Updated: Aug 20, 2020
This is my time to shine, nerd Reg is about to be unleashed. I know I know, most of the time I’m trying to do new creative things – which don’t worry, I am still figuring out a way to do a one legged Bosu Swiss Ball Inverted Single Arm Pushup while reciting the alphabet backwards (I keep messing up the alphabet part) – but I also love to embrace full on nerd status with reading and attempting to interpret science. The application of the science is where I am eager to grow as a sports medicine professional.
Being in an injured state, as many athletes are, my perspective have been framed by this question: How can I mitigate fitness (cardiovascular and strength parameters) losses to allow me to get back into the race circuit as quickly as possible once my foot is fully healed? To properly answer this question from a physiological standpoint, I must turn to the research.
In an ideal world, I would have data that represented my levels of fitness (VO2max , Squat 1RM, Deadlift 1RM, Anaerobic Capacity measured by the Wingate test, and even a Vertical Jump) before the surgery on my foot. Once I am fully healed, I would re-assess these parameters, then establish the percentage of decline from pre-surgery to recovered state. However, since I do not have these measures, I have to operate on a very subjective basis. My levels of fitness, since the date of the surgery early August, have absolutely declined. Which is normal, and expected. How much they have declined, based upon what I have done to mitigate losses, can only be qualified by my own personal assessment.
Although cardiovascular training has been incredibly difficult to implement since no weight/force through my foot. Single leg burpees get the heart rate up, but my left leg gets tired before my heart and lungs do! In terms of strength maintenance, there has been increasing research involving blood flow restriction (BFR) training. As described by the Owens Recovery Manual (2016) “Blood flow restriction (BFR) training in which a tourniquet is used on a proximal limb to limit arterial inflow while blocking venous outflow has consistently demonstrated strength and hypertrophy gains vs. controls and comparable gains to heavy load lifting” (page 7) (Owens, 2016). Essentially, this form of training utilizes a tourniquet adjusted to proper constriction to limit blood flow back towards the heart. The muscles that have limited blood flow have less oxygen, thus when placed under light loading, are metabolically at a disadvantage. This phenomenon occurs when lifting heavy loads in training, as the muscles require blood flow and oxygen to produce enough energy that accommodates the load being lifted. A lower limb injury such as mine dictates no heavy resistance training. However, causing the lower limb muscles to experience a metabolic environment similar to that as in heavy resistance training might help to moderate the strength losses in the affected limb, compared to doing nothing. This is where BFR comes in. Simply by the use of a tourniquet, and very low loads with short recovery periods between sets, the decreased availability of oxygen at the muscular cells with this low stress can cause a muscle growth stimulus. “There is a significant increase in hypertrophy using a tourniquet during low load exercise compared to the same exercise without a tourniquet (pg 9)”. For elderly or injured populations, professional application of BFR can be a method utilized to increase muscular strength and endurance. “If you are in the acute stages of rehabilitation rep max testing is probably not needed. The goal is to mitigate atrophy and increase neuromuscular activity (pg 122). Four sets of 30/15/15/15 (at 2 seconds concentric and 2 seconds eccentric) with a 30 second rest period equals 6 minutes and 30 seconds under tourniquet time (pg 39). Volume and light load is the key for metabolite response (pg 125). Since metabolite response is the goal, volume during the exercise session is the focus (pg. 124)”. (Owens, 2016)
The research presented above is part of a comprehensive manual, referenced at the conclusion of this post. This research has guided my application of these methods. Using my own injured status as an opportunity, I have appreciated the chance to personally go through and utilize BFR training. I have had to be creative with training, proper utilization of BFR, and disciplined with performing the training in accordance with the desirable adaptations. I am eager to continue utilizing BFR, and to speak to its effectiveness once I am in a recovered state.
Science aside- here is the real talk….. BFR isn’t fun. You know that muscle burn you feel when exercising, like just doing a ton of lunges? That feeling is what BFR does, just with super low intensities and lots of repetitions. The benefit of BFR comes from experiencing that “burn” due to the lack of oxygen at the cellular level. The mentality of BFR is to embrace that burn, as that is what is causing the muscle to adapt. As much it is mentally not the most fun, performing BFR has been a learning experience. I believe that I am a better professional having to go through BFR training and having to learn about the mechanisms behind it. Therefore, I feel as though I am more equipped to serve various populations who may have limitations to exercise.
At the end of the day…yay BFR, when utilized properly and with purposeful intention!
Incentive and innovation have no rest.
Keep on learning.
Reg. Sparkle Ninja Pony Unicorn.
Owens, J. (2016). Blood Flow Restriction Rehabilitation. In J. Owens, Owens Recovery Science. San Antonio, Texas : ORS, Inc.