By Dev Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Blood Flow Restriction (BFR) training involves use of KAATSU bands or pressure cuffs to temporarily restrict blood flow during resistance exercises
  • This type of training is reported to substantially increase the strength of the involved limb much more than resistance training alone, and in a much shorter time
  • NCAA D1 and professional sport trainers in the U.S. are using BFR more often now, particularly after conditions such as ACL surgery
  • I’m cautiously optimistic that this training could be a breakthrough method to improve strength but would like to see much more research on safety and effectiveness in recreational athletes

I wrote last week about the benefits of High Intensity Interval Training (HIIT) as a way to get fit aerobically and anaerobically in the shortest amount of time. I love the efficiency of HIIT and continuing the efficiency theme this week I’d like to briefly explore a very different type of training, Blood Flow Restriction (BFR).

Blood Flow Restriction exercise was first used by Dr. Yoshiaki Sato in Japan in the mid 1960s. He later patented his treatement, called KAATSU. This exercise involves performing low load resistive training while blood flow to the working muscles is partially restricted by a pressure cuff or KAATSU bands. Evidence collected over the past decade suggests that performing low-load exercise with modest BFR to the exercising muscles serves as a potent stimulus for increasing muscle mass, strength, and endurance. The beauty of BFR training is that it’s reported to work much better and faster than resistance training alone.

As an orthopedic surgeon I have to admit that when I first heard about BFR training I thought it was crazy. There are a several very serious conditions that can result from occlusion to the muscles themselves, such as compartment syndrome and rhabdomyolysis. But somehow the BFR methods, involving short duration lower amounts of restriction result in temporary restriction of the blood flowing back to the heart through the veins and apparently doesn’t result in pressure increase in the muscles.

There’s increasing research into the mechanisms and results from BFR training. Some researchers have found that BFR can result in a slowdown of the gene contributing to muscle breakdown, up-regulates another gene contributing to muscle growth, and decreases muscle Ph (physiologists say this is a good thing if you’re builiding muscle…).

I recently attended a symposium on the state-of-the-art on rehabilitation after knee ACL reconstruction where BFR training is being used by more and more NCAA Division 1 programs and many professional teams. Like many treatments utilized by elite athletes I expect this will find it’s way into the training methods of adult amateur athletes and eventually young athletes.

This is potentially exciting stuff, well worth following. Even though the method has been SideLineSportsDocaround for about 50 years it’s somehow now gaining a foothold in the rehabilitative and athletic performance communities. I’d like to see a lot more research into the safety and effectiveness for use in recreational athletes so for now I’d recommend we approach this with cautious optimism.