Nov 21, 2018
3 takes on blood flow restriction (part 1)
By Nicole Sorce

By now, you’ve probably heard of blood flow restriction, also known as BFR, the latest wave in the sports medicine world. This training and therapy strategy involves the use of a tourniquet that is inflated to a specific pressure and reduces blood flow into the limb during light exercise. In return, patients experience results that coincide with a high-intensity strength program but without the corresponding stress to the limb.

As more is learned about this emerging practice, sports medicine professionals are discovering its many benefits. “The latest trend in sports medicine is simply that everyone is utilizing BFR, even the elite sports that are typically very resistant to change,” says JoHan Wang, ATC, CSCS*D, SNS, Sports Science Advisor for RP Sports. “One thing that almost every client reports is that our BFR devices allow for a full range of motion and do not create pain during the treatment. The benefits are really kind of infinite.”

BFR’s appeal to a wide variety of athletes and activities also makes it a desirable modality. “It seems like it can treat everything. Especially if an athlete is injured, just spinning lightly on a bike or walking on a treadmill with a tourniquet on the limb is key for an athlete to maintain endurance,” says Johnny Owens, PT, founder of Owens Recovery Science, which is a one-stop shop for medical professionals seeking certification in personalized blood flow restriction (PBFR). “We’ve never heard any practitioner say it’s a waste of their time, and it will change the way they look at muscle physiology and do their jobs.”

Its crossover appeal into the strength training realm provides further benefits. “Especially with teams that travel a lot, you only get a couple days of rest, and usually those days are spent flying between cities and fitting in practice,” says Owens. “That makes it really hard to factor in your strength training program because if you lift a guy heavy on Tuesday with a game on Wednesday, they might still be sore and down in terms of their force output. By using BFR, you’d get the same effects as you would see from lifting heavy — without the downside effects of lost performance or muscle soreness.”

As more is learned about BFR, the possibilities expand. With so many options, the future looks bright for BFR — no matter how it is used.

Safety first

When Wang joined RP Sports as Director of Innovation and Technology in 2016, he was responsible for improving current products and researching new technology for the company’s portfolio. Every new product had to meet several important criteria, based on the company’s core values. “I made sure that every product was efficacious and evidence-based with significant scientific research demonstrating validity. The devices also needed to have a track record of safety and efficacy,” Wang says. “These are the things that our company values in all of our products.”

That’s how the company decided that distributing KAATSU and B Strong BFR devices would be the right fit for their clientele, which is comprised of more than 400 elite, college, and professional team clinicians across the NBA, NFL, MLB, NHL, MLS, and NCAA. “Our client list is pretty extensive across the United States,” says Wang. “We provide them with consulting services, as well as education programs for their entire staff.”

Although RP Sports specializes in the elite performance sector of athletics, Wang ensures that both KAATSU and B Strong BFR products are safe for use by people of all ages and from all walks of life. “That’s one of the great things about these modalities — they really fit everybody, and they’re not exclusive to a certain population,” says Wang. “There’s no ‘age minimum,’ but the specific population that we sell them to are clinicians, who ultimately make the decision. In terms of utilizing the technology, age is not a limiting factor.”

According to Wang, RP Sports first became associated with BFR products by distributing KAATSU, which he refers to as “the originator of BFR.” In order to purchase and obtain access to a KAATSU device, customers must complete an online certification course that instructs on how to utilize the equipment properly and safely. Once they pass the exam, the machine’s access code is provided. On the other hand, B Strong does not require a certification but does provide instruction and education through their guidance app. An optional live course is also available.

Wang says the difference in the policies of these two brands comes down to a simple fact. “The reason why is that our BFR devices are considered training modalities,” he explains. “They’re not classified as medical devices. It would be the same rationale as saying you need a certification to use a barbell at a gym. Can you get hurt using a barbell? Absolutely. But at the end of the day, it’s considered a tool to help you get the job done.”

While there are some slight differences in the technology of the B Strong and KAATSU devices, the ultimate outcome of the BFR treatment isn’t affected. “B Strong uses manual inflation, so it’s hand-pump driven with no automation,” Wang explains. “KAATSU is digital. It has a computer that controls the compressor and self-regulates the pressure. If there’s too much or not enough, the computer will self-adjust. It allows for automation and precision, and it has the ability to store treatments.”

Wang also warns to not just buy any BFR product on the market. A BFR device should be one that is safe and intended for this specific type of application. “When it comes to manipulating the body’s circulatory system, you want to use something that is actually designed and intended for BFR,” urges Wang. “Our products have safety in mind and are specifically designed for BFR. There are other devices on the market that are repurposed medical devices of some sort, intended for other purposes. It would be synonymous with using a blood pressure cuff to practice BFR instead of using a modality that’s specifically made for that type of application.

“Both KAATSU and B Strong are actually designed so that when you inflate them to a significant pressure, the devices make it nearly impossible to occlude the blood flow, which is key to getting a desired result — as well as safety,” he continues.

RP Sports has recognized that its clientele has placed a much higher emphasis on recovery as a whole, especially in recent memory. Aside from educating teams and organizations on how to use KAATSU and B Strong devices, the company has been assisting its clients in redesigning athletic facilities to dedicate a space just for athlete regeneration. “We may perform a needs assessment in terms of equipment, or it may be figuring out how to incorporate a recovery or regeneration room into an existing or new facility design,” says Wang. “All of the new facilities have a dedicated regeneration room, which is relatively new in the last two or three years. It hasn’t become a standard yet, but it’s sure moving that way.”

Based on Wang’s professional experience prior to joining RP Sports, he’s not surprised about the influence BFR has been having on the sports world. He spent a combined 12 years in sports performance roles with the Golden State Warriors and Los Angeles Clippers and was chosen as the Athletic Trainer for the 2011 NBA All-Star Game. “I was introduced to BFR very early on in 2014, when it was essentially introduced to the United States,” Wang recalls. “I had been chasing the technology for 10 years before that, and it all stemmed from an interest based on research I originally read on KAATSU. Once I was introduced to the technology, I quickly adopted it because the research was so strong.”

As far as Wang is concerned, BFR technology is only just beginning to evolve. “The one thing that all devices lack right now is attention to individuality, so there’s currently no way of creating prescriptions that account for individual physiologic differences and having the computer adjust to those,” says Wang. “In the future, I think the devices used for BFR treatments will become smarter and utilize individual patient metrics to drive prescriptions to make the process more automated.”

» Go to part 2

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