BFR Radio

Low load BFR training and achilles tendon adaptations - an alternative to high load training

Happy New Year everyone.

Today's podcast looks into low load BFR training and achilles tendons. This is quite an exciting paper due to the positive effects of Blood Flow Restriction training with tendon adaptation. Previously only high load strength training has shown positive responses to tendon so this is a great result for what BFR can bring to the user - i.e. we can finally use low load training to elicit a tendon response (with the addition of BFR).

The other advantage of this session was how simple it was. There was a couple of points that I feel are quite important to note. Firstly, it was a 14-week training intervention. Typically a lot of academic studies are of 4-6weeks in lengths and probably this is why previous studies may not have shown positive training responses. The other point, was an incremental loading protocol - although the loads were still low (20-35% 1RM) every 4 weeks the load was increased by 5% and the subjects' max strength was reassessed and readjusted. This highlights that the body needs a continual increase in strength, even if we are using low-load BFR training. Therefore we can start to look at bringing this type of training to an "at-home" situation providing a simple solution for everyone.

This same principle for other tendons (esp. shoulder and patella) I feel can also be applied. I've had great success with tendon issues acutely and this paper highlights that a longer (14 week) approach to tendon adaptation is needed.

The article I review today is:

Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training.

Centner C¹, Lauber B^1,2, Seynnes OR³, Jerger S¹, Sohnius T¹, Gollhofer A¹, König D¹.

J Appl Physiol 2019 Dec 1;127(6):1660-1667. doi: 10.1152/japplphysiol.00602.2019. Epub 2019 Nov 14.

Abstract

Low-load blood flow restriction (LL-BFR) training has gained increasing interest in the scientific community by demonstrating that increases in muscle mass and strength are comparable to conventional high-load (HL) resistance training. Although adaptations on the muscular level are well documented, there is little evidence on how LL-BFR training affects human myotendinous properties.

Therefore, the aim of the present study was to investigate morphological and mechanical Achilles tendon adaptations after 14 wk of strength training. Fifty-five male volunteers (27.9 ± 5.1 yr) were randomly allocated into the following three groups: LL-BFR [20-35% of one-repetition maximum (1RM)], HL (70-85% 1RM), or a nonexercising control (CON) group.

The LL-BFR and HL groups completed a resistance training program for 14 wk, and tendon morphology, mechanical as well as material properties, and muscle cross-sectional area (CSA) and isometric strength were assessed before and after the intervention. Both HL (+40.7%) and LL-BFR (+36.1%) training induced significant increases in tendon stiffness (P < 0.05) as well as tendon CSA (HL: +4.6%, LL-BFR: +7.8%, P < 0.001). These changes were comparable between groups without significant changes in Young's modulus.

Furthermore, gastrocnemius medialis muscle CSA and plantar flexor strength significantly increased in both training groups (P < 0.05), whereas the CON group did not show significant changes in any of the evaluated parameters.

In conclusion, the adaptive change in Achilles tendon properties following low-load resistance training with partial vascular occlusion appears comparable to that evoked by high-load resistance training.NEW & 

Before you go and listen to the podcast could I ask a couple of favours:

1. If you know of someone who is suffering from achilles tendon issues please get them to listen to this podcast.

2. If you are enjoying the podcast please give it a positive rating on iTunes.

 

Thanks for listening.

 

In the methods, there was a couple of points around how Tendon properties was calculated and I mentioned that I would put it in the notes:

How did they measure Tendon Stiffness?

To assess tendon stiffness, elongation of the Achilles tendon was determined during ramped isometric contractions by B-mode US scans at 100 Hz at the gastrocnemius medialis myotendinous junction

After familiarization with the procedure and preconditioning of the tendon with five trials at 80% of MVC, participants were instructed to steadily exert torque to their individual maximum with a standardized loading rate of 50 Nm/s. This loading rate was chosen because it resulted in a ramped isometric plantar-flexion contraction lasting between 3 and 5 s for all subjects. During this process, visual online feedback of the torque signal was provided. Achilles tendon force was calculated by dividing plantar flexion torque by the tendon moment arm with a subsequent correction for ankle joint rotation by kinematic data

Tendon moment arm was calculated by measuring the perpendicular distance from the inferior tip of both medial (L1) and lateral (L2) malleolus (center of rotation) to the posterior part of the Achilles tendon. For this purpose pictures were taken from the medial and lateral sagittal planes (Sony Cyber-shot DSC-RX100 Digital Camera). In accordance with previous studies, the mean of these two measurements (L1,2) was used for further calculations. Subsequently, the intersection of L1 and L2 was indicated with a needle and the perpendicular distance (M) from the needle to the tendon’s line of action was measured (32). Tendon moment arm was then determined by subtracting M from L1,2 (for detailed descriptions see Refs. 32 and 50). All analyses were conducted with ImageJ (1.51; NIH).

Tendon stiffness was then calculated as the slope of the force-elongation curve between 50% and 80% MVC. This procedure has previously been used in the scientific literature (56). Young’s modulus was calculated as the slope of the stress-strain curve between 50% and 80% MVC.

What is Young’s Modulus?

Young's modulus is a measure of the ability of a material to withstand changes in length when under lengthwise tension or compression. Sometimes referred to as the modulus of elasticity, Young's modulus is equal to the longitudinal stress divided by the strain.

Improve hamstring and hip extension strength with low load BFR Hip Thruster

Hi,

This is the last episode for 2020 and brings to a close a big year for me. I've started my accredited BFR workshop, seen BFR Podcast and the product demand grow. I've also designed my first piece of strength training equipment called the G-Thruster. It is a machine to help with the Hip Thruster movement and the feedback has been great. So today's episode is a case study looking at how using the Hip Thruster (G-Thruster) could be utilised to improved strength and hypertrophy of the lower body. 

It utilises a high-frequency (daily) and low load training methodology as per other BFR studies. Other strength-based studies (i.e.Squat, Leg Extension and Bench Press), high frequency (daily or twice daily) training using low load BFR has reported significant improvements in muscle hypertrophy and strength measures.

This case study also incorporates a few other important points:

• The muscular response to BFR training has been shown to be both distal and proximal to the cuffs. Furthermore, it is the exercise that uses specific muscles that gets the desired response. In other words, if you want response of the gluteals with BFR you need to incorporate Hip Extension and Glute biased exercise.
• Hip thruster movement has been shown to be an effective PAP for sprinting, which leads to a potentially good exercise to incorporate into strength training programs. Furthermore, the hip thruster is a great strength stimulus for athletes who can't load heavy axially through the spine (e.g. squat).

The case study involved the following:

• 2 weeks - daily (3 x week - twice daily)
• Hip thruster - double (+40kg) and single leg (+20kg)
• Reps x sets - Set 1 = 20-30reps, Set 2-4 = 10-15reps
• BFR - continuous pressure (50% AO) using a 10cm wide cuff
• Measurements:
  • Girth: Glutes (max circumference) and thigh (3 points: proximal third, mid-thigh & distal third)
  • Strength measure - Single Leg isometric maximal force output
    • Glute (knee at 90deg) 
    • Hamstring (knee at 170-180 deg)

Although the case study on me, my measurements are relatively stable so any changes would be due to the new stimulus.

The podcast goes through the results however I did see some very interesting girth and strength improvements lending support to using this type of training for athletes that are injured or trying to quickly accelerate change during specific time periods.

In closing for the year, thank you for your support. I appreciate your interaction and comments.

See you in 2021 for a bigger and better year.

BFR & Electrostimulation - combining modalities to accelerate injury recovery

Hi everyone,

With this episode of BFR Radio I was inspired by a recent post from a colleague who started to use a combination modality of BFR and Electrostimulation (EMS) for an athlete who was going through post ACL surgery rehab. Traditionally EMS requires a high level of intensity for it to be effective which is problematic for those who are in the acute postoperative stage. This is where the authors thought that the combination of BFR with a lower level of EMS may prove to be useful.

Before you head off and listen to the podcast, a few exciting updates:

• This week I am at the ASCA annual conference on the Gold Coast. I will have my Sports Rehab Tourniquets there to try and I am also debuting a new strength machine that I have developed. To date I haven't not seen this machine before so potentially a world debut.
• I am running a Brisbane BFR workshop on Saturday 23 November. Tickets can be purchased online only through eventbrite. There are lots of links through my social media and blog post. Click on this link to purchase your ticket  Click on this link to purchase your Brisbane BFR Workshop Ticket (direct link to Eventbrite page)

Hope you enjoy the podcast.

 

The Effects of Blood Flow Restricted Electrostimulation on Strength and Hypertrophy.

Slysz JT, Burr JF.

J Sport Rehabil. 2018 May 1;27(3):257-262. doi: 10.1123/jsr.2017-0002. Epub 2018 May 22.

Abstract

CONTEXT:

The combined effect of neuromuscular electrical stimulation (NMES) and blood flow restriction (BFR) on muscle mass and strength has not been thoroughly investigated.

OBJECTIVE:

To examine the effects of combined and independent BFR and a low-intensity NMES on skeletal muscle adaptation.

 

MAIN OUTCOME MEASURES:

Subjects had each leg randomly allocated to 1 of 4 possible intervention groups: (1) cyclic BFR alone, (2) NMES alone, (3) BFR + NMES, or (4) control. Each leg was stimulated in its respective intervention group for 32 minutes, 4 days per week for 6 weeks. Mean differences in size (in grams) and isometric strength (in kilograms), between week 0 and week 6, were calculated for each group.

 

 

Optimising BFR pressures for aerobic exercise

Hi everyone,

Things have been a little busy lately hence the late podcast.  With my normal S&C work commitments and a few workshops to prepare for I haven't been able to put together my normal schedule of podcasts.  Today's podcast actually appeared on another podcast Snippit Sports Science of which my mate, Jared and I produce.

Speaking about workshops, I will be in Sydney on Saturday October 13th (2 weeks time) to do a new BFR workshop.  Tickets are available through Eventbrite (click on this link to buy your ticket). Alternatively if you know of someone who'd benefit from this workshop I'd appreciate you letting them know and sharing the link.

Today's episode from a practical standpoint helps to understand the optimisation of Blood Flow Restriction pressures when doing aerobic (stationary-based) exercise. I personally have found that dropping my pre-determined BFR pressure by around 20mmHg works best and that if I stayed at this  pressure (I usually do my strength training at) it is just doesn't feel right and is too high. The debate of BFR pressures is an ongoing on and this article helps shed some light as to some great evidence.

Effects of DifferentPercentages of Blood Flow Restriction on Energy Expenditure.

Pfeiffer PS¹, Cirilo-Sousa MS¹, Santos HHD².

Int J Sports Med.2019 Mar;40(3):186-190. doi: 10.1055/a-0828-8295. Epub 2019 Jan 31.

Abstract

The study aimed to analyze the effect of differentlevels of bloodflowrestriction(BFR) on energyexpenditure(EE) and subjective perceptions of discomfort (SPD) during aerobic exercises.

A sample group of 24 young men was required to walk on a treadmill for 14 min at 40% of their maximum speed, with 4 differentpercentagesof BFR (0, 50, 80 and 100%) applied in the lower limbs (LL) once a week with a 7-day interval between the 4 evaluations. EE data were collected during the exercise periods; SPD data were collected after the exercises.

There was a significant increase in EE at 50, 80 and 100% BFR compared to the condition without BFR, and between 50 and 100% BFR; however, there were no differences between 50 and 80% and 80 and 100% BFR. Discomfort showed a significant increase according to the increase in BFR. During the walking exercises with BFR, the EE strongly increased until 50% of BFR; after this level the additional increases slowed.

It can be concluded that when performing aerobic exercises with BFR, there is no need to use BFR levels above 50% to reach satisfying level of EE with only a moderate level of discomfort to the practitioner.

Snippit Sports Science Podcast is sponsored by EliteForm, which brings together cutting edge Velocity Based Training technologies.  Please visit https://eliteform.com and check out their products, StrengthPlanner and PowerTracker.

 

If you want any more information about BFR training or want to purchase your own set of BFR cuffs please visit my website: www.sportsrehab.com.au

How to decrease muscle loss with passive BFR. "How you do BFR" guest is John Vincent

Hi everyone,

Today's article review was selected after a conversation with a colleague around the use of passive BFR to attenuate loss with injury or limb immobilisation.  This is also very relevant with my recent knee surgery and I've used Blood Flow Restriction heavily to assist my recovery.

The article I review is called:

Prevention of disuse muscular weakness by restriction of blood flow.

Kubota A¹, Sakuraba K, Sawaki K, Sumide T, Tamura Y.

Abstract

PURPOSE:

The aim of the present study was to compare the effects of periodic restriction of blood flow to lower extremities with those of isometric exercise on disuse muscular atrophy and weakness induced by immobilization and unloading.

METHODS:

The left ankle of each of 15 healthy males was immobilized for 2 wk using cast, and subjects were instructed to walk using crutches with non-weight bearing during this period. Subjects were divided into three groups: a restriction of blood flow (RBF) group (application of external compressive force of 200 mm Hg for 5 min followed by 3 min of rest, repeated five times in a single session, two sessions per day for 14 d); an isometric training (IMT) group (20 "exercises" of 5-s isometric contraction of the knee extensor, flexor, and ankle plantar flexor muscles followed by rest, twice a day, daily for 2 wk); and a control (CON) group (no intervention). We measured changes in muscle strength, thigh/leg circumferences, and serum growth hormone levels.

 

 

On "How you do BFR", my guest is Jonny Vincenti who recently opens his facility for me to host a BFR workshop in Perth. He is very generous with his time so if you have any questions please reach out to him.

A little about Jonny:

• John Vincenti has over 20 years of experience in the Strength & Conditioning industry, currently running his own Strength and Conditioning facility in Perth, Western Australia - V-Athletic Strength & Performance. V-Athletic is a private sector facility, concerned with the complete athletic performance requirements from junior to elite athletes. 

 

• John is also currently in his third Season as Head Strength and Conditioning Coach at the Fremantle Roosters Rugby League Club (NRLWA) and the Head Strength and Conditioning Coach at WESTSTAR Football Academy – an elite West Australian junior Australian Rules Football Academy.

 

• John is an Australian Strength & Conditioning Association (ASCA) Level 3 Coach, Professional Coaches Scheme Professional Coach and Level 3 Sports Power/Weightlifting Coach with the Australian Weightlifting Federation (AWF).

 Contact / Social Media:

• Email: jonnyv03@yahoo.com.au
• Facebook: V- Athletic Strength & Performance
• Instagram: @v_athletic (VA Strength & Performance)
• Twitter: @johnny_vincenti

Thanks for listening and if you want to order a set of your own BFR cuffs please visit my website: www.sportsrehab.com.au

Accelerate recovery from injury with BFR. "How you do BFR" guest is Nicolai Morris

Hi there,

Following exercise, neutrophils are the first immune cells to initiate the tissue remodeling process via several mechanisms including an increased production of cytokines and recruitment of monocytes/macrophages, which facilitate the phagocytosis of foreign particles, the differentiation of myoblasts, and the formation of new myotubes.

This review discusses the mechanisms through which metabolic stress and immune cell recruitment may induce skeletal muscle remodeling following BFR strength training. This is a fascinating concept to consider when trying to provide a thorough robust rehab model and also provides consideration around including Blood Flow Restriction as a valuable addition to any rehab program. 

The Role of Inflammation and Immune Cells in Blood Flow Restriction Training Adaptation: A Review (Front Physiol. 2018; 9: 1376.)

Authors: Fabrício Eduardo Rossi,¹Marcelo Conrado de Freitas,²Nelo Eidy Zanchi,³Fábio Santos Lira,^1,* and Jason M. Cholewa⁴

"How you do BFR" guest is Nicolai Morris.

Nicolai is an Australian Strength and Conditioning Coach who works at Sydney University as the senior strength and conditioning coach working with multiple sports including swimming, athletics, rugby, rugby 7’s, water polo and soccer.  Nicolai has been coaching as an S&C for 12 years working across private, schools, professional and university sport environments.

Nicolai discusses how she uses BFR in her own training and competition as an elite swimmer as well as the different scenarios with her athletes that she trains.  She is also very active on social media providing great insight into the great work that she does.  Make sure you follow her as I am sure you will gain a lot from her. 

Social Media

@Nicolai_morris (Instagram and twitter)

@susfstrengthandconditioning (work Instagram)

 

And thank you for listening to the podcast.  To purchase your own set of BFR cuffs please visit my website at www.sportsrehab.com.au

Ep 12. Money for Jam - improve cycling performance with BFR. "How you do BFR" guest is Jordan Kerby

Hi there,

Thanks for your patience in this episode. A recent trip to the USA has meant that i've had a lot of work to catch up on and hence this episode has been delayed a little.

Today's episode is cycling strong but the concepts in both the article review and the interview with Jordan Kerby highlight how BFR can be used as a training enhancement tool.

The article I review is called:

The effect of 1 week of repeated ischaemic leg preconditioning on simulated Keirin cycling performance: a randomised trial. 

Lindsay, A., Petersen, C., Blackwell, G., Ferguson, H., Parker, G., Steyn, N., & Gieseg, S. P. (2017).  

BMJ open sport & exercise medicine, 3(1).

Ischemic preconditioning involves a continuous cycle of BFR cuff inflation (3-5min) followed by deflation (2-3min) whilst sitting passively.  Aside from this study showing positive effects in 30second cycling sprint performance, the amazing thing is that it requires the user to do nothing except inflate and deflate the cuffs - Money for Jam I reckon.

In "How you do BFR" I interview elite cyclist and world champion Jordan Kerby.  I am always appreciative of people's time but the time and information that Jordan gave in this interview is just amazing.  I urge you to give this one time as what he is doing is reflective of an athlete who is really using all of his tools in the toolbox to maximise his performance.

A little bit of information about Jordan:

Bio:

• Has been in cycling both road and track for 14 years.
• Did 3 years professionally on the road. Along with winning a national u/23 championship. 
• Switched to track endurance cycling as a preference and it suited his physiology better.
• World Champion in 2017 in the 4000m Individual Pursuit.
• Part of the team that won the 2018 Commonwealth Games team pursuit. 
• Ambitions to go to the 2020 Tokyo Olympics.

Outside of Competing:

• Been a commercial cycling coach since 2016. Having coached multiple state and national medallists as well as an Age Group Triathlon world champion. 
• Currently studying a Bachelor of Exercise and Sport through Massey University. 
• Career ambition to coach a High Performance track cycling team at a World Championship or Olympic level. 

Social Media Channels.

• Twitter; @JordanKerby
• Instagram; @jordankerby
• Website that you can see what I do from a coaching perspective. thepedaler.com.au

Again a special thank you to Jordan for his time.

 

And thank you for listening to the podcast.  To purchase your own set of BFR cuffs please visit my website at www.sportsrehab.com.au

Ep 11. Heal achilles tendon injuries faster with BFR. "How you do BFR" guest is Alex Natera

Hi there,

Rehabilitation of an achilles tendon can be lengthy and problematic.  Today's episode looks at two case studies that used Blood Flow Restriction to accelerate the rehab process where "traditional" processes had previously failed. The article I review is:

 Blood flow restriction training after Achilles tendon rupture. The Journal of Foot and Ankle Surgery, 57(3), 635-638. Yow, B. G., Tennent, D. J., Dowd, T. C., Loenneke, J. P., & Owens, J. G. (2018).

In "how you do BFR" I interview Alex Natera who is strength and power coach for the GWS Giants AFL ("Aussie Rules"). Alex is well known for his isometric and eccentric work of recent time, but he delves into his journey of BFR.  Aside from highlighting some very interesting case studies we also discuss the importance of how to engage athletes in type of training methodology.

Alex regularly posts insightful and educational content on his social media so please give him a follow on the following platforms:

Twitter: @alex_natera

Instagram: @alex.natera

Thanks again for listening. 

If you enjoy my podcast, please leave a rating on iTunes.

Also, remember to purchase your own set of BFR cuffs please visit my website www.sportsrehab.com.au

Thanks for listening

Ep 10. Heal fractures faster with BFR. "How you do BFR" guest is Dr. Chris Brandner

Hi everyone,

Before I get into today's podcast, I thought I'd take this opportunity to let you all know that my new shipment of upper body cuffs is not far away. So I thank you for your patience.  

Today's episode builds on episode 7 on the positive effects of BFR on bone reformation.  This article review is a case study of a bodybuilder who had a lower body fracture and not only was able to continue training with BFR but also experienced an accelerate healing environment. 

Loenneke, J. P., Young, K. C., Wilson, J. M., & Andersen, J. C. (2013). Rehabilitation of an osteochondral fracture using blood flow restricted exercise: a case review. Journal of bodywork and movement therapies, 17(1), 42-45.

In "How you do BFR" I interview Dr. Chris Brandner to discuss a variety of topics associated with Blood Flow Restriction.  Chris did his PhD. in the area of BFR and he has seen quite an evolution over the last 10 years. He brings a wealth of academic and practical experience in this area so I am also honoured to have someone of his credentials on the podcast.

If you want to get in touch with Chris, his best social media contacts are:

• Twitter: @ChrisBrandner
• Instagram: @chris.brandner

 

 If you want to purchase a set of BFR cuffs I have my own brand - Sports Rehab Tourniquet and you buy them at www.sportsrehab.com.au.

I also have lots of information and videos on my various social media channels:

• Twitter: @chrisgaviglio
• Instagram: @chrisgaviglio
• YouTube: SportsRehabAUS

 

Thanks for listening.

Ep 9. How to implement BFR in a professional rugby club. "How you do BFR" guest is Ed Lea. Also your BFR questions are answered

Hi everyone and Happy New Year.

2019 will be an exciting year which I feel will see the Sports Rehab Tourniquet continue to grow in the BFR space. Recently I have upgraded the carry box to an EVA Protective Case.  A case will fit both your upper and lower body cuffs and pump. This is a much sturdier and portable solution to my original box. This is included in the normal price for all cuffs.  You can also purchase the case separately if you feel this would be a valuable addition to protect and carry your original SRT cuffs.

In today's podcast I answer a few questions that I get asked reasonably frequently.  These are some fundamental concepts to applying BFR in a practical setting so I think you will get a lot out if. I enjoyed doing the Q&A segment so if you have any other questions that you would like to be answered please contact me through my website (www.sportsrehab.com.au)

I also have Ed Lea from Harlequins Rugby Union on "How you do BFR."  Harlequins Rugby Union club are a professional team based in the UK.  Ed has been working as rehab Strength & Conditioning Coach at Harlequins for 6 seasons and has recently started to implement BFR over the last 12 months.  Ed discusses his journey with BFR but in particular highlights how he uses it in a few scenarios.  

If you want to get in touch with Ed his best contact is Instagram: @edlea87

Thanks again for listening.

If you enjoy the podcast please leave a comment on either iTunes or via my social media:

• Twitter:@chrisgaviglio
• Instagram: @chrisgaviglio