moving to the next topic something we get asked about especially after the podcast we did with Jeremy Leni which is Blood Flow Restriction and I think when you look at the muscle mass muscle strength sometimes people are dealing with injuries sometimes people maybe don't want to lift heavy weights and they're kind of dealing with various Orthopedic injuries whatever it could be how do you think about Blood Flow Restriction and where would you rank that in this ranking system I put bfr in the promising C um and again it depends on how you define the question but is the question um does using bfr and higher reps lower load weights produce Superior results to the same reps the same weights without bfr you know it's it's promising SL proven right I mean that that that is that is clearly the case um so so again just kind of backing up for a little bit and and for those who who didn't hear the podcast on this or who you know need need a little refresher so this is a topic that uh became of interest you know not that long ago right maybe in the last 25 years or so when it was demonstrated that if you applied a tourniquet around a limb as it was exercising um you would see Superior uh improvements in strength and muscle size relative to an unturn limb uh again provided they were both doing the same amount of work so um the you know the question is why perhaps right so why is it that applying a tourniquet well anybody who's done bfr uh can tell you it's not very comfortable right so when you impair Venus return slightly uh and that's really the goal of Blood Flow Restriction it's not complete occlusion it's partial occlusion you are allowing the accumulation of metabolites at a much higher rate right so more lactic acid is pooling uh more uh more metabolites of of of metabolism uh beyond that and um the the thought is that something about that is creating more of a stress signal um than would otherwise be present absent the uh tourniquet and and so an immediate use case became well look you know can we use far lighter weights um but produce you know still a profound amount of discomfort um and and and the obvious place where this showed up of course is around injury right so when a person is injured um you know let's use my example when I had shoulder surgery um I wanted to be able to still exercise that arm but for months after surgery I could not carry for example a barbell that was the same weight that I would have carried before right it was still too much pressure on the humoris in its newly repaired joint around the labrum so what if I used a third of the weight that I might have previously used I'll do a lot more reps but I'll create this Blood Flow Restriction around it and I experience a much higher training effect and so the the data have largely borne this out right when they do and the nice thing about these Studies by the way this is what makes this this type of research really elegant is every patient can be their own control because you're doing limb isolation right so it's a little goofy for the patient because you're going to have one leg that might get bigger or stronger than the other um but every patient can be their own control um uh and and so the analyses the studies and the metaanalyses and and and Jeremy linck who was the podcast guest we're talking about I think did a large meta analysis in 2011 it it showed that you know if you look at low-load resistance training in bfr without bfr it clearly results in Greater muscle strength and hypertrophy improvements uh and and it's it's not subtle right these are these are really pretty big effects all of that said Nick there's still a question that I don't think we know the answer to which is how does bfr training at higher reps lower weight compared to non bfr training with higher weight and presumably lower reps and and that's a much harder head-to-head to design because the the the question is like um how do you design the protocol in each because now you've broken one of the constants that have been preserved across all of these studies um and so I I think that the answer there is still unknown um and as such I I just wouldn't recommend that somebody exclusively rely on bfr I I think that there there there might be things that you first of all it's not that comfortable and you can't do it for everything right like it's it's very limb Centric um but even if you were just to talk about restricting it to how you train your arms and your legs um I still think there are lots of scenarios where using bfr doesn't make sense um and my personal use of bfr which I've talked about is I really like to use it as finishers in um you know there's like finish you know I'll do some sort of upper body finish and lower body finishers on on upper body and lower body days respectively um but it's not really like the bulk of what I'm doing um so so that that's that's kind of how I feel about this and again I think it is disproportionately useful in in the case and setting of a person who is rehabbing something and it's a great we use it so liberally with our patients as we're trying to get them moving immediately post Surgical intervention and we want to do it with I mean even just using their body weight so for example a patient that's had knee surgery you know the minute we get permission from the surgeon we've got them doing leg extensions with just the weight of their leg but doing it with a bfr cuff so there's actually a training effect in the quads but without overloading the knee because clearly you wouldn't want to post knee surgery put uh strain from the patellar tendon uh beneath the knee attachment and for people interested in learning more we'll link to podcast but if people want to try it um do you want to let people know which brand you use and obviously you can say too you have no affiliation with them we don't get paid by them or anything it's just one you've tried a lot of and you found real enjoyment with it yep I use a brand called katsu um and um they make various different types of to I I use two different types of Katsu devices and I apologize I don't remember the exact name but one of them is like maybe it's called the C3 and it's the it's my sort of bread and butter go-to one where I put the arm bands on put the leg bands on whichever I'm using you know inflate it to the pressure uh and then go and exercise and then they they have another one that I really quite like but it does what are called passive Cycles so if I'm just sort of trying to recover um you put this on and it just it'll do a I think it does like a 20 second inflate hold deflate repeat and I can can just sort of if I'm sitting at the computer like I've got this thing cycling on my arms or on my legs um and uh if nothing else honestly it just feels great like I really actually enjoy the feeling of it um uh so so yeah those those are the devices that I use and um there is a real art to this so I think it's um you know there's a clinical way that you want to be able to go about doing this where you have to it's not just put a tourniquet on which is what I used to do and hope for the best uh because you you have to make the pressure is such that you are still allowing both blood in and blood out you're just trying to blunt that somewhat [Music]