Why Long Beach’s premiere Sports clinic is using blood flow restriction (BFR) training and how it can help you?

There is conclusive evidence that Blood Flow Restriction (BFR) training will help you tremendously. If you have any injuries that have not allowed you to do “real” sustainable strength training, this is a must read. As Long Beach’s most sought after Sports Medicine Physical Therapy professional, blood flow restriction training has been an important piece in helping triathletes, weightlifting enthusiasts, runners, football, baseball, soccer, and basketball players get back to the routines they desire.

BFR got popularized when ESPN showed key sports athletes like Dwight Howards and some Houston Texans football players using it to rehabilitate from their surgery and/or injuries. The speed of their recovery highlights the ability to strength train sooner. This prevents muscles from getting weaker, called atrophy.

What many do not know is that BFR started with the work of Dr. Owens ( https://www.owensrecoveryscience.com/ ) from Texas. The immediate need and the innovation of BFR came from the desire to help the people in the limb salvage unit. They were weak and could not do many activities, but if there was a possibility of helping them do just a bit of activity, they would have a better chance of recovering. This is where BFR’s story started, becoming the white knight and hero for the very weak people.

The general idea is when performing BFR training, blood flow going back to the heart (venous) is blocked and the arterial blood flow to a region is not impeded. This results in tremendous benefits including the list below.

  • Increased type 2 fiber recruitment which is the faster and strength production type.
  • Increased local growth hormone and IGF-1 by 200-3000%
  • Greater and more rapid accumulation of metabolic by-products such as lactate
  • Muscle hypertrophy with lighter exercise via enhanced stimulation of muscle protein synthesis by 45-55%.
  • The building of non-contractile units that are designed to provide structure to the muscle fibers.

Who requires closer monitoring for BFR?

Cardiovascular diseases such as PVD, pregnancy, those at risk for blood clots, and high blood pressure.

Why does BFR work (in more detail)?

Metabolite theory. 

When you exercise and limit oxygen supply to the muscle, you shift the state towards an anaerobic metabolism state. This state releases lactate and hydrogen ions within the muscle. The pituitary gland in your brain releases growth hormones for you to gain muscle growth with this stimulation.

The benefit of BFR is that you limit the oxygen supply and trick the body to release the growth factor hormone. A commonly referenced study is by Takarada et al study in 2000 demonstrated that you get 290% versus a 170% growth hormone increase with low intensity with BFR or high intensity only, respectively.

The growth hormone helps with exercise recovery through collagen synthesis. You do not get the hypertrophy gains from protein synthesis, but the benefit comes from the collagen impact on tendon and muscle health. As you can exercise heavy, we want to enhance the tendon and muscle integrity for increased safety and sustainability to keep exercising.

There is a connection with growth hormone and the role in insulin-like growth factor-1 (IGF-1). This helps with hypertrophy and the strength gains you will feel after using BFR on a consistent short-term and long-term basis. As a quick summary, you get safety and progression in strength and tolerance with all your past painful functional activities.

As you can see when you are in a position to not stress the tendon as much as you should for progress, BFR can help bridge that gap of low exercise tolerance. The same goes for bone growth and osteoclast formation. Hewitt in 2005 showed occluding the veins has shown to increase bone density and new bone formation. The bone responds to stress load. When you can stress the muscle for growth or maintenance of strength, the benefits and load allow you to bring that to the bone.

Muscle Fiber recruitment. 

Muscles contain fibers that are connected through spinal motor nerves. As the spinal nerves activate a muscle, the strength is dependent on how many motor units within the muscles are being worked. When you exercise and build up lactate, you get more motor units to turn on so you can handle the strength or exercise load. This is the reason for feeling stronger within a short 2 weeks of strength exercising, even though you are not seeing muscle “bulking” in the mirror. Your nerve to muscle’s motor unit communication is more effective.

The same phenomenon goes for oxygen deprivation that occurs with BFR training. The brain gets tricked to turn on more motor units since you get the oxygen deprivation with the exercise resistance. You can DOUBLE the amount of motor unit with BFR when compared to without BFR.

Cellular swelling.  

When you perform strength exercise, you get protein synthesis and suppress breakdown called proteolysis. This is important as protein is needed to reinforce the cell membrane wall to resist the increase in muscle cell growth. When you perform BFR, this pushes the blood flow gains you get into the muscle fibers for hypertrophy.

Numerous studies have demonstrated that you get less atrophy (muscle size loss) when you use BFR. When people have surgery, such as an Anterior Cruciate Ligament Reconstruction to the knee, you can get a 30% decrease in protein synthesis and strength. There was a study that showed BFR without exercising reduced the atrophy. You get much less atrophy when there is BFR with simple exercises.

Myostatin inhibition. 

Myostatin is a protein that stops us from building muscle cell growth and differentiation. When you use BFR, you get this unlocking ability to get more muscle cell growth with minimal exercise load.

Other health benefits.

Cardiac response. As you are adding vascular flow resistance, the heart will have to work harder. The benefit is that you are training your heart muscle during the times of early rehabilitation. BFR brings a great side-benefit with minimal exercise load, and that benefit is improve cardiac health as a factor in prolong pain and sustained an injury.

Whole-body (systemic) benefits. As hormones do not discriminate one region of muscles, a workload to the legs will give you more strength to your arms. A study by Madarame et al in 2008 showed an increase in biceps brachii muscle strength after BFR to the legs. When you do BFR to the thigh, your gluteals muscle located before the occlusion reaps the strength gains. These gains greatly increase from 7-10% compared to 1-2% with BFR and no BFR respectively.

Are you are looking to break free of an old injury that has not recovered your way? Are you dealing with a new injury that you want the “sports-science” advantage? Click on the button below for our complimentary free session.


Danh Ngo PT, DPT, OCS, SCS

Doctor of Physical Therapy

Board Certified Specialist in Orthopedic and Sports Medicine

Onbase University Certified Pitching Specialist

Certified Advanced Movement Specialist – RockTape

Certified Mobility Specialist – Rocktape

Mind Body Health Results Coach