A New Frontier in Medicine

Posted In: All, Foot Health
May 3, 2016

Get certified in Blood Flow Restriction Therapy (BFR): a new and revolutionary exercise technique that’s been shown to increase muscle growth, V02Max and the healing speed of injured tissues.

If you are a medical practitioner and would like to become one of the first providers in the country to be a certified administrator of BFR Therapy, then we encourage you to attend the first-ever BFR Certification course in the Pacific Northwest on Saturday April 29th, in Downtown Portland. For more information on BFR, please read the article below or contact Dr. Sanatan Golden: sanatan@optimalresultspt.com.

Using Blood Flow Restriction (BFR) Therapy to help unlock the human body’s incredible ability to adapt, heal, and build capacity.

By Dr. Sanatan Golden PT, DPT, CSCS

Do you know anyone who would like to significantly speed up tissue healing and increase strength? If so, Blood Flow Restriction (BFR) Therapy might be a big piece of what they are looking for. As a full-time clinical Physical Therapist, my day is filled with patients wanting to heal faster and get stronger, and I have personally seen many career-best outcomes in muscle, bone, joint, tendon, and fascial injury recovery since I started treating my patients with BFR 9 months ago. These results have made me want to share this augmented exercise technique (including how to do it safely and effectively) with as many practitioners and patients as I can.

While it might be new to you, there is a sea-change happening right now at the highest levels of injury rehab and performance training, and that change is BFR. Teams in the NBA, NFL, MLB, and NHL are joining this movement each week to help heal and train their players. But one need not be an All-Star to reap the benefit of this technique. In fact, it might even work better for those who cannot push their bodies to the level of a gold medalist. The truth is, we humans basically all heal ourselves the same way, and many of us are not healing to our potential. So before discussing exactly what BFR is, and how it works, we must ask: Why might it be important to you?

Unrealized Potential: The Olympian in All of Us

What do all these athletes have in common with each other and with each of us? For one, despite their unusual feats of strength and skill, they are all human, just like the rest of us. Secondly, they have a body and mind that has been sculpted by repeated adaptation to the stresses of their environment. Sure, we all have different starting points, experiences, and goals, but we are also all shaped by our body’s attempts to heal itself and adapt to the challenges of our environment.

Dr. McClanahan’s visionary work with the feet is a fantastic example of this principal. As he has illuminated so beautifully, like the rest of our body, our feet are shaped by adaptations to their environment, which is usually our shoes and the activities we do with them. If we are constantly asking our heels to be elevated and our toes to be lifted off the ground and squeezed together, take a wild guess how our feet will end up being shaped via adaptation to these stresses? And it is the side effects of these adaptations that result in a majority of the preventable foot ills (e.g., plantar fasciosis, Achilles tendon problems, bunions, neuromas, stress fractures, etc.) that fill both of our clinics. That’s a big problem! And what is the most effective solution? Creating a new environment for healing by using footwear that allows for restoration of a more natural foot shape and incorporating Correct Toes into a daily foot health routine.

As evidenced by the athletes in the pictures above, we humans have an almost incredible ability to adapt, heal, strengthen, and improve. Sometimes, though, we get stuck due to pain, injury, or weakness, and we are not able to fully tap into our adaptation potential. Remember, each of us is walking around with this natural treasure trove of healing biochemicals and hormones sitting on the shelves of our internal medicine cabinet, just waiting to be stimulated for release. This is why I use BFR therapy: To help my patients tap into their inner Olympian, and heal like one.

Now on to the nuts and bolts.

What is BFR?

BFR is a paradigm-shifting intervention for the rehabilitation professional with over 160 peer-reviewed articles in the scientific literature. By applying a tourniquet briefly and intermittently to an exercising limb you can induce significant and substantial strength, hypertrophy, and endurance changes while using a very light load. It has been used and researched extensively in the military with our wounded veterans, and it is credited with markedly reducing blast-injury limb voluntary amputations.

In a nutshell, the system I use is a professionally administered treatment that combines FDA-approved 3rd generation Delfi medical tourniquets (which monitor and maintain a very low level of blood flow) with low intensity exercise to create a lactic acid environment similar to extreme exercise. The stress of this environment stimulates the body to grow muscle and heal faster. Below is an example of a patient exercising with the Delfi tourniquet system.

How Does it Work?

The fatigued and lactic acid-filled environment that results from light exercise under occlusion (i.e., reduced bloodflow) stimulates the body to release levels of growth hormone (>200x resting levels) and other repair hormones equal to or greater than a high-intensity resistance training workout. Basically, BFR stimulates the body to tap into own its self-repair and growth potential, without the traditional level of required stress and breakdown. The result is markedly accelerated collagen healing/synthesis, muscle growth/hypertrophy, and/or post-surgical atrophy elimination, and even fibrosis/tendinosis reduction. Treatment sets usually last between 6 and 15 minutes, depending on the issue being addressed.

If you want to see what it looks like, sometimes video can be worth a thousand words. ESPN just featured a couple of “Outside the Lines” news reports on the explosion of BFR in the NBA, including one featuring Houston Rockets center Dwight Howard (see “Superman” picture above) and how it has helped him heal and get stronger.

● OTL: Game-changer? (April 10, 2016)
● OTL: Hustle with less flow (April 10, 2016)

Why Use BFR?

BFR training has consistently demonstrated strength and hypertrophy gains vs. controls and comparable gains to heavy load lifting. There are many quality ongoing studies examining this new technique.

• Research suggests that when low load resistance exercise (20-30% 1 RM) and low load aerobic exercise.

• Low-load resistance muscular training during moderate restriction of blood flow is an effective exercise for early muscular training after reconstruction of the anterior cruciate ligament. (Ohta 2003)

• In a study by Abe et al., they examined BFR cycling at 40% VO2 Max for 15 minutes and compared the results to a control group that cycled for 45 minutes at 40% VO2 max without BFR. Thigh and quad muscle volumes increased, extension strength increased, and VO2 max increased in the BFR group compared to the control group. (Abe 2010)

Who is Appropriate to Treat With BFR?

When administered by trained and certified medical personnel with an FDA-Approved device, BFR can be safe for the vast majority of the population. Clinically, we (i.e., myself, the military, and the few dozen teams and research centers who now use BFR) have applied it to many diagnoses with very positive results, including but not limited to tendinopathies, total joint arthroplasties, postoperative weakness, Achilles tendon repairs, fractures, rotator cuff repairs, muscle strains, nerve injuries, post-operative knee reconstructions, and cartilage repairs.

How Can I Use BFR Therapy? How Do I Learn How to Use it With My Patients?

If you are a medical professional:
Because medical tourniquets are FDA-regulated devices, you are required to be trained and certified in order to treat your patients with them. If you are interested in learning this technique, your first chance will be on June 18th, when I will be co-teaching the Pacific Northwest’s first BFR certification course, in downtown Portland. I will be co-instructing this course with Johnny Owens PT, MPT, who is the Army researcher at the epicenter of this movement, and from whom I learned this technique directly. If you have any questions about how BFR might be able to help your patients or you would like observe it in action, or even if you would like to try it out yourself, feel to contact me directly (sanatan@optimalresultspt.com). If you would like to sign up for the Portland course you can follow this link: Get Certified in BFR.

If you are a patient:
Tourniquets are FDA-regulated medical devices, and at this point, the Delfi unit I use in my practice is the only one that has achieved FDA approval. In order to be treated with this technique, you must find a medical practitioner who is trained and certified to administer BFR. Since this is an emerging technique (outside of the professional and collegiate sports ranks), there are currently only a few dozen certified medical professionals in the country performing BFR therapy. At this point, besides the trainers for the Portland Trailblazers, I am one of three practitioners in the Pacific Northwest who is certified to administer BFR with an FDA approved tourniquet. You may contact me directly (sanatan@optimalresultspt.com) or either of my Portland clinics (Optimal Results Physical Therapy or Evolution Healthcare & Fitness) if you have any questions or want more information about BFR. If you are not in the Portland area but are interested in BFR, worry not, because the BFR movement will likely come to your area soon. Starting this June, I will be teaching certification courses to bring BFR to medical professionals throughout North America.