:53] rehab protocol, so they've had surgery, but something that you

[00:09:56] don't want to do is load the knee too significantly too early after

[00:10:02] you have that surgery, because the graft, the new ACL that they put in

[00:10:05] is tender and is in a compromised position.

[00:10:09] So you don't want to start loading it heavily or else that-

[00:10:12] Yeah, you have to give it the time to heal.

[00:10:13] Give it the time to heal.

[00:10:14] But they have found doing some of this blood flow restriction training

[00:10:19] is a great way to start getting that quad muscle on the front of your

[00:10:22] thigh, working and firing well very early after surgery in a way that

[00:10:28] previously we weren't able to do safely or confidently.

[00:10:31] Yeah, there's a lot of studies now coming out on ACL rehabilitation with

[00:10:35] using blood flow restriction, which I think is cool.

[00:10:38] And when we look at, you know, just in general, if we're trying

[00:10:40] to improve our stimulate muscle growth, some of the protocols that

[00:10:46] we look at are pretty, pretty consistent with resistance training

[00:10:51] in general, right?

[00:10:52] You're not going to do it every single day.

[00:10:54] So they looked at a combination of dynamic exercise.

[00:10:57] So they looked at doing it two to three times a week for over three weeks,

[00:11:03] intensity one to two times a day, repetition, 75 reps overall.

[00:11:08] So they're looking at 30 reps, 15 reps, 15 reps, 15 reps.

[00:11:12] So four sets of that, two to four sets.

[00:11:15] Set pressure between 40 to 80% and restriction time, five to 10 minutes

[00:11:21] of exercise with rest between 30 to 60 seconds.

[00:11:25] So pretty similar to what you would see, especially with like

[00:11:29] low load resistance training.

[00:11:30] Now you're just adding that blood flow restriction to it and seeing

[00:11:34] the results that helps to stimulate the muscle growth.

[00:11:37] So it's not something that you need to be doing every single day.

[00:11:40] I mean, this obviously depends too on where you're at.

[00:11:43] So say you are really early in your rehab journey and you're not doing a lot.

[00:11:48] You could afford to do a little bit more, but if you are actually just trying

[00:11:53] to stimulate muscle growth and you're just, you know, working with this,

[00:11:57] you doing it just like you would with regular exercises, I think

[00:12:00] is a good way to look at it.

[00:12:01] Yeah.

[00:12:02] And I think that so again, the breadth and the different types of people

[00:12:07] that this can benefit or be beneficial for is pretty amazing because they've

[00:12:11] actually done studies with people in the intensive care unit or people who are

[00:12:16] even to the level of almost comatose where they are not moving at all.

[00:12:20] Yeah, I think that's cool.

[00:12:21] And one of the biggest risks in those populations is deconditioning

[00:12:25] significantly to the point where if you wake up or if you start trying

[00:12:28] to do exercise again, your body is so deconditioned that you can't

[00:12:31] do much or you're in a, you're in a pretty tough spot.

[00:12:34] And so they've done passive limb movement.

[00:12:37] So literally putting on the blood flow restriction cuffs and doing

[00:12:40] passive limb movement in patients that are in intensive care units.

[00:12:44] And it was shown as an effective way to reduce the muscle wasting.

[00:12:48] They specifically were measuring the thigh muscle because easy muscle

[00:12:51] to kind of monitor and measure the size of in people in the intensive

[00:12:56] care unit, and that's an area in medicine that is hugely important

[00:13:00] because deconditioning during stays in the intensive care unit is a huge problem.

[00:13:06] So we also looked at, you know, there's a study on blood flow

[00:13:08] restriction and pain sensitivity, and I think this is a huge one for a lot of people.

[00:13:13] So when they were kind of looking at a ton of different studies

[00:13:16] and looking at what they were really saying, higher pressure

[00:13:21] blood flow restriction results in greater exercise induced analgesia,

[00:13:26] which is helping to, you know, really relieve your pain

[00:13:31] compared to lower pressure.

[00:13:32] And this is kind of the same of like exercising to failure,

[00:13:35] which produces a reduction in pain sensitivity with or without blood flow restriction.

[00:13:39] So they're saying, you know, essentially kind of what we've been talking about

[00:13:44] blood flow restriction, including low intensity exercise, can be an effective

[00:13:49] treatment to help reduce that pain threshold and really kind of introduce you back into movement.

[00:13:55] And I think that's what's really effective.

[00:13:56] Every podcast that we talk about, there's movement involved.

[00:13:59] There has to be movement in order to move you forward and getting you out of pain.

[00:14:03] So if this is helping you get to that point of being able to exercise and move,

[00:14:08] I think it could be a really cool practice to integrate with people who have really high pain.

[00:14:13] Yeah, it's a great tool, again, in that period where we talk about manual

[00:14:18] therapies and rolling and things that are done to you.

[00:14:22] Like this is more active.

[00:14:23] I feel like it allows people to feel more involved in the therapy itself.

[00:14:27] If you're doing movement, you know, getting that same

[00:14:31] pain analgesia, like the pain reduction, as if you're exercising to failure,

[00:14:36] just by doing blood flow restriction and doing supervised exercise is great.

[00:14:39] And there are studies done on osteoarthritis.

[00:14:42] There are studies done on patellofemoral pain that show this,

[00:14:45] that you can get a significant amount of pain reduction, in some cases even higher than

[00:14:50] the groups that are doing exercise, like the control group that's just doing normal exercise.

[00:14:54] Blood flow restriction groups will often see equal or greater pain relief.

[00:14:59] So again, a massive tool to help people get start getting into movement when they otherwise

[00:15:04] might not be able to or might not be able to safely.

[00:15:07] But there are safety considerations, which we've already been kind of alluding to.

[00:15:11] Like there are definitely a lot of symptoms that you might like adverse reactions or symptoms

[00:15:17] that you might start to experience, which is why the first thing and we've said it already,

[00:15:21] this should be done supervised and in a way that's prescribed, especially since most of

[00:15:26] the studies we've been talking about have to do with people that are either injured

[00:15:29] in their early rehab recovery stages or people in the hospital, like on cardiac floors or people

[00:15:35] in intensive care units. So definitely should be something done that is under supervision.

[00:15:40] Right. Exactly. I mean, even if you're not used to it, like it might not be an adverse

[00:15:46] effect, but even you might experience a lot of delayed onset muscle soreness or some bruising.

[00:15:50] You get the same soreness as if you were exercising very heavily.

[00:15:53] And that could feel very alarming if you're not used to it. So again, working with someone who

[00:15:58] can help educate and talk you through what is happening and make sure you're not going beyond

[00:16:02] your threshold is so important. And anytime we're talking about

[00:16:06] literally occluding blood flow, like if you're somebody who has blood pressure issues,

[00:16:10] if you're somebody who has different cardiac or heart issues, like that can be a big concern.

[00:16:16] And anytime we're occluding blood flow and then taking that pressure off and letting

[00:16:20] the blood flow and return back to the heart, there can be what are called syncope events or

[00:16:25] you feel like you're going to faint. So a lot of things that lead us to say,

[00:16:31] and lead the research to give recommendations that you should be doing this under supervision.

[00:16:37] And again, to reiterate, to be able to see changes in pain populations, I think is a

[00:16:44] really great way to be able to utilize. And so maybe you are asking a physical therapy office,

[00:16:51] do you do blood flow restriction? I think it could be really beneficial. I'm having a lot

[00:16:55] of pain. I just want to get back to movement. And if that's something that you think,

[00:16:59] maybe you've been dealing with this for a long time because they see it not only with

[00:17:03] knee osteoarthritis, but also with patella femoral syndrome. So if you're having a lot

[00:17:09] of knee pain, a lot of knee discomfort, you don't feel like you can load, you could do

[00:17:12] resistance training, you could put a lot of effort into your body, getting some supervision

[00:17:17] and getting, you know, starting movement with blood flow restriction can be a great access point

[00:17:23] into starting to rebuild the muscle strength, confidence within your body and get you moving

[00:17:27] a little bit more. Thanks so much for joining us on another episode. If you heard something

[00:17:32] that you think could be beneficial to someone, you've heard someone talk about blood flow

[00:17:35] restriction or question it, or you think, oh, I think this could help someone get moving,

[00:17:40] please share the episode. We love to help educate and spread the word. And the only way

[00:17:45] we can do that is with your support. So if you haven't yet, please leave a rating and review

[00:17:49] and we'll see you back on another episode of the optimal body podcast.