[{"id":565173223478,"title":"What is Blood Flow Restriction Training?","created_at":"2024-02-22T02:09:11-05:00","body_html":"\u003ch2 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eModern day BFR training \u003c\/strong\u003e\u003c\/h2\u003e\n\u003cdiv data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe concept of blood flow restriction is becoming common practice in many different fields of musculoskeletal health. A simple \u003c\/span\u003e\u003ca href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ePubMed\u003c\/span\u003e\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e search will return hundreds of peer-reviewed research papers conducted all over the globe, while dozens of products of varying shapes and sizes exist on the market with the sole purpose of restricting blood flow during exercise. The proposed benefits of blood flow restriction training have been observed in many populations from elite-level athletes to intensive-care patients. This technology has been applied in a vast number of different environments including musculoskeletal rehabilitation, high-performance training, military operations, and even outer space travel! So why has blood flow restriction training gained such popularity over the past 20 years, and how does it really work?\u003c\/span\u003e\n\u003c\/div\u003e\n\u003cdiv data-mce-fragment=\"1\"\u003e\u003c\/div\u003e\n\u003cdiv data-mce-fragment=\"1\"\u003e\u003c\/div\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e\u003c\/strong\u003e\u003c\/h3\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eWhat is it? \u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBlood flow restriction training is typically used in combination with low-intensity resistance exercise or cardiovascular training. It involves the application of a pneumatic cuff device to limit arterial blood flow to a limb, while fully restricting venous outflow in working muscles. By modifying blood flow in this way, users can train at remarkably low intensities, and achieve comparable training results as more traditional resistance training methods.\u003c\/span\u003e\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e \u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e\u003cimg height=\"249\" width=\"249\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/products\/1.1copy_05c7fac2-c1ff-4d89-a33c-2daa8410f4dc_480x480.jpg?v=1679392326\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/products\/1.1copy_05c7fac2-c1ff-4d89-a33c-2daa8410f4dc_480x480.jpg?v=1679392326\"\u003e\u003c\/span\u003e\u003c\/strong\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe \u003ca href=\"https:\/\/sujibfr.com\/shop\/suji\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/sujibfr.com\/shop\/suji\"\u003eSuji Device\u003c\/a\u003e: AI-Powered, BFR Training Equipment\u003c\/span\u003e\u003c\/strong\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eDoes it work?\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eWhile BFR was conceived as a passive strategy, it is most commonly used to increase muscle mass and strength in combination with low-intensity resistance training. Current guidelines from the \u003c\/span\u003e\u003ca href=\"https:\/\/www.acsm.org\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.acsm.org\/\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eAmerican College of Sports Medicine\u003c\/span\u003e\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e suggest that in order to increase muscle mass and strength an individual is required to train 2 to 3 days per week at 70% of a 1 repetition maximum (1RM). However, when combined with BFR, significant increases in muscle mass and strength have been achieved with a training intensity of as little as 20% 1RM (Takarada et al. 2002). Early research achieved a 10% increase in strength and a 5% increase in thigh muscle mass with only 5x2 min bouts of treadmill walking when combined with BFR (Abe et al. 2006). The benefits of BFR training also likely apply to tendons, bones, and the cardiorespiratory system, however, these pathways will be explored in future blogs.\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eWhy is it important?\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eUsing a low-intensity training stimulus such as walking and light resistance exercise exposes users to a low mechanical load. This means less force going through bones, tendons, muscles, and joints. This means that people who are typically considered contraindicated to high-intensity exercise, such as those who are injured, the elderly, or those in poor health, may still be able to benefit from rigorous physical activity. Within the current literature, blood-flow restriction training is currently being explored in over 25 conditions of clinical disease and musculoskeletal rehabilitation. A recent survey of practitioners currently using BFR revealed that the most common objectives of BFR exercise were to induce muscle hypertrophy, followed by use during injury rehabilitation. Universities and elite or professional sporting teams are the most frequented users of BFR, with the age bracket of 21-30 years being the most common age bracket (Patterson et al. 2017).\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eWhat's next?\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eIn this series of blogs, we will explore how to use BFR training safely and effectively. We will also look at how it is being used to improve performance, rehabilitate injury and treat diseases worldwide.\u003c\/span\u003e\u003c\/p\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003eReferences:\u003c\/h4\u003e\n\u003col data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eSato, Y., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe history and future of KAATSU training\u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003e. International Journal of Kaatsu Training Research\u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e,\u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003e 2005. 1: p. 1-5. \u003c\/span\u003e\u003ca href=\"https:\/\/www.jstage.jst.go.jp\/article\/ijktr\/1\/1\/1_1_1\/_article\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.jstage.jst.go.jp\/article\/ijktr\/1\/1\/1_1_1\/_article\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ehttps:\/\/www.jstage.jst.go.jp\/article\/ijktr\/1\/1\/1_1_1\/_article\u003c\/span\u003e\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eTakarada, Y., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eEffect of resistance exercise combined with vascular occlusion on muscle function in athletes, \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eEuropean Journal of Applied Physiology, 2002. 86 (4): p. 308-14. \u003c\/span\u003e\u003ca href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11990743\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11990743\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ehttps:\/\/www.ncbi.nlm.nih.gov\/pubmed\/11990743\u003c\/span\u003e\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eAbe, T., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan 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. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Applied Physiology, 2006. 100: 1460-1466. \u003c\/span\u003e\u003ca href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16339340\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16339340\/\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/16339340\/\u003c\/span\u003e\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003ePatterson, S., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe role of blood flow restriction training for applied practitioners: A questionnaire based survey. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Sport Sciences, 2017, 36 (2): 123-130.\u003c\/span\u003e\u003ca href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28143359\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28143359\/\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cspan data-mce-fragment=\"1\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/28143359\/\u003c\/span\u003e\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e.\u003c\/span\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003ePatterson, S. et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eEditorial: Blood Flow Restriction: Rehabilitation to Performance. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eFrontiers in Physiology, 2021. 12: p. 1-4.\u003c\/span\u003e\n\u003c\/li\u003e\n\u003c\/ol\u003e","blog_id":81849581622,"author":"surinder rawat","user_id":77638467638,"published_at":"2024-02-22T02:09:11-05:00","updated_at":"2024-02-22T02:09:12-05:00","summary_html":"","template_suffix":"","handle":"what-is-blood-flow-restriction-training","tags":"","image":{"created_at":"2024-02-22T02:09:11-05:00","alt":"","width":465,"height":500,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Screenshot_2023-05-01_at_9.38.24_PM_520x500_171669b0-98b0-4adc-9041-456c4fe39825.webp?v=1708585752"}},{"id":565173190710,"title":"BFR Training and The Athletic Knee: Pain, Rehabilitation, and Performance","created_at":"2024-02-22T02:08:14-05:00","body_html":"\u003ch2 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eIntroduction:\u003c\/strong\u003e\u003c\/h2\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eChronic knee pain and acute or traumatic knee injury is a major cause of time loss in many competitive sports. A recent injury surveillance study identified knee injury as a leading cause of injury burden across all the top four professional sports codes in the United States and North America, including: basketball, baseball, football and ice hockey. Not surprisingly, the search for rehabilitation strategies that optimize knee health and improve performance remains a top priority within the sports medicine world. Blood flow restriction training is fast becoming a common part of gold-standard management in many different forms of knee injury rehabilitation including:\u003c\/span\u003e\u003c\/p\u003e\n\u003cul data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eACL reconstruction\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eOsteoarthritis\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ePatellofemoral joint pain\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eTotal knee arthroplasty\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ePatella tendinopathy\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eKnee arthroscopy\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eMeniscal\/joint surface injury\u003c\/span\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBFR is typically used as a strategy to improve skeletal muscle mass and strength in load compromised or injured individuals. However, research is emerging to demonstrate the proposed benefits may also apply to bone, tendon, cardiovascular health, cognitive function, neuromuscular performance and pain mitigation. The purpose of this blog is to explore the different ways in which BFR training is currently being used to improve clinical outcomes and athletic performance in acute and chronic knee injury. \u003c\/span\u003e\u003c\/p\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eAcute Knee Injury:\u003c\/strong\u003e\u003c\/span\u003e\u003c\/h2\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe use of BFR methods in acute knee injury dates back more than 20 years when Takarada and colleagues demonstrated that the use of BFR as a passive strategy had the capacity to diminish muscle atrophy following ACL \u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ereconstruction surgery. Since then, more than 50 publications have explored the use of BFR both passively, and in combination with low-intensity exercise in multiple forms of knee injury. A recent review from Hughes et al (2018) described the use of BFR following ACL surgery and identified four key phases through which BFR may be implemented.\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e1 – Post-operative BFR:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe objective of this phase is preventing muscle disuse atrophy and strength loss, minimising joint effusion and pain management. Passive application of BFR can stimulate muscle protein synthesis and has been shown to minimise muscle atrophy when applied as soon as 2-days post ACLR surgery. The most common protocol is 5 sets of 5 minutes occlusion with 2-3 minutes of rest. Higher occlusion pressures, perhaps full limb occlusion (100% LOP)\u003c\/span\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cspan data-mce-fragment=\"1\"\u003emay be required to provide a sufficient stimulus to trigger muscle adaptation. Combining passive BFR with voluntary muscle contraction or neuromuscular electrical stimulation has also been demonstrated as an effective strategy to promote muscle hypertrophy and optimize early stage return of muscle function post traumatic knee injury. \u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e2 – Early Loading with BFR:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe objective of this phase is to further prevent muscle atrophy, normalize gait patterns and improve quadriceps muscle function. Combining BFR with walking and low-intensity cycling has been shown to increase muscle size, strength and function. BFR application may also promote muscle deoxygenation and enhance aerobic and strength endurance adaptations. When using BFR in conjunction with aerobic exercise higher pressures between 60-80% LOP are typically required to optimize improvements in strength. Anecdotally there is often concerns that using BFR can exacerbate joint effusion. However, evidence from Hughes et al (2019) demonstrated that the application of BFR in post-operative ACL reconstruction can reduce joint effusion and reduce pain during this stage of rehabilitation. \u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e3 – Low-load Resistance Training with BFR:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eDuring the phase the application of BFR to low-intensity resistance exercise is commonly used to maximize muscle hypertrophy. The benefits of BFR combined with resistance exercise are well documented, with improvements in muscle hypertrophy being comparable to heavy traditional resistance exercise, and improvements in strength superior to an exercise matched control. Programming within this phase should be consistent with principles of progressive overload and specificity. Metabolic stress and mechanical load should be systematically increased through changes in limb occlusion pressure\/time under occlusion and intensity respectively. Training loads between 20-40% 1RM combined with cuff pressures between 40-80% LOP are recommended for improvements in muscle strength and hypertrophy.\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e4 – Heavy Resistance Training with Low-load BFR Training:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe end goal of any rehabilitation program it to progress athletes to be able to tolerate high intensity strength and plyometric training. Heavy strength training is more effective than low-load BFR at improving maximal muscle strength, and plyometric training is essential at re-training leg power and reactive strength qualities. During this phase traditional high-intensity training methods can be supplemented with on-going to continue to target improvements in muscle hypertrophy with a low-cost training intervention.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e\u003cimg height=\"128\" width=\"525\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Screenshot_2023-05-01_at_10.00.41_PM_480x480.png?v=1682992862\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Screenshot_2023-05-01_at_10.00.41_PM_480x480.png?v=1682992862\"\u003e\u003c\/span\u003e\u003c\/p\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eFigure 1 – Programming considerations for BFR in acute knee injury.\u003c\/span\u003e\u003c\/i\u003e\u003c\/strong\u003e\u003c\/h4\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eChronic Knee Pain:\u003c\/strong\u003e\u003c\/h2\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eChronic and degenerative knee conditions such as patellofemoral joint pain or patella tendinopathy have the potential to cause pain for many years. 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). Movement strategies that avoid loading the painful knee may trigger a vicious spiralling decline in physical function characterised by progressive muscle weakness and decreased joint stability, which may in-turn expose the athlete to more significant injuries. While traditional resistance exercise is commonly considered the most effective rehabilitation strategy this form of training has the potential to increase load through the injured area and potentially aggravate symptoms\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eRecent research has shown that performing light BFR exercise may have a pain modulation effect. A landmark study from Korakakis (2018) demonstrated that subjective pain scores while performing functional tasks (single leg squat and step down) were reduced by more than 60% following BFR exercise in subjects with anterior knee pain. Hughes et al (2019) speculated that there may be several mechanisms by which BFR might influence pain:\u003c\/span\u003e\u003c\/p\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e\u003ci data-mce-fragment=\"1\"\u003eConditioned pain modulation:\u003c\/i\u003e\u003c\/strong\u003e\u003c\/h4\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe simplest way to describe conditioned pain modulation is with the expression 'pain cures pain'. Within the conditioned pain modulation paradigm, a painful conditioning stimulus, may inhibit the perceived pain of a secondary stimulus. 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\u003c\/p\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e\u003ci data-mce-fragment=\"1\"\u003eOpioid and endocannabinoid systems:\u003c\/i\u003e\u003c\/strong\u003e\u003c\/h4\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\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 of neuropeptides produced within the nervous system. Specifically, beta-endorphine is thought to play a key role in exercise-induced pain relief. Recent evidence from Hughes et al (2020) demonstrated an increase in beta-endorphine and 2-arachidonoylglycerol levels following high-pressure BFR exercise, and that these changes were associated with increased post-exercise pain relief. \u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eWhile the evidence supporting BFR as a pain relief strategy is relatively new, the implications for states of chronic knee pain are significant. Not only does BFR have the potential to alleviate pain which may allow for more traditional rehabilitation loading strategies, evidence indicates a moderate effect of BFR exercise on increasing muscle strength in individuals suffering musculoskeletal weakness. This mean BFR exercise can target changes in function, pathology and pain, the three hallmark symptoms of chronic knee injury. There are three primary use cases by which BFR is currently being implemented: \u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e1 – Pre-loading strategy:\u003c\/strong\u003e Heavy resistance training is still viewed as the gold standard rehabilitation strategy in multi-factorial anterior knee pain; however, pain often contraindicates many people from being able to lift sufficient loads. Pre-loading with BFR exercise may enable individuals to successfully complete high-intensity resistance exercises to improve muscle strength. Hughes et al. (2020) demonstrated that the pain-relieving effects of BFR can last up to 24 hours and are likely dependent on the intensity of the BFR stimulus. It appears higher occlusion pressures up to 80% LOP may provide the most potent pain relief strategy.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e2 – Pre-competition strategy:\u003c\/strong\u003e While higher occlusion pressures may optimize pain relief, using such a fatiguing stimulus prior to competition may not be desirable. Occlusion pressures as low as 40% LOP have been shown to be effective at providing significant pain relief, while also providing an effective post-exercise potentiation stimulus (Zheng et al 2022).\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe capacity to relieve pain and improve leg power performance makes the use of BFR prior to training or competition a desirable strategy.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003e3 – A stand-alone rehabilitation tool:\u003c\/strong\u003e BFR in combination with resistance exercise has the capacity to increase skeletal muscle strength, increase bone cell turnover, stimulate changes in tendon morphology, and improve conditions of chronic pain in individuals with complex anterior knee pain. When using BFR as an isolated rehabilitation tool it should be noted that BFR is not able to increase muscle strength to the same extent as traditional heavy resistance training. Users are encouraged to systematically increase mechanical load as a part of their progressive overload protocols.  \u003c\/span\u003e\u003c\/p\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e\u003cimg height=\"99\" width=\"546\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Screenshot_2023-05-01_at_10.01.44_PM_480x480.png?v=1682992921\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Screenshot_2023-05-01_at_10.01.44_PM_480x480.png?v=1682992921\"\u003e\u003c\/span\u003e\u003c\/h4\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eFigure 2 – Programming considerations for BFR in chronic knee pain.\u003c\/span\u003e\u003c\/i\u003e\u003c\/h4\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eReferences:\u003c\/span\u003e\u003c\/h4\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eTakarada, Y., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eApplications of vascular occlusion diminish disuse atrophy of knee extensor muscles. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eMedicine \u0026amp; Science in Sports \u0026amp; Exercise, 2000. 32 (12): pp 2035-2039.\u003c\/span\u003e\n\u003c\/h4\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eHughes, L., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBlood Flow Restriction Training in Rehabilitation Following Anterior Cruciate Ligament Reconstructive Surgery: A Review. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eTechniques in Orthopaedics, 2018. 33 (2): pp 106-113.\u003c\/span\u003e\n\u003c\/h4\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eHughes, L., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eComparing the Effectiveness of Blood Flow Restriction and Traditional Heavy Load Resistance Training in Post-Surgery Rehabilitation of Anterior Cruciate Ligament Reconstruction in Patients: A UK National Health Service Randomised Controlled Trial. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eSports Medicine, 2019. 49: pp 1787-1805.\u003c\/span\u003e\n\u003c\/h4\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eKorakakis, V., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eLow load resistance training with blood flow restriction decreases anterior knee pain more than resistance training along. A pilot randomised controlled trial. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003ePhysical Therapy in Sport. 34: pp 121-128.\u003c\/span\u003e\n\u003c\/h4\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eHughes, L., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eLow intensity blood flow restriction exercise: Rationale for a hypoalgesia effect.\u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003e Medical Hypotheses, 2019. 132: pp 1-7.\u003c\/span\u003e\n\u003c\/h4\u003e\n\u003ch4 data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eZheng, H., et al., \u003ci data-mce-fragment=\"1\"\u003eThe Influence on Post-Activation Potentiation Exerted by Different Degrees of Blood Flow Restriction and Multi-Levels of Activation Intensity. \u003c\/i\u003eInternational Journal of Environmental Research and Public Health, 2022. 19: pp 1-12.\u003c\/span\u003e\u003c\/h4\u003e","blog_id":81849581622,"author":"surinder rawat","user_id":77638467638,"published_at":"2024-02-22T02:08:13-05:00","updated_at":"2024-02-22T02:08:14-05:00","summary_html":"","template_suffix":"","handle":"bfr-training-and-the-athletic-knee-pain-rehabilitation-and-performance","tags":"","image":{"created_at":"2024-02-22T02:08:14-05:00","alt":"","width":422,"height":500,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Screenshot_2023-05-01_at_9.57.09_PM_520x500_b8162ef0-9958-4a73-9d50-c3c1e59cf0da.webp?v=1708585694"}},{"id":565173157942,"title":"BFR Training and Athletic Groin Pain: A Theoretical Framework for Managing Complex Hip and Groin Pain","created_at":"2024-02-22T02:07:05-05:00","body_html":"\u003ch1 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eAthletic hip and groin pain:\u003c\/strong\u003e\u003c\/h1\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eHip and groin pain presents an enormous challenge for practitioners involved in diagnosis, rehabilitation and prevention. The complex anatomy, along with a lack of understanding of the aberrant mechanisms that predispose an athlete to injury makes the management of these injuries notoriously difficult. A systematic review evaluating risk factors for groin injury identified four key factors that might predispose an individual to injury: a previous history of groin injury, reduced hip adductor strength (absolute and relative to hip abductor strength), more elite levels of competition and lower levels of sport-specific training (Emery et al 2015). These injuries are a significant burden to professional team sports. A recent meta-analysis demonstrated that hip, groin and pelvis injuries accounted for 28.3% of all injuries in men’s ice hockey (Szukics et al 2022). While in elite level soccer these injuries account for between 13 and 20% of all injuries (Sherman et al 2018).\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe etiology of hip and groin injury remains poorly understood, at a fundamental level these injuries typically occur as a disconnect between the load (both acute and cumulative) that the region is exposed to, and the capacity of both the contractile and non-contractile tissues. Certain injuries will require that these tissues are unloaded and rested, while others demand an increase in tissue capacity. For this reason, rehabilitation methodologies that are capable of impacting muscle, tendon and boney tissue, and that are a low mechanical cost, are of great interest in the management of groin injury.\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eBlood flow restriction training:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBlood flow restriction training has recently gained popularity as a method for increasing muscle mass and strength using resistance training loads as low as 20% 1RM. Traditional resistance training methods typically demand loads greater than 70% 1RM be used in order to trigger a muscle hypertrophy response, making BFR an appealing alternative. The use of BFR in musculoskeletal and clinical rehabilitation is rapidly becoming a critical part of gold standard care. To the authors knowledge there is currently no research exploring the use of BFR in the management of hip and groin injury, however, many of the core principles in the rehabilitation of these injuries indicate that BFR may be a useful strategy for several reasons.  \u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eAbove and below the cuff:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eMost of the 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. Recent 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. Likewise, Constantinou et al (2022) demonstrated a significant increase in hip extensor strength following 4 weeks of BFR training, compared to traditional heavy resistance exercise in individuals suffering from patellofemoral joint pain. These findings suggest that BFR may be a viable strategy to improve the capacity of the tissues that surround the hip and lumbopelvic region and be a useful strategy in managing complex hip and groin injury.\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eHip torque ratios and muscle strength:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe muscles surrounding the lumbo-pelvic-hip complex work synergistically to balance the pelvis and create movement. This region acts as a central hub for load transfer during all movements and is often subject to forces up to 15x body weight during high-intensity efforts such as sprinting and change of direction. There is good evidence to suggest that both the absolute strength of these muscles, along with their relative strength and balance across the pelvis is important in managing and rehabilitating hip and groin pain. For example, there is strong evidence that the relationship between hip adduction and abduction strength (referred to as the ADD:ABD ratio) is important in managing and preventing hip and groin pain. The precise desired ratio depends on the research and is likely influenced by the athlete population and the demands of the sport, however generally speaking to create balance across the pelvis the hip extensors should be the biggest producers of force across the hip closely followed by the hip flexors, and the hip adductors should be slightly stronger than the hip abductors. Depending on the nature of the injury will determine whether it is the more dominant or weaker structures that are subject to injury. Regardless, optimizing strength balance across the pelvis requires intelligent programming. In order to change the peak force generating capacity of a muscle, we typically require high-intensity resistance training methods which in conditions of hip and groin pathology can be highly provocative. While we currently lack evidence directly exploring the use of BFR in optimizing hip torque ratios and improving athlete outcomes in hip and groin rehabilitation, BFR training has been shown to improve the strength and capacity of the hip extensor, hip flexor and hip abductor muscle groups. By providing a low-cost alternative to traditional resistance training that may be better tolerated by injured athletes, BFR offers a training solution to expedite the desired improvements in maximum strength and hypertrophy of muscle that support the hip and pelvis. General guidelines for prescribing BFR training to achieve improvements in muscle strength and hypertrophy are outlined below. To achieve sustained improvement the program should be progressed based on how each individual presents clinically and their desired training outcome. See Figure 1 for some more ideas.\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003ePain mitigation:\u003c\/strong\u003e\n\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eMany athletes managing hip and groin injury suffer from long-term chronic pain. Often the symptoms of hip and groin pain are not significant enough to remove the athlete from competition and symptoms are managed alongside training. In these cases, finding appropriate times to effectively load the muscles across the hip is limited, and the athlete risks further aggravation of symptoms and reductions in strength. Recent research suggests that performing light load blood flow restriction exercise may have a pain modulation effect.\u003c\/span\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\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. Hughes et al. (2020) recently demonstrated that BFR may activate a hypoxia-dependent endocannabinoid pathway that plays a central role in exercise-induced hypoalgesia. Other proposed mechanisms include conditioned pain modulation and the preferential recruitment of high-threshold motor units. By temporarily relieving pain, the BFR stimulus might allow the athlete to complete more intensive traditional heavy resistance training methods pain free, or potentially train and compete in their sport with reduced pain levels. For more information on programming BFR for pain relief, check out our recent blog titled Blood Flow Restriction Training and the Athletic Knee.\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eAthlete load management:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eAs we previously discussed, the lumbo-pelvic-hip complex represents the central point of load transfer across the various kinetic chains within the body. Therefore, completing meaningful strength and power training sessions using traditional methods can often be problematic in athletes suffering from hip and groin pain, and other tissues within the body risk becoming deconditioned. While the research supporting BFR training in maximal muscle strength and hypertrophy is well recognized, BFR training may also be able to develop more high threshold training adaptations that are crucial to sporting performance. Eccentric strength is widely considered an essential physical quality in injury prevention and speed development. Changes in eccentric strength are typically reserved for training strategies that supersede an individual concentric 1RM such as the Nordic hamstring exercise. However, recent research from Jones et al. (2023) has demonstrated similar increases in eccentric hamstring strength using loads at 30%1RM + BFR when compared to 80%1RM eccentric training. Similarly, BFR training when combined with plyometric and speed training has been repeatedly shown to influence speed and power performance. When combined with practical BFR using elastic wraps 100m incremental runs led to a significant increase in 100m sprint time and isometric rate of force development performed on a leg press (Behringer et al 2010). Similarly, when combined with plyometric exercise, the application of BFR led to significant improvements in vertical jump performance, reactive strength and peak force at high contraction speeds in post-operative ACL patients (Demirci et al., 2020).\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eTake home messages:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eAthletic hip and groin pain is a complex and multi-factorial injury, making prevention, diagnosis and rehabilitation a significant challenge. Blood flow restriction training presents as a potential strategy to positively impact rehabilitation and management via three key mechanisms:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e1 -Providing a low-cost method to optimize torque ratios between muscles that cross the hip and pelvis. This may be achieved by improving the absolute strength levels of individual muscle groups or by improving the balance of strength across the pelvis.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e2 – Providing symptomatic pain relief for athletes as a pre-loading or pre-training strategy.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e3 – By maintaining high-threshold physical qualities such eccentric strength and leg power during periods or relative unloading.\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eReferences:\u003c\/span\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eWhittaker, J. L., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eRisk factors for groin injury in sport: an updated systematic review.\u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003e British Journal of Sports Medicine, 2015. 49 (12): pp 803-809.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eSzukics, P. F., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eA Scoping Review of Injuries in Amateur and Professional Men’s Ice Hockey. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eOrthopedic Journal of Sports Medicine, 2022. 10 (4): pp 1-12.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eSherman, B., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eHip and Core Muscle Injuries in Soccer. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eAmerican Journal of Orthopedics, 2018. 47 (10): pp 23-29.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBowman, E. N., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eProximal, Distal, and Contralateral Effects of Blood Flow Restriction Training on the Lower Extremities: A Randomized Controlled Trial\u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003e. Sports Health, 2019. 11 (2): pp 149-156.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBowman, E. N., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eUpper extremity blood flow restriction: the proximal, distal, and contralateral effects – A randomized controlled trial. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Shoulder and Elbow Surgery, 2020. 29: pp 1267-1274. \u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eConstantinou, A., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eComparing hip and knee focused exercises versus hip and knee focused exercises with the use of blood flow restriction training in adults with patellofemoral pain\u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003e. European Journal of Physical and Rehabilitation Medicine, 2022. 58 (2): pp 225-235.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eHughes, L., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe effect of blood flow restriction exercise on exercise-induced hypoalgesia and endogenous opioid and endocannabinoid mechanisms of pain modulation. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Applied Physiology, 2020. 128: pp 914-924.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eJones, M. J., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eLow Load With BFR vs. High Load Without BFR Eccentric Hamstring Training Have Similar Outcomes on Muscle Adaptation. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Strength and Conditioning Research, 2023. 37 (1): pp 55-61.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBehringer, M., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eLow-intensity Sprint Training With Blood Flow Restriction Improves 100-m Dash. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Strength and Conditioning Research, 2010. 31 (9): pp 2462-2472.\u003c\/span\u003e\u003c\/p\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eDemirci, S., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe Effect of Plyometric Training with Blood Flow Restriction After Anterior Cruciate Ligament Reconstruction, \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003e2020. 52: pp 798.\u003c\/span\u003e","blog_id":81849581622,"author":"surinder rawat","user_id":77638467638,"published_at":"2024-02-22T02:07:05-05:00","updated_at":"2024-02-22T02:07:06-05:00","summary_html":"","template_suffix":"","handle":"bfr-training-and-athletic-groin-pain-a-theoretical-framework-for-managing-complex-hip-and-groin-pain","tags":"","image":{"created_at":"2024-02-22T02:07:05-05:00","alt":"","width":511,"height":500,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Screenshot_2023-06-14_at_10.29.30_AM_520x500_601db1c3-2074-4650-8a39-d1bb8045d8a5.webp?v=1708585626"}},{"id":565173026870,"title":"Blood Flow Restriction Training in the Management of ACL Reconstructive Surgery","created_at":"2024-02-22T01:58:00-05:00","body_html":"\u003ch2 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eIntroduction:\u003c\/strong\u003e\u003c\/h2\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eAnterior cruciate ligament (ACL) rupture is a highly prevalent orthopedic injury, with over 120,000 injuries occurring each year in the United States. Rehabilitation timeframes are typically between 6 and 12 months with many sufferers encountering muscle atrophy, strength loss, joint effusion and arthrogenic muscle inhibition. ACL repair represents one of the most studied orthopedic injuries and thus rehabilitation techniques have evolved over several decades. Blood flow restriction (BFR) training is rapidly emerging as a viable strategy at multiple stages of ACL rehabilitation and is widely considered an integral part of gold-standard ACL injury management. The use of BFR in ACL management was first explored over 20 years ago as a passive strategy to minimize muscle loss in the first 2 weeks post-surgery (Takarada, 2000). Since then, interest in BFR as a rehabilitation strategy has grown exponentially, and more research has sought to explore the use of BFR in a progressive model through all stages of rehabilitation from pre-surgery conditioning, right the way through to a return to sporting performance. \u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe aim of this blog is to provide a framework for BFR to be used as a part of a holistic and progressive management strategy, across the various stages of ACL rehabilitation. \u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eStage 1 - Stronger in = Stronger out:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eRehabilitation following ACL surgery can begin even before the surgery has started. Increasing lower limb muscle strength prior to surgery is believed to attenuate the deterioration of muscle mass and function in the aftermath of invasive surgery. The adequately named “preconditioning” program presents a unique challenge to deliver an exercise stimulus sufficient to increase muscle mass without exacerbating effusion and pathology in a joint that has suffered significant trauma. A recent randomized controlled trial explored the use of a BFR intervention in the 10 days prior to ACL reconstruction surgery on maximal muscle strength, muscle endurance, surface EMG and muscle blood flow (Zargi et al 2018). As few as 5 BFR exercise sessions were completed, and resulted in significant improvements in muscle endurance, muscle activation and blood flow within the first 4 weeks after ACL reconstruction. These findings demonstrate that a short-term BFR training program may be a valuable addition to standard rehabilitation programs for patients elected for ACL reconstruction surgery. This protocol used a high volume set and rep scheme (3x sets to volitional failure), combined with a low training intensity (40 repetition maximum) and a high absolute pressure (150mmHg with a wide cuff). These variables suggest that biasing the programming variables to achieve a high level of metabolic stress may be an effective pre-surgery strategy to achieve sustainable change in muscle endurance and activation.\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eStage 2 – Post-operative care - How early can you start?\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eWithin the confines of a clinical research facility, the use of BFR has started as early as 2-days post-surgery. The objective of this phase is preventing muscle disuse atrophy and strength loss, minimizing joint effusion and pain management. Passive application of BFR can stimulate muscle protein synthesis and has been shown to minimize muscle atrophy when applied as soon as 2-days post ACLR surgery. The most common protocol is 5 sets of 5 minutes occlusion with 2-3 minutes of rest. Higher occlusion pressures, perhaps full limb occlusion (100% LOP) may be required to provide a sufficient stimulus to trigger muscle adaptation. Combining passive BFR with neuromuscular electrical stimulation has also been shown to be an effective strategy to increase muscle mass in post-traumatic knee injury. Three papers have thus far explored the use of BFR within the first 10 days post-ACL surgery and have not reported any incidence of an adverse event or contraindication (Takarada et al 2000, Iversen et al., 2016, Prue et al., 2020). Prue et al (2022) implemented BFR + LI resistance exercise intervention at 9 days post-surgery and reported a small number of episodes of dizziness, paraesthesia and itching.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eIn an applied setting, many practitioners will avoid the use of BFR in the early stages post-surgery amid fears of an increased risk of a thromboembolism and anecdotal concerns about exacerbating acute joint effusion. While there is little evidence substantiating these concerns when BFR is used appropriately (initial evidence suggests BFR training may reduce joint effusion post ACL surgery), Hughes et al. (2019) proposed a criteria-based assessment to commence the use of BFR training post-surgery. This list included a return to basic muscle function and joint health demonstrated by:\u003c\/span\u003e\u003c\/p\u003e\n\u003cul data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eUnilaterally weight bear without pain for \u0026gt;5s without support\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eDemonstrate knee ROM of 0-90 degrees.\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ePerform repeated straight leg raises without quadriceps muscle lag.\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eMinimal effusion changes with activity.\u003c\/span\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eStage 3 - Regaining muscle size and strength:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ePerhaps the most common use of BFR training is in combination with low-intensity resistance exercise to target improvements in muscle mass and strength during early-stage re-loading. The benefits of BFR combined with resistance exercise are well documented, with improvements in muscle hypertrophy being comparable to heavy traditional resistance exercise, and improvements in strength superior to an exercise matched control. When compared traditional rehabilitation strategies like high-intensity resistance exercise, BFR combined with LI-RT has resulted in:\u003c\/span\u003e\u003c\/p\u003e\n\u003cul data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eGreater improvements in joint pain, range of movement, self-reported knee function and knee extensor muscle torque\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eComparable improvements in muscle mass and repetition maximum muscle strength.\u003c\/span\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eWhen compared to an exercise-matched control group, BFR combined with LI-RT has resulted in:\u003c\/span\u003e\u003c\/p\u003e\n\u003cul data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eGreater improvements in quadricep muscle cross-sectional area, knee extensor and knee flexor muscle torque.\u003c\/span\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eProgramming within this phase should be consistent with principles of progressive overload and specificity. Metabolic stress and mechanical load should be systematically increased through changes in limb occlusion pressure\/time under occlusion and intensity respectively. Training loads between 20-40% 1RM combined with cuff pressures between 40-80% LOP are recommended for improvements in muscle strength and hypertrophy.\u003c\/span\u003e\u003c\/p\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eGet back on track\u003c\/strong\u003e\u003c\/h2\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eChronic muscle atrophy and strength loss:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eAfter ACL reconstruction many individuals do not completely regain quadriceps size and muscle strength. Persistent quadriceps asymmetries predispose individuals to altered joint loading and gait mechanics, limited physical function and joint, increased risk of re-injury, and early onset of osteoarthritis. Long-term strength deficits are often associated with other signs of joint pathology and therefore regaining muscle size and strength can pose a significant challenge. Recent research from Kilgas et al (2019) explored a home-based BFR intervention in individuals with persistent muscle atrophy and strength deficits 5 years post-ACL reconstruction. Within the study a 4-week BFR intervention resulted in a ~10% increase in quadricep muscle mass, and a 20% increase in knee extensor muscle torque, while returning the limb symmetry index to 99±5% across all markers. Further research from Noyes et al (2021) explored this concept across various post-surgical patients including total knee replacements and meniscus repairs, alongside ACL reconstruction who were on average 5.3 months post-surgery. In this prospective study, patients had undergone ~5 months of traditional rehabilitation and presented with persistent strength deficits in the quadriceps (43%) and hamstrings (38%). After 6 weeks of BFR training most patients experienced improvements in muscle torque by \u0026gt;20% in both muscle groups. \u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cstrong data-mce-fragment=\"1\"\u003eConclusion:\u003c\/strong\u003e\u003c\/h3\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eThe use of BFR training has now become commonplace in the management of ACL reconstruction rehabilitation. As we learn more about the practical implications of BFR training, and the mechanisms through which BFR influences the neuromuscular and skeletal muscle systems, we identify more potential use-cases throughout the ACL rehabilitation journey. Further research is still required to fully explore the efficacy of BFR as a rehabilitation strategy, however with 20+ years of research and 30 peer-reviewed publications, the initial evidence is too promising to ignore. Practitioners are encouraged to establish clarity in their purpose when implementing and programming BFR into their rehabilitation protocols and have clear systems in place to track progress and monitor for setbacks.\u003c\/span\u003e\u003c\/p\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eReferences:\u003c\/span\u003e\u003c\/h3\u003e\n\u003col data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eTakarada, Y., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eApplications of vascular occlusion diminish disuse atrophy of knee extensor muscles. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eMedicine \u0026amp; Science in Sports \u0026amp; Exercise, 2000. 32 (12): pp 2035-2039.\u003c\/span\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eZargi, T., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eShort-term preconditioning with blood flow restricted exercise preserves quadriceps muscle endurance in patients after anterior cruciate ligament reconstruction. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eFrontiers in Physiology, 2018. 9: pp 1-13.\u003c\/span\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003ePrue, J., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eSide Effects and Patient Tolerance with the Use of Blood Flow Restriction Training after ACL Reconstruction in Adolescents: A Pilot Study. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eInternational Journal of Sports Physical Therapy, 2022. 17 (3): 347-354.\u003c\/span\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eIversen, E., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eIntermittent blood flow restriction does not reduce atrophy following anterior cruciate ligament reconstruction. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eJournal of Sport and Health Science, 2015. 5: pp 115-118.\u003c\/span\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eHughes, L., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eComparing the Effectiveness of Blood Flow Restriction and Traditional Heavy Load Resistance Training in Post-Surgery Rehabilitation of Anterior Cruciate Ligament Reconstruction in Patients: A UK National Health Service Randomised Controlled Trial. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eSports Medicine, 2019. 49: pp 1787-1805.\u003c\/span\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eKilgas, M. A., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eExercise with Blood Flow Restriction to Improve Quadriceps Function Long After ACL Reconstruction. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eTraining and Testing, 2019. 40: 650-656.\u003c\/span\u003e\n\u003c\/li\u003e\n\u003c\/ol\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eNoyes, F. R., et al., \u003c\/span\u003e\u003ci data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBlood Flow Restriction Training Can Improve Peak Torque Strength in Chronic Atrophic Postoperative Quadriceps and Hamstring Muscles. \u003c\/span\u003e\u003c\/i\u003e\u003cspan data-mce-fragment=\"1\"\u003eArthroscopy, 2021. 37(9): pp 2860-2869.\u003c\/span\u003e","blog_id":81849581622,"author":"surinder rawat","user_id":77638467638,"published_at":"2024-02-22T01:58:00-05:00","updated_at":"2024-02-22T01:58:24-05:00","summary_html":"","template_suffix":"","handle":"blood-flow-restriction-training-in-the-management-of-acl-reconstructive-surgery","tags":"","image":{"created_at":"2024-02-22T01:58:00-05:00","alt":"","width":410,"height":500,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/Screenshot_2023-07-04_at_3.44.46_PM_520x500_fada47bb-6b06-4800-b6c7-d5340bae21af.webp?v=1708585080"}},{"id":565172863030,"title":"Announcing the Launch of Revolutionary CEU Courses on Blood Flow Restriction Training for Athletic Trainers - Powered by Suji","created_at":"2024-02-22T01:37:02-05:00","body_html":"\u003cp data-mce-fragment=\"1\"\u003e\u003cb data-mce-fragment=\"1\"\u003eIntroduction\u003c\/b\u003e\u003cspan data-mce-fragment=\"1\"\u003e:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eWe are thrilled to announce the launch of a groundbreaking set of Continuing Education Units \u003ca href=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Suji_CEU_info.pdf?v=1686762641\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Suji_CEU_info.pdf?v=1686762641\"\u003e(CEU) courses\u003c\/a\u003e tailored exclusively for Athletic Trainers – a comprehensive educational program on Blood Flow Restriction (BFR) training. All of our courses and certifications are proudly approved by the Board of Certification (BOC).\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBuilding on the growing success of our state-of-the-art BFR technology, we are excited to empower Athletic Trainers with cutting-edge knowledge and practical skills to revolutionize their training programs.\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eIntroducing Suji – Pioneers in BFR Technology and Education:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eAt Suji, we are passionate about pushing the boundaries of athletic performance and recovery. As a company that offers state-of-the-art BFR technology, it was a natural progression for us to extend our expertise to the education sector. By developing these specialized CEU courses, we aim to empower Athletic Trainers with the knowledge and practical skills to leverage the immense benefits of BFR training for their athletes.\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eUnlocking the Power of Blood Flow Restriction Training:\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBlood Flow Restriction (BFR) training has emerged as a game-changing technique in the realm of sports medicine. BFR training enables athletes to achieve remarkable physiological adaptations with reduced training loads. The advantages of BFR training are vast and we want to empower Athletic Trainers to utilize BFR across a range of use cases.\u003c\/span\u003e\u003c\/p\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eOur CEU courses offer Athletic Trainers an unparalleled opportunity to delve into the science, principles, and practical applications of BFR training. Developed by industry-leading experts, these courses provide a comprehensive curriculum that equips professionals with the expertise to optimize athletic performance and facilitate efficient injury recovery.\u003c\/span\u003e\u003c\/p\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cb data-mce-fragment=\"1\"\u003eCourse Highlights:\u003c\/b\u003e\u003c\/p\u003e\n\u003cul data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eFundamentals of BFR Training: This course serves as a comprehensive introduction to BFR training, covering the fundamental principles, safety considerations, and optimal application techniques. Participants will gain a deep understanding of the physiological effects of BFR training and learn how to tailor protocols for various athletes and performance goals.\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eBFR Training for Rehabilitation: Focused on the practical application of BFR in the rehabilitation setting, this course equips Athletic Trainers with specialized strategies to optimize recovery and expedite return-to-play protocols. Participants will learn how to develop individualized rehabilitation plans and adapt BFR interventions for different injuries.\u003c\/span\u003e\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\u003cspan data-mce-fragment=\"1\"\u003eAdvanced BFR Training Techniques: Designed for seasoned Athletic Trainers, this advanced course explores cutting-edge techniques and protocols in BFR training. Participants will gain in-depth knowledge of optimizing training variables, advanced occlusion strategies, and integrating BFR with other training modalities to maximize performance enhancement.\u003c\/span\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cbr data-mce-fragment=\"1\"\u003e\n\u003cp data-mce-fragment=\"1\"\u003e\u003cb data-mce-fragment=\"1\"\u003eConclusion:\u003c\/b\u003e\u003c\/p\u003e\n\u003cspan data-mce-fragment=\"1\"\u003e Suji – the pioneers in BFR technology, have now released cutting-edge CEU course for Athletic Trainers. Approved by the BOC, these courses are poised to revolutionize athletic training practices, equipping Athletic Trainers with the knowledge and practical skills to optimize performance and expedite injury recovery. Embrace this unique opportunity to stay at the forefront of sports medicine and unlock the potential of BFR training for your athletes. For more information click \u003c\/span\u003e\u003ca href=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Suji_CEU_info.pdf?v=1686762641\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/Suji_CEU_info.pdf?v=1686762641\"\u003e\u003cspan data-mce-fragment=\"1\"\u003ehere\u003c\/span\u003e\u003c\/a\u003e\u003cspan data-mce-fragment=\"1\"\u003e or contact us at sales@sujibfr.com\u003c\/span\u003e","blog_id":81849581622,"author":"surinder rawat","user_id":77638467638,"published_at":"2024-02-22T01:37:02-05:00","updated_at":"2024-02-22T01:37:03-05:00","summary_html":"","template_suffix":"","handle":"announcing-the-launch-of-revolutionary-ceu-courses-on-blood-flow-restriction-training-for-athletic-trainers-powered-by-suji","tags":"","image":{"created_at":"2024-02-22T01:37:02-05:00","alt":"","width":400,"height":500,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/becomesujicertified_1_520x500_31565338-4147-4460-8dc4-ebe73a59b092.webp?v=1708583823"}},{"id":565173289014,"title":"Is Blood Flow Restriction Training Safe?","created_at":"2024-02-22T02:11:31-05:00","body_html":"\u003cspan data-mce-fragment=\"1\"\u003eBlood flow restriction (BFR) training involves partially occluding blood flow to a muscle during resistance or cardiovascular exercise using a pneumatic tourniquet (\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 form of training is generally viewed as an effective alternative for traditional weight training due to the proven benefits for muscular hypertrophy and cardiovascular fitness using relatively low intensity training. There is a growing body of evidence supporting BFR training as a safe and effective training method, when used appropriately. However, the safety and practicality of BFR training has not been extensively studied. While only one large-scale epidemiological study has explored the potential health implications of BFR training (Nakijima, 2006), there remains several proposed risks that should be addressed.\u003c\/span\u003e\n\u003cdiv data-mce-fragment=\"1\"\u003e\n\u003cimg height=\"300\" width=\"300\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/cuff-600x600.jpg\" class=\"size-medium wp-image-499\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/cuff-600x600.jpg\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eFigure 1: BFR training involves the partial occlusion of blood flow to the exercising muscle.\u003c\/div\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eWhat are the risks of BFR?\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe primary concerns surrounding BFR centre on four key areas; increasing muscle damage, blood clotting, augmenting blood pressure and pain\/discomfort.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eBFR and muscle damage:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThe research surrounding BFR training and muscle damage is highly varied. It appears that BFR training has the capacity to cause significant muscle damage, and in severe conditions, rhabdomyolysis (Wernbohm et al 2020). The extent of muscle damage appears to be dependent on the training protocol used, specifically the extent and duration of the occlusion stimulus. Muscle damage is a normal response to an unaccustomed training stimulus\/exercise, and there is little evidence to suggest adding BFR to exercise adds to the risk. To prevent excessive muscle damage, start with a low level occlusion pressure (discussed below), and gradually progress how long you wear the cuffs during your session.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eBFR and blood clotting:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eResearch from surgical tourniquet tells us that complete vascular occlusion can cause the formation of a thrombus (blood clot). The incidence rate of suffering a venous thrombosis during BFR training is 0.06%, and this number is lower than the general population figure. The appropriate use of BFR during exercise does not lead to complete occlusion of blood flow. The timeframe for occlusion is relatively low (5-10mins) and the active muscle contraction pumps blood through the exercising limb. Using excessively high pressure during your training, or using the cuffs for an extended period of time may increase your risk.\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eBFR and blood pressure:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eBFR training can augment the cardiovascular response to exercise when compared to an exercise matched control. However, the changes in heart rate and blood pressure observed with BFR training are relatively comparable to what is observed with traditional resistance exercise. While relatively understudied, it is hypothesized that these changes are driven by a decreased venous return and stroke volume, and by an accumulation of metabolites triggering a muscle chemoreflex response. Alternatively there is also strong research that suggests that BFR training facilitates improvements in vascular function. Ten weeks of walk training with BFR increased arterial compliance in a group of 23 elderly subjects (Ozaki et al 2011). Similarly six weeks of walk training with BFR increased venous compliance in 16 elderly females, including subjects considered to be hypertensive (Iida et al 2011).\u003c\/span\u003e\n\u003ch3 data-mce-fragment=\"1\"\u003eBFR and pain\/discomfort:\u003c\/h3\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eOnce again, the research surrounding BFR training and pain or ratings of perceived exertion, is somewhat conflicting. Some of the more common perceptual responses include fainting\/dizziness and numbness. Fainting\/dizziness is likely caused by post-exercise hypotension or a vasovagal response. Numbness is likely driven by compression of the peripheral nerve and is often influenced by cuff pressure and the use of a narrow cuff applying direct pressure to the nerve. Both responses have a relatively low incidence rate (0-2%), coincident with traditional resistance, or cardiovascular training. Further, there is no evidence of any long term nerve damage or health implications and these sensations should subside when the cuff pressure is released.\u003c\/span\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eWho is at risk?\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eWhile there is a growing body of evidence supporting BFR as a safe method of training, it remains relatively understudied. Care should be taken when monitoring individuals considered to be at an increased risk of an adverse reaction to a BFR training protocol. A recent study from Kacin et al (2015) developed a comprehensive screening protocol that is widely considered best practice in assessing suitability for BFR training. Those who appear to be at risk include:\u003c\/span\u003e\n\u003cul data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003ePeople with an increased risk of cardiovascular complications should be closely monitored for changes in heart rate and blood pressure. Exercise should be performed with more frequent reperfusions and rest periods. Individuals with a family or personal history of clotting disorders, or level 1 hypertension, may not be safe to complete a BFR training protocol.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003ePeople at a high risk of nerve injury such as diabetics should be constantly assessed for any changes in limb sensation and should consider more comprehensive monitoring of blood glucose.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eThose at an increased of rhabdomyolysis or muscle damage should be monitored for excessive pain or muscle weakness and should consider a passive acclimatization process prior to combining BFR with resistance or cardiovascular exercise.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003cdiv class=\"mceTemp\" data-mce-fragment=\"1\"\u003e\u003c\/div\u003e\n\u003cdiv data-mce-fragment=\"1\"\u003e\n\u003cimg height=\"200\" width=\"300\" alt=\"\" src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/suji-system-600x400.jpg\" class=\"wp-image-798 size-medium\" data-mce-fragment=\"1\" data-mce-src=\"https:\/\/cdn.shopify.com\/s\/files\/1\/0550\/5151\/8133\/files\/suji-system-600x400.jpg\"\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eFigure 2: SujiBFR can measure your individual occlusion pressure ensuring you can train safely and effectively.\u003c\/div\u003e\n\u003ch2 data-mce-fragment=\"1\"\u003eHow can I use BFR safely?\u003c\/h2\u003e\n\u003cspan data-mce-fragment=\"1\"\u003eThere is currently sufficient evidence that, if used appropriately, BFR training can be administered safely and effectively in a wide range of populations. So, what can you do to keep yourself safe during BFR training?\u003c\/span\u003e\n\u003col data-mce-fragment=\"1\"\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eUse a personalized limb occlusion pressure (LOP).\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003eThe amount of pressure required to occlude blood flow is highly individual and driven by various intrinsic (limb circumference, muscle mass, blood pressure) and extrinsic (cuff width, cuff shape, cuff material) factors. Several products exist on the market that have the capacity to accurately measure how much pressure is required to occlude blood flow, giving you piece of mind that your pressure is both safe and effective (Figure 2).\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eProgress your training gradually.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/strong\u003eLike any new health and fitness training routine, your body may take some time to adapt. BFR training is a unique stress on your body. Start at a lower pressure (30-50% LOP) and progress as you get more confident. Once you've achieved your target pressure, you can begin challenging yourself with increasing exercise intensities as able.\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003e\n\u003cstrong data-mce-fragment=\"1\"\u003eListen to your body.\u003c\/strong\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eBFR training, as with any other form of exercise, contains some element of risk and health complications. Specifically, muscle soreness, numbness, fainting\/dizziness and bruising are among some of the more common symptoms that you may experience. While there is very little evidence of any long term health implications and these symptoms will likely subside once the pressure cuff is released, if you experience any of these symptoms, you should cease the exercise protocol and consult your healthcare professional.\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\"\u003eThere is now sufficient evidence that, if used appropriately, BFR training is a safe and effective form of training. As with all forms of training, there is an inherent risk associated and BFR is not immune to this, however adding BFR to exercise does not seem to add to the risk.\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\"\u003eNakijima, T., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eUse and safety of KAATSU training: Results of a national survey.\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eInternational Journal of KAATSU training research, 2006.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e2\u003c\/strong\u003e: 5-13.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca href=\"https:\/\/www.researchgate.net\/publication\/324094275\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.researchgate.net\/publication\/324094275\"\u003ehttps:\/\/www.researchgate.net\/publication\/324094275\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eWernbohm, M., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eCommentary: Can Blood Flow Restricted Exercise Cause Muscle Damage? Commentary on Blood Flow Restriction Exercise: Considerations of Methodology, Application and Safety.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eFrontiers in Physiology.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e11\u003c\/strong\u003e(243): 1-7.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2020.00243\/full\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2020.00243\/full\"\u003ehttps:\/\/www.frontiersin.org\/articles\/10.3389\/fphys.2020.00243\/full\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eOzaki, H., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eEffects of 10 Weeks Walk Training With Leg Blood Flow Reduction on Carotid Artery Compliance and Muscle Size in Elderly Adults.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003c\/em\u003eAngiology, 2011.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e62\u003c\/strong\u003e(1): 81-85.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20682613\/\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/20682613\/\"\u003ehttps:\/\/pubmed.ncbi.nlm.nih.gov\/20682613\/\u003c\/a\u003e\n\u003c\/li\u003e\n\u003cli data-mce-fragment=\"1\"\u003eIida, H., et al.,\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cem data-mce-fragment=\"1\"\u003eEffects of walking with blood flow restriction on limb venous compliance in elderly subjects.\u003c\/em\u003e\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003eClinical Physiology and Functional Imaging, 2011.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003cstrong data-mce-fragment=\"1\"\u003e31\u003c\/strong\u003e: 472-476.\u003cspan data-mce-fragment=\"1\"\u003e \u003c\/span\u003e\u003ca href=\"https:\/\/www.researchgate.net\/publication\/51701072\" data-mce-fragment=\"1\" data-mce-href=\"https:\/\/www.researchgate.net\/publication\/51701072\"\u003ehttps:\/\/www.researchgate.net\/publication\/51701072\u003c\/a\u003e\n\u003c\/li\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\u003c\/ol\u003e","blog_id":81849581622,"author":"Ali Cianciulli","user_id":79137341494,"published_at":"2020-11-06T09:30:00-05:00","updated_at":"2024-04-23T01:41:16-04:00","summary_html":"","template_suffix":"","handle":"is-blood-flow-restriction-training-safe","tags":"","image":{"created_at":"2024-02-22T02:11:31-05:00","alt":"","width":520,"height":346,"src":"\/\/www.trysuji.com\/cdn\/shop\/articles\/suji-system_520x500_24852469-e315-451f-a70b-9e8309e9b91c.webp?v=1708585892"}}]