 What’s up, everyone. One of the many treatment options that we offer at Athletes’ Potential is something called Personalized Blood Flow Restriction Training (PBFRT). This is something I remember being blown away about while in physical therapy school and seeing the results that research was showing. To put it simply, it’s one of the best evidence supported treatment options out there and we are thrilled to be able to offer it to the Decatur and greater Atlanta area. There are a ton of awesome benefits with PBFRT, but first let’s take a look at what exactly BFR is. PBFRT is the brief and intermittent use of a tourniquet in order to restrict the amount of blood flow from coming into your limb (arterial flow) while performing low-load resistance training. The way PBFRT works is it reduces the amount of oxygenated blood reaching a working muscle in order to trick your body into thinking it’s working at a higher intensity than it actually is. By using this form of engineered suffering, you’re able to use extremely light resistance and still get the same increases in size and strength as lifting at higher intensities with heavy weight! Exactly how this happens is laid out below:
Essentially, PBFRT is a true biohack that allows people to work at loads that are non-stressful on the tissue but still get improved size and strength. A true game-changer in the world of strength and conditioning. But just like everything else in the world of sports medicine, PBFRT has to be used appropriately and with the right population. Otherwise, you could risk wasting your time and resources. So, who exactly would benefit? Below are three of the most common scenarios that people see the best results.  Post-Injury/Surgery: Muscle breakdown (atrophy) after a surgery or injury happens incredibly fast. For example, when you’re injured or you’re not allowed to put any weight through one of your limbs, in as little as two weeks that limb goes into a state of anabolic resistance and protein synthesis shuts down leading to a 30% loss of muscle mass in that limb! This is obviously extremely problematic and slows down recovery from an injury dramatically. However, with PBFRT we now have the ability to combat that significant muscle loss because we are able to use low intensity and weight levels that are safe and tolerable to the patient and get the same increases in muscle size and strength as lifting at 65% of your one rep max or higher. A great example of just how beneficial PBFRT can be for patients rehabbing from injury comes from Dr. Zach Long who was working with an elite level olympic lifter after tearing his ACL. With this type of injury, more than 65% of patients demonstrate quadricep weakness even a year out from surgery. However, Dr. Long’s patient’s surgical leg became one inch larger than his healthy leg in just three months time after his surgery! Sport Performance: PBFRT has shown numerous benefits to enhancing sports performance, but perhaps the most documented is the ability for athletes to maintain muscle size and strength without the dip in performance caused by muscle soreness. This is possible because there is no muscle tissue breakdown associated with PBFRT since the intensity is kept so low.
PBFRT has also been shown to have a profound effect on your aerobic capacity as well by increasing your VO2 max and capillary beds.
Recovery: Imagine this. You’re training for an upcoming triathlon and are starting to feel a little banged up from the volume pulling, or you’re gassed trying to prepare for a CrossFit competition, or maybe you’re midseason in soccer and have been trying to push through some nagging issues. Now, imagine during your recovery day you rode for just 15 minutes, at a pace well below a typical recovery ride pace, and we’re able to give your tendons that increased HGH we mentioned above, all while boosting your VO2 max AND letting your tissue continue to recover. Sounds pretty cool; right? We have people do that all the time here in the clinic and we are consistently seeing people hit PR’s and feel good doing it. Rehab, Performance, Recovery. That covers a vast majority of the population, and that’s on purpose. The research (over 600 published studies) is incredible and the results we are getting wiht people speak for themselves. However, as the old adage goes, “If all you have is a hammer, everything looks like a nail.” Personalized blood flow restriction training isn’t for everyone, and that’s okay. At Athletes’ Potential we firmly believe we have the most skilled doctors of physical therapy who can use a vast array of treatment options to help you reach your injury or performance goals. Whether you are training through a nagging injury or looking to improve your performance, we would love to help you achieve your goals. Give us a call at 470-355-2106 or fill out the contact request form below and we will be happy to contact you. Thanks for reading, Dr. Jake, DPT, CSCS
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 Last week, we covered the training volume in part 1 of load management. If you missed it, go check it out. Today, we’re going to take a deeper dive into components of load management itself and what you as an athlete, coach or healthcare professional can do about it. I geek out on this stuff so get ready. Any injury ever: FORCE/LOAD > CAPACITY This means any force/load that exceeds the capacity of your tissue’s ability to withstand that force/load. Some examples:
Enter LOAD MANAGEMENT. The goal is simple: to protect you from injury and maximize performance Proper training must be prescribed. Over-training and under-training both increase risk of injury. You want to:
I’d be remiss to not give credit where credit is due: Tim Gabbett and company have been leading the front on this area and are really changing the way teams and athletes are handling training. Now, let’s define LOAD: It is broken down into 2 variables – external load and internal load
We use these two variables to create the: ACUTE: CHRONIC WORKLOAD RATIO (ACWR) This is also commonly referred to as FATIGUE compared to FITNESS. Fatigue being the acute workload and fitness being the chronic workload.
With technology nowadays, we have a number of ways to track this type of data. The most commonly cited method in the research is Session RPE (sRPE), which is time (total number of minutes) multiplied by the RPE for a given training session. The RPE is usually taken after a training session to gauge level of exertion/difficulty. This is measured as “arbitrary units” or “exertional units”.  For example, in week 5, let’s say a soccer player practices one day for 60 minutes at an RPE of 8. That gives us: 60 x 8 = 480 units. She practices 4 times during week 5 with a similar intensity. This gives us our ACUTE WORKLOAD (4 x 480 = 1920 units) for week 5. Now we have to look at her CHRONIC WORKLOAD for weeks 1-4.
When we compare the two, you get: 1920/1808 = 1.06 Now what does this number tell us? This ratio helps delineate whether you as the athlete are prepared for the task at hand – what you’ve done compared to what you’re prepared for – that can be a running a marathon, doing a CrossFit Open workout, playing in a professional football game or doing parkour in your living room.  In terms of injury risk, acute:chronic workload ratios within the range of 0.8–1.3 is considered the training ‘sweet spot’ where injury risk is at its lowest, while acute:chronic workload ratios ≥1.5 represent the danger zone. If you look at the trend of the curve before 0.80, you should notice the injury risk climbs back up – similar to a “U-shaped” curve. This relationship between workload and injury demonstrates that both inadequate and excessive workloads are associated with injury. Now let’s say from the example above that week 5 workload came out to 3500 arbitrary units. That would make the ratio: 3500/1808 = 1.94 No bueno.  If you don’t get this reference, we’re not friends. This athlete is at an increased risk of injury. When training load is fairly constant (ranging from 5% less to 10% more than the previous week) players had <10% risk of injury based on the study by Gabbett et al. However, when training load was increased by ≥15% above the previous week's load, injury risk escalated to between 21% and 49%. This is commonly represented by ‘spikes’ in acute load relative to chronic load. To minimize the risk of injury, we should limit weekly training load increases to <10%. There’s room to work within this, but a great starting point. Athletes accustomed to high chronic loads have fewer injuries than those accustomed to lower loads, and this supports Gabbett’s assertion that higher chronic loads can act as a protective effect against future injury.  These two graphs give a great depiction of what happens when load is applied appropriately:  Compared to excessive load and/or lack of recovery:  This is something I use every day with my patients and athletes. I’ll look at their training program and see if there is a mismatch in training volume and load management. We start here then look to optimize other components of injury and performance training such as stress management, tissue tolerance, biomechanics, physiology, strength, power, etc. At the end of the day, ask yourself this question: Is your body prepared for the demand of the task?
Cheers, Dr. Ravi Patel, PT, DPT, CSCS References:
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