Blood Flow Restriction Training

Joseph Marcus

joseph-marcus-catalyst-podcast
Catalyst - Health, Wellness & Performance Podcast

Full Transcript

Dr. Cooper

What if you could reduce the amount of weight that you’re using in the weight room or the wattage level on your bike trainer to get the same or better results? I know it sounded like science fiction to me when I was first introduced the idea of blood flow restriction training, but we looked in the evidence and this is the real deal. Our guest today is Joseph Marcus, founder of vault, the most respected name in blood flow restriction training. And he walks us through this fascinating option that is research-based not only for surgery and rehab settings, but also for athletes looking to get faster and stronger. Welcome to the latest episode of the Catalyst Health, Wellness, and Performance Coaching Podcast. I’m your host, Dr. Bradford Cooper of the Catalyst Coaching Institute. And this one literally came out of left field for me, but this is, this is the real deal. And you’ll be glad you tuned in. On the coaching front, if you’re looking to pursue your health and wellness coaching certification, including the NBHWC national board certification, if desired, your next opportunity is June 5th and 6th. And this one started filling even before we closed out our March program. So if this is important to you and that timeframe works, don’t wait to check it out. All the details are available at CatalystCoachingInstitute.com or feel free to reach out to us anytime. And we’re happy to answer all your questions, email is, [email protected]. Now let’s tune into the intriguing insights of Joseph Marcus and the opportunities that exist with blood flow restriction training on the latest episode of the Catalyst Health, Wellness, and Performance Coaching Podcast.

Dr. Cooper

All right, Joseph Marcus, thank you for joining us, buddy. This is, uh, this is going to be an intriguing conversation and I appreciate you making time for it.

Joseph Marcus

Cheers Brad, looking forward to it.

Dr. Cooper

So let’s set the stage a little bit because as I mentioned to you, when we were talking beforehand, a lot of folks are like, wait, blood flow restriction training. I don’t even know what that is. I did some research leading to this obviously, but what is it? How’s it used? And how long has it been in the, and we’ll use mainstream a little bit soft here today, but talk us through that a little bit.

Joseph Marcus

Yeah. So, um, the method of blood flow restriction, training dates back to the very late 1960s with it’s development in Japan, when it became a popular or more mainstream in Japan in the early 1990s in the Westport, in the, in the early two thousands, when it sort of gained more notoriety and use from the first exposure, but then also clinically, uh, with sporting teams then practitioners using it for rehabilitation mostly, but the prominence of blood flow restriction training over the last five years has gained momentum dramatically. Yeah, because if you can’t engage in high load training cause of injury or being load compromised, there’s no real good second option. So this lends that, that sort of, um, applicability as being a good second option to high load training.

Dr. Cooper

So tell us a little bit more what, I know what it is just cause I’ve, I’ve looked at some of the videos, that kind of thing, but for the person that’s listening to this on a podcast and they’re like, wait, what, what I mean, you’re, you’re essentially restricting the blood flow to some of the major muscle groups as you’re working. Uh, can you give us a little visual of that? So people understand what we’re talking about?

Joseph Marcus

Yeah. So, um, blood flow restriction training is, um, the application of a tourniquet like device, uh, applied to the upper limbs. So for the upper body, it would be the most proximal humerus area. So the deltoid tuberosity is the landmark you’re looking for and for the legs would be the um, basically it’s inferior to the inguinal fossa, basically as high up on the thigh as possible. So you have the application of about tourniquet devices on the limbs in combination with, uh, exercise, uh, typically low load exercise. So around 30% of the previous one hour and what that does. So the, basically the addition of, uh, the restriction bands or the blood flow restriction causes the muscle to fatigue at a much lower threshold than typically we would, that that would happen. So in that fatigue is what is instrumental in causing the positive adaptation. So say a low, cause low load training, isn’t ineffective and high load training is very effective, but basically it’s training to failure. So 10 RM is 10 repetition max. So the amount of weight you can lift 10 times. So theoretically you can’t lift an 11th rep because you failed 10. So that’s why high load training typically is very effective because it’s psychologically, physically very difficult, but psychologically lifting five reps versus lifting a lighter weight, five 50 times or a hundred times, it takes a lot more psychological energy. And also it takes a longer time as well. That’s why low load training isn’t typically prescribed and typically well tolerated by people in a rehabilitation setting or athletes trying to gain a performance edge because it’s difficult to implement and, uh, difficult to basically progress because you’re training has so many reps and doing so many sets. So BFR training decreases the amount of reps required to reach failure. So say, uh, without, or the application of blood flow restriction, you’d need 50 reps to reach failure with a low, a low weight, say 20% of your RM or whatever, whatever it may be with BFR, you reduced the amount of reps required. So you fail much more quickly. Um, and you get a lot more benefits in a shorter period of time, depending on the previous level of, of your previous level of fitness. If you’re quite detrained, you would get a much more pronounced, um, uh, response. But if you’re quite trained, the response might be a little bit diminished.

Dr. Cooper

And just for the folks listening to that said, wait a minute, did he see a tourniquet? And yeah, those of you listening and not, not, you know, and you’re not pulling this up online or something. It literally is like a tourniquet at the top of the, kind of where the biceps drop back into the deltoids and then at the top of the quadriceps. So can you talk us through some of the, just throw out a study or two on this? I know there’s a ton of research on this cause I dug in before we chatted, but the folks listening are going, wait, you’re telling me, put a tourniquet on my arm and that’s going to give me an advantage either in rehab or as an athlete? Give us a couple of examples if you could?

Joseph Marcus

Yeah. Uh, quite, uh, quite interesting example from two years ago, now three years ago now 2018 was with, um, elite power lifters, basically with a power lifter, you assume that they’re at their threshold of muscular development. Um, as you would imagine the strength training, but they, um, so this is a study by boron and yeah, it was basically with national level powerlifters application of blood flow restriction training in addition to that a six week training block. Um, and then the interesting thing about this study, it was not of in, um, concurrent basically sessions. It was, it was sort of separated by an hour rest period in between. So, so it was two, one week blocks of BFR training and it led to so, um, the strength there was no, and at the end of the intervention period of six and a half weeks, that the, that they didn’t have an improvement in, um, strengths because you would assume it after it already they’re fresh off of strength, but they had an improvement in, um, quite an improvement in muscle size, which is quite interesting in that study as well. So that was sort of an elite sporting sort of athletes can still get a performance benefit from lifting say 30% their one RM. So that was quite an interesting study, which came out from elite sports in terms of more sedentary populations or whatnot. I think that’s probably where the bulk of the sort of benefits can be seen is the fact that like it seemingly leads the comparative results. One study from 2012 through Vento is looking at, um, again physically active, um, males. So not elite elite athletes, but still physically active males. And one was doing high load training. So they were looking at doing 80% there. Um, uh, one-rep max. So I think the traditional sort of three by eight rep scheme, and this was, was full body, uh, knee extension, uh, exercise. And then also the BFR group was looking at training with 20%, their one RM, and there was more of a high sort of three sets of 15 or so eight weeks. So they were doing two sessions a week. The, I think probably looking at close to a 40% improvement in the strength, one RM strength at the end of the intervention period, probably around a 6% improvement hypertrophy and the same for the high intensity group as well. But the usefulness is in that particular scenario was one group was lifting 80%, their one rep max and the group was lifting sort of 20%, their one rep max. So you’ve just reduced 60% of the load necessary to sort of see the equivalent equivalent responses in strength and hypertrophy. So again, I think that’s probably, um, the usefulness of BFR training would be the decrease in sort of joint stresses required to achieve results. And I think the results are more with sort of the more detrained you are. So if you’re a highly trained athlete, you may get some benefits and add the additional blood flow restriction training. But if you’re returning from an injury, if you’re elderly, if you’re detrained, I think that’s where you get a much more pronounced exercise effect.

Dr. Cooper

Well, and as you were saying that I’m thinking exactly what you just said, that the elderly opportunity here, if you’ve got a 70 year old, that’s wanting to stay fit, but doesn’t want to be sitting there throwing 200 pounds on to squat or bench press or something like that. Any safety considerations here, has there been anything out there? Of well, you know, you need to be, obviously you can’t tighten it too much, but any guidance along those lines for people that are saying, I need to check this out.

Joseph Marcus

Just like generally with exercise prescription, there is contraindications to doing, but for restriction training, um, which would be similar contraindications to doing exercise training just more generally, particularly immediate red flags, which come to mind with say safety concerns, which probably most people have in their mind when they think about tourniquets and whatnot would be, venous thromboembolisms would be number one, a history of any sort of, um, hypercoagulability or like blood clotting disorders. And then lymphedema would be something else to flag active cancer and peripheral neuropathy or diabetes would be sort of immediate contraindications or at least warrant medical follow-up just to investigate sort of, cause I think ultimately with any modality it’s safety is the balance or the definition of safety is the balance between risk and reward. So I think, yeah, so I think nothing’s inherently safe. It’s just the risks and rewards are outweighed by the risks. So, but in some circumstances the risks may be higher than the rewards. And then maybe you would, you don’t complete that modality. So I think it’s up to the individual to determine the suitability of those things, but basically understanding there is some contraindications and risks, but there is a multitude rewards available, but whether that that’s on a case by case worth it, case by case basis worth it to the individual.

Dr. Cooper

Okay, good. So endurance training versus strength training, is there a value for, let’s say a endurance, a marathon runner, a triathlete in anything? Because when I think, okay, in the first study, the elites had hypertrophy, so that’s just adding weight so that the endurance athlete doesn’t want that unless there’s strength that goes with it. Have had there been any studies done that you’re aware of that benefited the marathon or the 10,000 meter runners, the track athletes, et cetera, outside of say a hundred meters?

Joseph Marcus

Yeah. The, there hasn’t been so much that, that I’ve read anyway so much to look at sort of the application in particular endurance sports of that nature. There’s definitely, um, aerobic benefits that can be achieved with BFR training just generally with the application of blood flow restriction and cardiovascular exercise. So in terms of what that looks like the criticals generally, so say for strength training, they’re looking at the application of four sets of an exercise with 50% restriction of blood. And then that’s sort of the strength protocols and for improvements in sort of VO2 max or aerobic improvements, the application is about 40 to 50% of the current VO2 max or using heart rate reserve as the percentage to train out so 40 to 50% of that value and just engaging in low load aerobic exercise can lead to improvements in VO2 max in individuals there that wouldn’t be a multitude of studies looking at, but there’s quite some emerging literature looking at the, at the aerobic benefits of blood flow restriction. And yeah, there’s one study which comes to mind by Abe in 2010, which is basically the addition of the blood flow restriction to low load cycling three days a week, 15 minute sessions. And they compared that to free flow exercise for 45 minutes first for the same three to three patients a week for three weeks, the free flow exercise training at 40% of the VO2 max had no improvements or very little improvements in muscle strength and VO two max, but then the BFR group had, I’ve just pulled it up now. So they are training at 40% of their VO2 max for 15 minutes, three times a week for three weeks, they improved quadricep muscle size by 3.4% quadriceps strength by seven and a half percent VO2 max by six and a half percent. Um, and that was their training at 40% of their VO2 max, 15 minutes.

Joseph Marcus

So I think in that example, um, it lends itself to some interesting applications in terms of endurance athletes, wherever it may be 5,000 meters or 10,000 meters or ultra, it’d be difficult to determine. But the interesting thing is the utilization. Basically the, I imagine the fitness of the muscle to utilize energy is improved with exercise training just generally. And I think blood flow restriction training improves the ability of the muscle to use and utilize X energy much more efficiently in the same way as, as exercise training does genuinely. So I think in terms of improving aerobic performance in that respect, I think that would be limited in terms of, uh, as you get further and further away to a more of the aerobic system, then the cardiopulmonary system becomes more of a driving force. So I think as the distance increases, maybe the utility of BFR training decreases in terms of that, in that athlete, but for say, yeah, particularly for a detrained athlete, the application of BFR training to improve aerobic fitness would be, a good utilization, cause it just generally improves the muscle function and its ability to utilize energy. So that will then allow for a higher level of cardiac output, but say someone who’s very trained, then it might be the result of BFR training would be diminishing.

Dr. Cooper

Yes. Okay. You really got my attention now. This is interesting. So would they actually run with these on their quadriceps or does that only work with cycling because you’ve got a little bit more separation. What have, have you, have you seen folks using it in running?

Joseph Marcus

There hasn’t been, I haven’t seen running, um, but definitely, uh, sprint walking intervals and cycling and rowing exercises, which are, and, um, there were, there was one study which I can recall was with sprinting. So, but they were running at reduced rate and weren’t necessarily sprinting. I think they were training at say, it may have been sort of 50% of max sort of speed I’ll have to pull that up, but because the addition of blood flow restriction things quite interesting in terms of the applications in the space of more performance. And I think that that’s a space, which all they could do a little bit more deep diving into because strengthened hypertrophy can be sort of studied quite easily in a lab, I imagine, or think that the higher level sort of performance aspects, I think that there was some studies looking at the application of blood flow restriction training intercession. And there was some interesting results with that, but in terms of a late scores or prolonged aerobic activities, I can’t recall doing any studies.

Dr. Cooper

So another question down this path. So when you think of a triathlete or, or an endurance athlete, one of the problems is fitting everything into your life. So if you have a, uh, I don’t know, a tempo ride day where you’re really hitting hard on the bike, then you go out to work out in the gym and you’re just like, you’re cooked there’s just nothing in there. I’m imagining that you’re saying, okay, you do the hard bike workout, and then you, you do the BFR. And now, even though you’re tired going into the weight workout, you can still get benefits, even though your body’s not ready to do the, you know, one rep max or even five rep backs, but we can drop that down. Am I hearing that right? Is that, is that the potential you’re talking about?

Joseph Marcus

The question which comes up quite often is basically the application cause there’s no doubt that BFR training is a useful modality, but what’s the case in terms of how when and why you’d use BFR is sort of a little bit unknown at the moment, so people know that it’s a useful modality, but then how do you utilize it to get the most effect? And I think having discussions sort of along those lines over the years, I think as you’ve mentioned for an apparently healthy athlete who has no other injuries or whatnot application of BFR probably would be a user case, as you mentioned. So if they’re psychologically fatigued, if they’re physically fatigued and the idea of doing a second session a day with heavy resistance training, isn’t possible, and then still being able to get a stimulus into that day with a low load session, which then will offer, uh, results, which are more profound than low load training. I think that’s, uh, quite a, um, could be a, quite a useful application of BFR training would be the fact that if you went out for a 10 kilometer run and you were quite, your central nervous system was quite taxed and you were in the idea doing sort of heavy resistance training, wasn’t possible the application of BFR training to a low load session, um, would be a good user case. I would say in terms of that application, just to get in that volume of training without exerting, without sort of the additional physical stress, because you are training with 20 to 30% of your one rep max, it is BFR training. Isn’t, isn’t easy, but in terms of the metabolic effects, because you get so much because basically, so how the BFR training works is when you apply the cuts to the upper arms or legs arterial flow from the heart is underneath high pressure. So it goes into the limbs and then basically how blood flow works is the veins then bring the blood back to the heart, which are underneath lower pressure. And blood flow restriction training you’re sort of targeting. You want to be more specifically targeting the venous return back to the heart, which is underneath the lower pressure, but you are partially restricting the oxygenated blood into the limb. But so because there’s blood always going, um, uh, into the, into the limb, you get that blood pooling effect of blood, not being able to come out and that’s what’s causes the, um, basically the muscle to fatigue. So you get that muscle burn feeling. So it’s not, um, the exercise, it’s not like it’s easy, but it’s not as once the cuff comes off, you don’t feel that heavy aching of having done a five by five squat session or whatnot, which you get typically, right? So it’s very, very transient in terms of the response in terms of it’s very difficult when the cuts are on and you’re exercising, but once the cuts come off within three to five minutes, you’ve got full recovery and yet you feel quite recovered.

Dr. Cooper

So what if the reverse is done then instead of, you know, I’m more endurance focused. So I would do the bike first and then go do the gym. But, but with this, it sounds like, yeah, hit the weight room, do this because as soon as you take those things off, you’re going to be fine. Now you can hop on the bike and do your thing. Is that more?

Joseph Marcus

I would say you’d emphasize what was most important to the athlete, but that sounds like a cause you weren’t, I don’t imagine if anything. Yeah. There’s there was one study which came out, which is quite interesting. It hasn’t got to a full, a full ground-based, uh, a multitude of studies to support it just at the moment, but it was looking at the, the application of blood flow restriction with, uh, one exercise in that study, it was looking at a dynamic lunge, split squat exercise and application of blood flow restriction training doing I think it was four sets of 12 of a lunge exercise with blood flow restriction cuffs on the legs and immediately taking the cuffs off and then completing a jump exercise. And the jump that the flight time was improved by 4.9% immediately afterwards. So they’ll do a neuromuscular patterning kind of a potentiation occurring, um, which improved the physical outcome of jumping. So that’s, I find that interesting in terms of the, cause typically for neuromuscular activation, you’re training with heavy weights or doing some sort of active, strenuous active drills. So the application of BFR, some body weight squats, and then saying that improves a physical outcome like, um, uh, jumping, then there might be some use of, a pre some sort of physical drill or activity with BFR could be a useful addition. So if that’s the case, say if the athlete was doing a weight session with BFR and then went through the cycle, I’m curious to know sort of how their session would go. I would say that that’s just anecdotal. I haven’t sort of read that, but I wouldn’t imagine there would be too, um, uh, taxed in terms of, um, compromising this, um, performance on the bike, but that that’d be something to be explored.

Dr. Cooper

And then I’ve read about potential benefits on recovery days. What are your recommendations in terms of athletes or individuals using it as a recovery tool to make that in-between day allow them to do get more results, but not feel the fatigue that sets up the following day as a disaster day?

Joseph Marcus

Yeah. Uh, that’s a good one. Um, in terms of the use of BFR training as, as sort of active, um, recovery tool, or I would say in terms of, um, there won’t be too much, too many studies looking at basically, uh, improving recover,y but in terms of how it could improve scheduling exercise sessions would be what we just discussed in terms of exercise, the dose it’s very low in terms of what’s being exerted upon the joints and ligaments that you could still get an exercise session in between heavy transitions. Right. So, yeah.

Dr. Cooper

Yeah. It’s not improving your recovery, it’s just allowing you to do that workout with less need for recovery.

Joseph Marcus

Exactly. I would say that unless I’m strain and muscle damage is occurring, so you’re not getting the complete sort of tearing of fibers and then excessive joint stresses and the taxing system of your own central nervous system. Yeah. So I I’d say, cause it works more metabolically as opposed to mechanical, so mechanical stress of heavyweights isn’t there, but in the system of, um, uh, of metabolic fatigue can be cleared by the body quite effectively after the tourniquet has been removed. So it’s very much more of a trained response in athletic athletic population. They’re, they’re, they’re doing BFR training daily. Yeah. So it’s been six days in a row in one study, um, and that led to improvement. Um, I think that was yeah. Power and strength. So in terms of, um, versus high load training, it seems to be well tolerated in that respect, but just like anything is still is an addition continuous with an athlete who is conscious of their load at this, do have to be mindful of where that sits into their training schedule. Right.

Dr. Cooper

So do we need to, with that said, do we need to cycle on and off? Do you need to use BFR for a month and then not for two weeks and then come back? Or what do you recommend there? And I know not everything’s established with complete, you know, detailed research, but what are your recommendations?

Joseph Marcus

Yeah. In terms of cycling through BFR, there’ll be no reason to cycle on and off. You’re not going to get in terms of basically if you’re not using it on too many, non-consecutive, on too many consecutive data. So you have, you’re applying basically the same principles of exercise prescription. So one day on one day off, maybe alternating between muscle groups, maybe an alternating between aerobic and resistance training as well. You’d be okay to implement BFR long-term. And then basically the only thing you’d be doing is every two weeks or so, um, reestablish your values or the pressure that you’re using and get another baseline and continue exercising again.

Dr. Cooper

And in terms of those values in the, the, the pressure you’re the founder of the air bands, did the air bands do that for you? Is there any, I’m thinking the athletes that’s working out by themselves, you know, athletes, we can be a little psychotic sometimes like, Oh, I’ll just go harder. Are there some things that they need to be aware of? Or does the air band or other devices like it protect you from being an idiot?

Joseph Marcus

Yeah, that’s probably the main point to emphasize with blood flow restriction training cause the pressure are submaximal cause you’re still wanting, uh, oxygen, which, which makes it that that’s what adds the, um, makes it effective. It’s the fact that there is oxygen and makes it safe as well. The fact that there’s oxygenated blood entering the limb, and you’re only sort of specifically openly targeting the deoxygenated blood pressures are sub maximumal. So that value is traditionally called arterial occlusion pressure arterial occlusion pressure, which is basically the amount of pressure required to cut off blood flow distal to the application of a tourniquet with the, um, uh, some devices don’t do that. And then application of a distal probe is required. So say for the more manual devices, the cuff goes on a distal probe is applied to the radio artery. Um, the cuff is pumped up and at the point where the radial artery is absent is that determined would be your occlusion pressure. And then you exercise at 50% of that value. So say if that was 150, your BFR pressure would be 75. And the idea there is it’s high enough to target venous flow back. So you’d diminish the slope, but low enough to allow arterial flow installing. So that’s what helps with the cell swelling, um, gets causes all the blood and then causes the fatigue and the muscle, and that triggers the pathways to improve strength and hypertrophy. So that’s submaximal would be what they’re after and with air bands, they are then mapped algorithm where they basically a sensor, which determines sort of the blood pressure, the blood values to be used. And it gives you that gives the athlete that value automatically. So without the necessity for a digital program.

Dr. Cooper

So the athlete that’s like, Oh, I’m going to go hard. That’s not a thing like the, the machine keeps you from being an idiot basically?

Joseph Marcus

Yeah. The machine makes recommendations to use basically values, uh, presented to you and then there’s prefix values of percentages to use. Um, yeah. So I’d say it’s strongly encouraged that you don’t succeed basically 50% is generally a benchmark to be training around with BFR training. And there’s no reason to go any higher than that unless you’ve been invited. Um, otherwise I’ll be working with the specific goals of the strength and hypertrophy. It gives the percent of that value seems to be a very good place to be training at of the occlusion pressure. In some studies they use higher pressures, but they’re trying to achieve different results. So for strength or endurance would be 50%. Let’s say if you’re using BFR training to cause a modulation of pain responses in all them. So say someone’s, who’s had recent, he has anterior knee pain that they’ve done some studies application of, uh, 80% of the pressure value to reduce pain acutely. That seems to be quite promising in pain reduction and also in the absence of exercise. And you’re just trying to use BFR training, passively prevent muscle loss. Again, using a hundred percent has been shown in some studies to be an effective way of reducing muscle atrophy without the presence of exercise. But the idea I imagined how I visualize it is kind of like a Seesaw. So if mechanical stress is very high, then you need very little BFR. So if the athlete can train or the athlete is training very heavy, then they don’t need any, if the load is 50% and then they, maybe they, they may, they can use a little bit of BFR to get additional thinners. And as the load is very little, maybe they use a lot of BFR to get stimulus. So it’s kind of like, it works inverse.

Dr. Cooper

So we’ve been talking mainly about athletes, but you touched on the rehab setting there. Can you talk us through how it’s been used? There is it primarily, knee surgery, shoulder surgery, elbow, like what are some of the most common uses in the rehab setting for the BFR? Because everything you’ve told us would fit for the rehab setting, but, but where are you seeing this used the most?

Joseph Marcus

Yeah, the most one wide adoption has been post-operative ACL’s has been, um, because I think with postoperative ACL, there’s such a small window where you can gain a lot of, um, of benefit by cause preventing attributes. So I think 48 months postoperative a lot most, ACL patients still experience knee pain, which is directly, I started sharing it with quadricep strength. Quadriceps strength is number one predictor of outcomes. If you can prevent the loss of quadricep strength, post-operatively immediately, then you’re just accelerating the rehabilitation program because you haven’t lost the muscle strength. You don’t have to regain it. So that’s why BFR in that acute period, um, seems to be very widely used by elite sporting teams are particularly in the U S you’d say we’ve been on the forefront of utilizing blood flow restriction training in an, in an elite sporting setting. I’d say the majority of, of professional teams in the US would be using blood flow restriction training in some way, but most likely postoperatively and most likely with ACL’s.

Dr. Cooper

Achilles biceps elbow?

Joseph Marcus

There’ll be no reason why the application will be different for the same injuries, Achilles, whether it’s repair, whatever the condition may be, if you can benefit from, uh, the maintenance of muscle mass and the improvement of strength, BFR training. And if you have your, and then if you’re worried about the graft or the surgical site being compromised by high loads, BFR is very, very, very good option. And particularly if you can use BFR multiple ways. So the roadmap for say, using that for instruction training, say it’s used, uh, an ACL as an example, the athlete ruptured their ACL, typically they also then damaged their medial collateral ligament, and also the meniscus. So they’ve done a lot of damage to their knee so that they may be not that ambulatory. And typically I think they wait four weeks. And so between injury and surgery to operate on that application would be sort of post-injury pre-surgery to maintain or improve quadricep mass as much as we can leading into the third surgery, um, would be a good option. And then studies looked at applying, uh, blood flow restriction training, I think as little as a day to postoperative ACL. And they used it for day two to date 14. And in that study, again, it hasn’t been super widely researched in terms of its ability to prevent muscle loss. This is quoting a hand, a handful of studies, but, um, it took a run at, I think was 2000 book that fits the percent reduction in the quadriceps cross-sectional area of the leg it’s application of blood flow restriction, uh, at very high pressures. Um, again, not, not widely replicated, but again, an interesting study to look at, but the combination of, um, different modes, layering modalities, I think the coupling BFR with sort of knee exercises passively in bed, a coupling BFR with stimulation, and there seemed to be promising things to improve the effectiveness of other modalities. Let’s say, let’s say for a ACL, you can use it preoperatively. You use it immediately, post-operatively passively. And then once able, maybe the additional blood flow should share plus cycling to again, improve quadricep mass and cardiovascular fitness, and then the additional blood flow restriction training just the close chain open chain exercises. So it sort of gets you to the point where you can begin a more strenuous, rehabilitation exercises, but without having as much downtime in between injury and a more medium to high load training. That seems to be how the elite sporting teams are using it, basically in those acute period where load is an issue and they can bridge the gap between no trainings and high trainings.

Dr. Cooper

Okay. Um, okay. So a lot of our listeners are health and wellness coaches. So it’s outside of our scope of practice to say, you should try this, but as we continue to see this more and more clients are gonna be asking about it, what are some of the key questions the coach should ask the client to clarify whether maybe it is something they should look into or not? I mean, is this something, you know what it’s for pretty much everybody post rehab post-injury pre surgery athletes. Is there anything they should be looking for where the person kind of gives them a red flag that I better not talk about this much?

Joseph Marcus

Yeah. I’d say, um, the, the, uh, clients, uh, preparedness for exercise generally. So there, I haven’t had much experience with resistance training, just, uh, in particular pain. They are, they’re very, um, if you, if you didn’t, if you didn’t advise someone that did that, that they’re going to experience muscle pain or DOMS post exercise,

Dr. Cooper

And DOMS is delayed onset muscle soreness, everybody just for the rest of the folks. Yeah.

Joseph Marcus

And then if, if, if, and then you took them to a strenuous exercise session two days after a day after they, they might think something’s very wrong. I imagine. So I think with blood flow restriction and changes, letting them know that what they experience of muscle tightening, enlargement transient discomfort is very normal during the exercise, during the exercise and be able to differentiate between normal symptoms and bad symptoms, the bad symptoms would be changes in temperature of the skin. So cold, hot, inability to determine temperature of the skin. That means you effected the nerves too much pins and needles would be, would be one. And I’m just kind of like any sort of sharp shooting pains. So being able to do discern between those two sort of okay, um, reactions and not okay reactions to the blood flow restriction, uh, people’s sort of, uh, ability to robustness, to withstand sort of discomfort as well. So if someone doesn’t typically like resistance training anyways, and then you’re not only getting to do resistance training, you also then getting your resistance training underneath and additional stimuli, but just generally it wouldn’t be beyond the medical red flags in terms of contributions, I’ll say BFR training would be useful for most populations barring any sort of explicit contraindications. Cause I think it’s a, in terms of pain, it’s not uncomfortable. It’s just, it’s not painful. It’s just relatively uncomfortable, but you should get used to discomfort after, after a few sessions. Um, and I think they wouldn’t be in terms of broaching it with the client athlete, if an athlete would benefit from expediated exercise sessions because of time inefficiencies, then BFR would be useful. An example was recently the COVID situation was gym’s closures, right. Um, and we had a number of clients that are elite sporting team clients cured some, um, some, some blood flow restriction cuffs to train in the hotel rooms because they didn’t have access to, uh, high loads with their machines.

Joseph Marcus

So just trying to improve the effectiveness of body weight exercises, try and improve the effectiveness of low resistance exercise training. Um, this could be useful in that sort of remote exercise setting. So if you have a client and you’re training them remotely, then take taking some BFR cuffs with you could be very useful. So that, that could be a useful strategy for an athlete who doesn’t like resistance training. BFR could be a useful addition because a lot of those football players or soccer players, don’t like doing resistance training and they like training on the pitch. So BFR training in the addition of sideline exercises could be a good way of introducing load and preventing sort of improving robustness in the athlete. And without having them get in the gym, that’d be the user cases in terms of why BFR may be useful in sort of an athletic setting. But I’d say generally there wouldn’t be too many populations, which would say it’s not effective for understanding how, when and why you’re using it and using it, what sort of intent. So, you know, if you’re having, if you have an athlete who has low back pain, and you’re saying, okay, yeah, I can’t get him to squat. Um, he’s going to miss a squating session, but we can put some BFR cuffs on him again, to do some body weight squats, at least that way he’s still getting his pattern of the squat pattern squat in, but we’re improving his glute strength, improving his quad strength, but we’re not exacerbating his lower back pain. So that that’d be a good addition to a blood flow restriction if an athlete, but as you said, had a game, they were injured, but just generally after say a football game after a big run, you’re not injured, but you have sort of ankle, elbow pain. Yeah. So the addition of BFR, the low load session afterwards did sort of stimulate some improvements in strength and hypertrophy, the wear and tear that could be a useful addition.

Joseph Marcus

And then also supplementing high load training. So if you got an athlete to do five sessions of high load training a week, so 80% of one RM, they eventually going to get injured at some point, just through general wear and tear. But if you supplement two or three of those sessions with BFR sessions, you’re still getting in a high dose of stimulus, but you’re reducing the wear and tear on the athletes and the mileage and the athletes joints. So I think that that could be an interesting way of looking at it as a, whether it’s to high load sessions, two BFR sessions in a week or whatever that may be, I think, um, uh, be good to hear them because currently BFR is quite interesting. It’s very lab based as in, it was sort of born out of research. It was used clinically, but then the user cases weren’t super well developed in terms of how a junior athlete uses BFR, how a basketball player uses BFR who’s injured and not injured. Do we include it into the in season use? Do we not include an in-season use? Does it replace high load training? Does it supplement high load training like through I think, um, the user map is something I look forward to when basically as it gets more widespread, um, strength, strength, coaches using it with their athletes and figuring out, well, Hey, if we use some BFR pushups prior to a bench, press bench, press strength goes up or whatever it may be or whatever it may be or recovery days. I think I’ve mentioned in conversation with some baseball coaches, um, coaches working in baseball about how they use utilize BFR training as sort of a, uh, flushing, uh, active recovery muscle muscle stimulation. Um, modality pre and post pitching and they are getting results. That’s very interesting to me in terms of where this is going in as, as the cases are going.

Dr. Cooper

Yeah, wow. Joseph, this is so fascinating. I knew you were going to wake me up to some things, but the utilization seems so widespread potentially, uh, for folks that are wanting to hear more about air bands or, or they want to follow what you’re doing or some of the research, what’s the best way to keep track of you? What’s, what’s the best, what’s the best way to tap into what you’ve got?

Joseph Marcus

Yeah. So, um, the, the, the, the airbandsbfr.com would be a platform to reach. Um, we’re very active on Instagram and then it’s Airband BFR as well. And basically Airband BFR across all our platforms. We’ve been mindful of the fact that, um, education and content is useful as well for a lot of people. So we’re trying to put out some research studies and things of that nature. So I think we are the most active on Instagram, but again, website, and you can reach us directly by email as well, [email protected] And, um, yeah, I can be reached directly as well through that email channel. So I think, um, yeah, happy to reach out in any way of being useful. I think, because I think it’s still an emerging area. I think people, a lot of our high level of strength coaching are aware of BFR now, but again, and then that’s, I think the next sort of five years will be people have gained confidence in using it and things like this where people go, Oh, I had no idea. Yeah, yeah. I’ll say as people get, um, as utility gets more widespread than the individual user cases will increase, and the people will research that and become quite ready to use BFR in more unique situations.

Dr. Cooper

Well, I really appreciate you joining us. I know your schedule is a little haywire sometimes, and we’re figuring out the time difference between Australia and the US but thanks for making this work, really appreciate it.

Joseph Marcus

Thank you very much.

Dr. Cooper

Wasn’t that fascinating? Again, I get it. It sounds crazy, but the research backs it up and I’ve tried it myself since we recorded this interview. Definitely something I’ll be continuing to integrate into my own future training and not just while I’m recovering from shoulder surgery, but long after that piece is in my rear view mirror. Thanks for tuning into the number one podcast for health and wellness coaching. Next week’s guest is an interview I’ve wanted to do for years. It’s with professor Timothy Noakes. Yes. The Timothy Noakes who identified the central governor theory about why we slow down before our physiological reserves tap out. The same Timothy Noakes that was the first one to discover the problem with over, not under hydration among endurance athletes, the same Timothy Noakes who penned the lore of running before running was really much of a thing. You will love this discussion with a true pioneer across so many fronts. As always, if you have any questions about pursuing a career as a health and wellness coach, we’re happy to connect. Just drop us a note to [email protected], or you can access a library of resources at CatalystCoachingInstitute.com. Now it’s time to be a catalyst on this journey of life, the chance to make a positive difference in the world, not by burning ourselves out, but instead by simultaneously improving our own lives along the way. This is Dr. Bradford Cooper, of the Catalyst Coaching Institute, make it a great rest of your week. And I’ll speak to you soon on the next episode of the Catalyst Health, Wellness, and Performance Coaching Podcast, or maybe over on the YouTube coaching channel.