Sports Physio Clinic Richmond - Evolutio

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Blood Flow Restriction training during this Glittering tropical fuckstorm of Cosmic Proportions

At time of writing the only people who have access to all the gym equipment they need to train with any kind of normalcy are either very lucky, very resourceful or very rich.

Personally, I’m not the kind of person to have a gratitude journal but if I did I’m sure there would be many pages on how grateful I am that my amazing gym loaned me some of their weights, I was able to borrow some from the clinic, and my twin sister has been stockpiling second-hand gym equipment from Gumtree for years (I’m sorry about all the jokes Kel - it wasn’t weird, you are a fkn genius.) 

Everyone else has to be a bit creative with what they can do at home, and it’s great to see the number of home workouts and creative new things being shared around.

A lot of the people putting that content out there are a lot more qualified, original, innovative and fun than I am so far be it from me to to try to add to that pile.

What I would like to bring to the table is the renewed relevance and utility of Blood Flow Restriction training during this glittering tropical fuckstorm of cosmic proportions in which we find ourselves.

BFR training involves applying a device to the arms or legs that partially occludes the blood flow, before performing body-building type exercises. I’ll get into the science-y crap in a bit, but basically what makes it especially useful at the moment is that it allows you to train, very hard, with weights that are only about 20-30% of what you would usually be using. In addition to that, it allows you to place an enormous stressor on the muscles, while taxing the joints and tendons relatively less. Which, certainly for me, neatly ticks both the “I’m using isolation to get totally massif” and the “maybe I should be using this time to let my body recover a bit” boxes.

Blood Flow Restriction - (BFR) Soleus Calf Raises with Kettlebell sitting down.


So how do you do it? Ideally you have a blood pressure cuff for each side but you can also use elastic wraps. These are applied at the top of the arm or leg, or below the knee for calves. Tightly. Well, not to start with but they do get real cozy real fast.

Don’t worry, they mostly occlude venous return rather than arterial supply to the muscle. That means blood is still coming in, but it’s not getting back out of the area. You have to get it pretty wrong to do any damage. We recommend occluding for the time it takes you to do a superset, so probably around five minutes. But I’ve been occluded for up to half an hour and I still have both arms, promise.

It’s really only useful for hypertrophy training, so should be used with high reps. One of the more common BFR rep schemes is 30-15-15-15, but 4 or 5 by 20 is also good and we do 40-30-10-2 because LOLsies. It’s not really that important what rep scheme you choose because they all work fine and you probably won't be able to do the last reps of the sets anyway.

How does it work? Ok here we go. There are a lot of theories and I’ll try to outline the main ones I’ve seen - if you don’t care about the science then you can snooze here for a bit.

As I mentioned just then, BFR allows blood to enter the working muscles, it just blocks the ‘used’ blood from getting back out. This results in a pooling effect where there is physically a higher volume of blood in there than there ‘should be’. AKA the pump is very, very real. One theory suggests that this can lead to cellular-level swelling and muscle growth is an adaptation to try and accommodate the extra blood.

In addition to the sheer volume of blood, the muscles become deprived of oxygen and waste products accumulate, creating a LOT of localised metabolic stress, which is one of the three mechanisms of muscle growth. (The others being mechanical tension and muscle damage.)

On top of that, due to the diminished availability of oxygen, slow-twitch fibres will fatigue much more quickly. Slow twitch fibres are oxygen-dependant and they are the ones we are training with body-building type exercise. BFR allows us to not only create that hypertrophy stimulus for slow-twitch fibres using much smaller weights, but once they spent the fast-twitch fibres will also get called in. Those guys usually only get out of bed for sprints, explosive work and very high weights (aka higher-risk training), but if you can get them working they really come to the party for muscle growth.

If you want to dive down another level, there is also evidence that BFR training elevates hypertrophic signaling, specifically growth hormone and insulin-like growth factor, as much as or possibly more than equivalent but non-occluded resistance training. Hypertrophic signaling is a term for the hormones and substances that are released in response to exercise. They signal to the body that some (good) damage has occured to muscle fibres and that they need to be rebuilt - but a bit bigger and stronger to resist damage in case that activity happens again. This is the adaptation that training is trying to elicit.

In a rehab setting, BFR allows us to perform hypertrophy or strength-endurance training on a muscle group when an associated joint, ligament or tendon is perhaps not ready for loads that those muscles would otherwise need. This allows for low-risk re-introduction of resistance training, and is great for reversing muscle-loss or atrophy after injuries.

OK downsides chat:  as you can see, it’s kind of a way to trick your muscles into growing bigger. However, ya central nervous system isn’t as easily duped. Gains in actual strength come from neurological adaptation to load as well as growth in muscle size. At the end of the day we’re still lifting pretty light weights during BFR training so it doesn’t increase strength as much as it works on muscle size. That said, most strength programs start with a lower-weight hypertrophy phase - so we can transition smoothly into strength gains once quarantraining is over.

Oh also it burns. A lot. In a way that it would be pointless for me to try and describe; you reeeeeally have to experience it yourself. But you can’t say I didn’t warn you. The flipside of this downside is it’s pretty hard to think about COVID-19 when your arms are full of molten lava.

So if you're interested in giving this a go, we would love to hear from you! We have floss bands in stock and all it takes is a virtual appointment to get you started. We will ask for pain face photos afterwards though because that's almost the best part.


Peta is our Remedial massage therapist at Evolutio. She's an elite Surf Boat Rower, holds the 1km Ergo world record (30-39yrs F) has coached CrossFit for several years and is a qualified S&C coach. Peta works Tuesdays and Thursday afternoons at our clinic in Richmond. You can book in with her here