How Blood Flow Restriction Training Revolutionises Fitness

If you are interested in bringing up lagging body parts, making muscle and strength gains consistently, and having the raging feeling that you crushed your workout, then this article is going to be perfect for you.

Let’s be honest, there is a lot of what I like to call, shiny s**t in fitness. Stuff that looks good, but has no basis in efficacy, evidence, or substance. Exercises that make for good Instagram reels. Techniques that get a lot of views on Youtube.

I originally believed Blood Flow Restriction (BFR) was the same. A technique that looked cool, but likely was not nearly as effective as good old fashioned strength training. Then, I stumbled across some research, then read another study, and another. In 2017 I went as far as writing my thesis for my Master's degree on BFR.

Long story short, BFR is effective. As effective as traditional strength training as crazy as that may sound.

Here’s the history, research and how to implement BFR into your training program.

But, the training technique I'm going to tell you about is certainly revolutionary.

History

BFR was discovered by exercise scientist Y. Sato in 1966. During a Buddhist ceremony, Sato, after having been in a kneeling position for a long period of time, realized, “hey this kind of feels like the burn from resistance training.”

Many years of research later, and the concept of Blood Flow Restriction crossed over into the western hemisphere.

Now, 57 years later, BFR has become so popular that you’ve likely seen people using cuffs to occlude their limbs at your local gym.

How Does it Work?

Essentially, you occlude (not cut off), blood flow at the proximal location of your limbs. Just below the shoulders or just below the glutes.

As you know, when performing an exercise, blood gets pumped into the active muscles to contend with the induced stress from the external resistance. Occluding the limbs allows blood to get into the muscles, but not get out of the muscle (as quickly). The blood builds up giving you the best/worst pump you will ever experience. Best because the pump is massive. Worst because it’s also quite painful.

This leads to one of the first misconceptions people have about BFR. It induces muscle growth by causing massive amounts of metabolic stress. However, we are learning that metabolic stress is not a driver of muscle growth. Mechanical tension is the sole driver of muscle growth. And metabolic stress simply leads to more mechanical tension. Same thing with BFR.

Further evidence this is the case comes from research on the surrounding muscles being trained while performing BFR. If metabolic stress was the driver of growth, then it stands to reason only the occluded muscles would see growth. However, it doesn’t pan out that way in the research. A meta-analysis of 9 studies found BFR induces as much muscle growth in the surrounding muscles as the muscle being restricted. For example, if performing the bench press with your arms occluded, you will see as much muscle growth in the pecs and anterior deltoids as you will in the occluded triceps.

How to Occlude

You can use many different apparatuses to occlude blood flow. I’ve just used knee wraps. You can use those floss bands from rogue.

Of course the legs are thicker than the arms (or they should be if you’re not skipping leg day). So you will need something wider and thicker for your legs (like knee wraps). There are also occlusion band cuffs you can get over on Amazon.

You should also seek a 7/10 as far as tightness. Tight enough to restrict, but not so tight that you totally restrict blood flow. If you start to get tingling or your limb turns blue, definitely too tight.

If you don’t want to have to worry about self-regulating the tightness and want the perfect amount of pressure (based on the research) the gold standard is the Smart Tools SmartCuffs. They regulate pressure based on the thickness of your limb as well as your blood pressure. Their 3.0 model uses a small pump with a few quick settings to help you get occluded and lifting more quickly. Their new 4.0 model connects to their app and uses bluetooth, which is fantastic. I highly recommend them. (This is an affiliate link)

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How Well Does BFR Work?

Incredibly, BFR induces as much muscle growth as standard training. This is even more amazing considering you won’t use more than 30% of your 1 rep max on a given exercise when using occlusion cuffs.

This brings with it all kinds of amazing benefits. First, going lighter and still getting the same amount of muscle growth is big for two populations, the injured and the elderly. Of course, a person with a knee injury won;t be able to go heavy on an exercise like the squat or leg extension. But with BFR, that is no longer a limitation. Using a much lighter weight will allow the injured person to still train the surrounding musculature and see muscle and strength gains. There is also evidence suggesting this will help heal damaged joints and tendons. So not only will you be able to continue seeing gains through an injury, but heal from said injury faster.

All these same benefits apply to the elderly. Elderly people don’t necessarily need to do very much differently in regards to their strength training. But, in the majority of cases, the elderly will suffer from some injuries. With use, the human body begins to break down. There are things to help prevent this of course, but in general, it’s not a matter of if an injury will happen, but when. And the longer you’re on this earth, the more opportunity there will be for an injury. Again, however, BFR will allow for an elderly person to not use heavy weights, while still getting the benefits of heavy weights. It’s a win-win.

I would also argue there’s some reason to use BFR for non-injured young lifters as well. If you want to increase the amount of volume you’re doing without putting a lot more stress on your joints, BFR is a great option.

Say for example you want to increase the size of your triceps, but doing lots of skullcrushers, overhead tricep extensions, etc… is uncomfortable on your shoulder and elbow joints. Being able to do these exercises with a fraction of the weight you would otherwise use will keep stress low on the joints, while still causing growth.

BFR also induces the same amount of strength gain as heavier training. On the surface, it wouldn’t seem like that should be the case. But the high amount of metabolic stress, and therefore mechanical tension, induces strength gain.

How to Add BFR to Your Training

Very simple. Replace whatever heavier training you have planned for that workout with its BFR equivalent. Instead of doing 3 sets of 6-10 on a tricep pushdown, perform blood flow restriction with a much lighter weight.

The protocol across most of the research for Occlusion Training is

• 3-4 sets

• 30-40 reps on the first set

• 15-20 reps on all of the following sets

• Roughly 30 seconds of rest between sets

In most of the research, the subjects kept the occlusion cuffs on while resting. This would make sense from the perspective that you want to maintain the occlusion for the entire set. However, one recent study found an improved amount of muscle and strength gain from removing the cuffs between sets.

I recommend keeping the cuffs on for two reasons. Because there is a larger body of evidence supporting keeping them on. And taking them on and off is a massive pain in the ass.

You do not need to do any more volume on top of the Occlusion Training within a workout for that body part. After doing your 3-4 sets, the affected muscles will be toasted. For this same reason, I also recommend leaving BFR to the end of your workout. Your arms and legs won’t be usable afterward.

A quick note on exercise selection. You can use pretty much any exercise you want. Of course, general exercise selection principles still apply. Consider the muscle you want to hit, and reverse engineer things from there. I do prefer using isolation exercises with BFR since I am usually seeking to hit one muscle when using the technique. But compound exercises work as well, and can be beneficial by helping you get some extra volume for the surrounding muscles.

BFR works very well with supersets as well. Particularly for the hamstrings and quads, and the triceps and biceps. Just set up the two exercises you’re performing, and then go through the protocol listed above. Take the 30 second rest break after performing the second exercise. Warning. The most pain (good pain) I have ever experienced in the gym was using occlusion training while performing a leg extension and leg curl. I was crawling out of the gym afterward.

Like always, you should be getting stronger.

Strength and muscle growth are not the same thing, but they are adaptations that usually happen at the same time. So, if you're getting stronger, you can safely assume that you're also building muscle.

As I've said before, use strength as a test for the effectiveness of your muscle growth routine.

BFR is no different.

You should consistently add more weight, reps, or sets, to your KAATSU training.

Once you can complete the top end of the BFR rep-set scheme (40, 20, 20) with consistent form (no cheating), add the smallest amount of weight possible on your following workout. If you’re unable to get to the bottom end of the range (30,15,15) the weight is too heavy.