Monday Morning MD: Game changing rehab/workout technique

Athletes have long searched for a shortcut to success. Blood flow restriction (BFR) training may be that answer. Yesterday, ESPN featured BFR training on Outside the Lines and how it is catching on in professional leagues. BFR training involves light workouts with tourniquet bands to control blood flow to the extremities. It can be overly simplistically described as a convenient way to altitude train in a lower oxygen state, but that would be short-changing the muscle hypertrophy and potential systemic benefits. Modifying circulation to the extremities allows the body to use up the oxygen carried in blood. This creates an environment where light activity can reproduce the gains of heavier workouts. BFR is the recent American term that is catching on. The Japanese were the first to popularize it decades ago. BFR I first learned of and reviewed this cutting-edge technology over 10 years ago in the form of KAATSU training. While traveling to Tokyo with the USA Rugby Sevens team five years ago, I sought out Dr. Sato and spent a day with the inventor of this specific form of BFR training. He refers to it as blood flow modification (as opposed to restriction). This blood pooling technique has been popular in Japan for over two decades. Decreased blood flow equals less oxygen available to limb muscles allowing light resistance exercises to equal that of heavier workouts. There is local effect of lactic acid buildup but there is a claimed systemic effect as well. Where BFR training has taken off is in the rehabilitation world. In the United States, its roots began with use in the military in treating severe limb injuries. Among the first NFL users was Jadeveon Clowney as he “looked spectacular” in his recovery from 2014 microfracture knee surgery. ESPN injury analyst Stephania Bell has been a proponent of BFR training and reported that 20 NFL teams were now using the technique. It has been presented at the NFL Physicians Society meetings during the Combines. I have believed in this technique for years and currently am using it on three USA Rugby players as they recover from surgery (2 ACL tears and a tibia fracture) and hope to make the short timeline of the Rio Olympics this August. Athletes lose muscle girth when not able to workout in the post-operative period. BFR training allows one to keep muscle mass and fitness when you are limited in workout abilities. Muscle gain at lower loads has many implications beyond making middle-aged Americans looking for a workout shortcut happy. If one can put less stress on the body to maintain fitness, that potentially leads to career longevity for a professional athlete. It may even lead to reduced late season injury and breakdown from cumulative stress. An NFL player with articular cartilage wear essentially has limited “tread on his tires”. Imagine if he could workout at lower loads and still stay in shape while not “burning more rubber”. The potential systemic benefits of BFR type training is even more exciting. In theory, BFR training also stimulates the pituitary gland to produce natural and legal human growth hormone (HGH). In addition, this type of HGH is more effective than the synthetically produced kinds. Also VO2 max (oxygen usage or a measure of aerobic fitness) is said to be improved with even light bike riding. Safety is a natural concern when limiting blood flow. However, BFR training has been proven over time to have few complications. KAATSU, the most vetted type of BFR training, has shown an excellent safety profile over more than two decades. When used with proper medical supervision or training, there has not been reports of nerve or vascular injury. After all, in surgery, we routinely will use tourniquet for up to two hours, whereas this total training here is targeted for under 30 minutes. BFR training/rehab makes intuitive sense. Athletes feel the burn with light exercise and early results are encouraging. With more and more NFL, MBA and MLB teams jumping aboard, this type of training has definite potential to be revolutionary. Who wouldn’t be excited to train at lower loads with less stress and get the same benefit?
Dr. David Chao
Two decades of NFL team physician experience including two Super Bowls and two Pro Bowls. Providing unique perspective to injuries and the NFL sideline/locker room. Successful orthopedic surgery and sports medicine practice in Southern California.

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