How When & Why BFR

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Why & When?

Occlusion training for bodybuilders only?

No, not at all! In fact, there are important research on miscellaneous muscle and skeletal pathologies which proves that occlusion training has significant effect on both strength and Patient Reported Outcome Measures (PROM)!

As a rule of thumb occlusion training is indicated if you have an acute or overload injury where you cannot do conventional resistance training i.e. lift heavy. For example, following orthopedic surgeries with relevant weight-bearing restrictions. Or more chronic conditions such as arthritis, as a majority will find joint pain worsens during heavy training. In theses cases occlusion training should be “first-line therapy”.

One can wonder why few private or public providers offers BFR? – But as with so much other new technology, thus evidence-based by research, the implementation is always delayed. Especially considered the amount of high quality research i.e. randomized controlled trials and the meta-analysis, occlusion training is here to stay and grow in popularity.

Below is listed some of the relevant issues and pathologies in which scientific litterature suggests that occlusion training is an effective treatment strategy

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  • Unspecific knee and hip pain (1,2,3)
  • Arthritis i.e. osteoarthritis and rheumatoid arthritis (4,5,6)
  • Prehab and Rehab after ACL injuries (7,8)
  • Patella femoral pain (PFP) aka. anterior knee pain (9,10)
  • Joint replacements i.e. artificial shoulder, hip or knee (11,12)
  • Degenerative and acute meniscus injuries (13,14)
  • Hip impingement (FAI) (15)
  • Unspecific shoulder pain (16,17)
  • Osteoarthritis of the GH and AC joint (different shoulder pains) (18,19)
  • Frozen Shoulder (16,17)
  • Bone fractures (18,19)
  • Tendon injuries and tendon surgery (15,20,21)
  • Disc herniation and non-specific back pain (22,23)
  • Cartilage Injuries (17,24)
  • Various muscle injuries (1)
  • Sarcopenia, osteopenia and osteoporosis (24)
  • General muscle building for the elderly as an alternative or supplement to other training methods (25)
  • Sports specific performance and support training (26-28)
  • Aerobic Performance (VO2max) – Cardiovascular training – low-load exercise i.e. on bike or treadmill (29-32)
  • Patient Reported Outcomes Measures (PROM) – Especially relevant for the elderly or impaired (5)
  • Tendon Health – Though not yet known if BFR is feasible in the treatment of tendinopathy (33)
  • Football aka. Soccer Performance (34)
  • Immobilized limbs – Contra Lateral Effect on strength and hypertrophy (35)
  • Hand Strength relevant for hand and finger arthritis (36)
  • Sprint Speed / Running Velocity (37)
  • Hypoanalgesic responce aka. acute pain reduction (38)
  • Improved Cardiovascular Health (39)
  • Hip arthroscopy rehab (research study in progress) (40)
  • Physical function indicative of Activities of Daily Living (ADL) (41)





Hvorfor & Hvornår?

Okklusionstræning kun for bodybuildere?

Nej, ikke udelukkende! Faktisk er der forskning inden for flere forskellige muskel-og skeletproblemstillinger som viser, at okklusionstræning har signifikant effekt!

Generelt så er okklusionstræning indiceret, hvis man har en akut- eller overbelastningsskade, hvor man ikke kan eller må træne tungt. Fx efter operationer, hvor man enten ikke må løfte tungt eller der er vægtbæringsrestriktioner.

Ved andre kroniske tilstande som fx flere gigttyper, vil en majoritet opleve at ledsmerterne forværres med tung træning, netop her bør okklusionstræning være “first-line therapy”.

Man kan undre sig over, at få private og offentlige udbydere kan tilbyde okklusionstræning? – Men det er ligesom med så meget andet medicinsk teknologi inden for det etablerede sundhedsvæsen, at selvom evidens er uomtvistelig, så er implementeringen altid forsinket. Med udgangspunkt i de randomiserede kontrollerede forsøg (lodtrækningsforsøg) og deraf metaanalyserne, så burde okklusionstræning allerede være et tilbud til flere patientgrupper.

Nedenfor er der en oversigt over de primære problemstillinger, hvor man videnskabeligt har fundet evidens for at okklusionstræning er et effektfuldt alternativ til anden træning.

    • Uspecifik knæ- og hoftesmerte (1,2,3)
    • Gigt herunder osteoartrose og reumatoid artrit (slidgigt og leddegigt) (4,5,6)
    • Genoptræning efter korsbåndsskader før, efter eller uden operation (7,8)
    • Patella femorale smerter (PFP – forreste knæsmerter) (9,10)
    • Alloplastikker (kunstig skulder, hofte og knæ) (11)
    • Degenerative og akutte meniskskader (12,13)
    • Hofte impingement (FAI – afklemningssymptomer) (14)
    • Uspecifik skuldersmerte (15,16)
    • Osteoartrose i skulder- og kravebensleddet (15,16)
    • Frossen skulder (15,16)
    • Knoglebrud (17,18)
    • Seneskader og seneoperationer (14,19,20)
    • Diskusprolaps og uspecifikke rygsmerter (21,22)
    • Bruskskader (23,16)
    • Forskellige muskelskader fx fibersprængninger (1)
    • Osteopeni og osteoporose (afkalkningstilstande) (23)
    • Generel muskelopbygning for alle som et alternativ eller supplement til anden træning (25)
    • Specifik sportsstøttetræning (26,27)
    • Konditionstræning – lavbelastningstræning på motionscykel, løbebånd eller crosstrainer (28,29,30)


(1a) Natsume et al. 2015 – Effects of Electrostimulation with Blood Flow Restriction on Muscle Size and Strength

(2a) Slysz et Burr 2018 – The Effects of Blood Flow Restricted Electrostimulation on Strength and Hypertrophy

(1) Hughes et al. 2017 – Blood flow restriction training in clinical musculoskeletal rehabilitation a systematic review and meta-analysis

(2) Slysz et al. 2016 – The efficacy of blood flow restricted exercise A systematic review & meta-analysis

(3) William et al. 2017 – Blood Flow Restriction Training- Implementation into Clinical Practice

(4) Segal et al. 2015 – Efficacy of Blood Flow Restricted Low-Load Resistance Training in Women with Risk Factors for Symptomatic Knee Osteoarthritis

(5) Ferraz et al. 2018 – Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis

(6) Roschel et al. 2016 – Low-intensity Resistance Training With Blood Flow Restriction Increases Muscle Function And Mass In Rheumatoid Arthritis

(7) Hughes et al. 2018 – Blood Flow Restriction Training in Rehabilitation Following Anterior Cruciate Ligament Reconstructive Surgery A Review

(8) Ohta et al. 2003 – Low-load resistance muscular training with moderate restriction of blood flow after anterior cruciate ligament reconstruction

(9) Giles et al. 2017 – Quadriceps strengthening with and without blood flow restriction in the treatment of PFP

(10) Korakakis et al. 2018 – Blood Flow Restriction induces hypoalgesia in recreationally active adult male anterior knee pain patients allowing therapeutic exercise loading

(11) Franz et al. 2018 – Blood flow restriction training as a prehabilitation concept in total knee arthroplasty: A narrative review about current preoperative interventions and the potential impact of BFR

(12) Gaunder et al. 2017 – Occlusion training- pilot study for postoperative lower extremity rehabilitation following primary total knee arthroplasty

(13) Blood Flow Restriction Training in Patients With Weight Bearing Restrictions After Knee Surgery. (Not finished)

(14) The Effect of Blood Flow Restriction Training on Muscle Atrophy Following Knee Surgery. (Not finished)

(15) Scott et al. 2015 – Exercise with blood flow restriction: an updated evidence-based approach for enhanced muscular development

(16) Dankel et al. 2016 – The Effects of Blood Flow Restriction on Upper-Body Musculature Located Distal and Proximal to Applied Pressure

(17) Yasuda et al. 2010 – Effects of low-intensity bench press training with restricted arm muscle blood flow on chest muscle hypertrophy- A pilot study

(18) Loenneke et al. 2013 – Rehabilitation of an osteochondral fracture using blood flow restricted exercise – a case review

(19) Cancio et al. 2018 – Blood Flow Restriction Therapy after Non-Operative Management of Distal Radius Fracture- A Randomized controlled pilot study

(20) Mohmara et al. 2014 – 5 Effects Of Low-intensity Concentric Combined With Blood Flow Restriction On Achilles Tendon

(21) Yow et al. 2018 – Blood Flow Restriction Training After Achilles Tendon Rupture

(22) Amano et al. – Effectiveness of blood flow restricted exercise compared with standard exercise in patients with recurrent low back pain: study protocol for a randomized controlled trial (not finished)

(23) Stavres et al. 2018 – The Feasibility of Blood Flow Restriction Exercise in Patients With Incomplete Spinal Cord Injury

(24) Bittar et al. 2018 – Effects of blood flow restriction exercises on bone metabolism: a systematic review

(25) Clarkson et al. 2017 – Blood flow restriction walking and physical function in older adults- A randomized control trial

(26) Takarada et al. 2002 – Effects of resistance exercise combined with vascular occlusion on muscle function in athletes

(27) Behringer et al. 2016 – Low-Intensity Sprint Training With Blood Flow Restriction Improves 100-m Dash

(28) Abe et al. 2015 – Eight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes

(29) Bennett et al. 2019 – effects of blood flow restriction training on aerobic capacity and performance: A systematic review

(30) Kim et al. 2016 – Comparative Effects of Vigorous-Intensity and Low-Intensity Blood Flow Restricted Cycle Training and Detraining on Muscle Mass, Strength, and Aerobic Capacity

(31) Daeyeol et al. 2016 – Comparative Effects of Vigorous-Intensity and Low-Intensity Blood Flow Restricted Cycle Training and Detraining on Muscle Mass, Strength, and Aerobic Capacity

(32) Tanaka et al. 2017 – The impact of aerobic exercise training with vascular-ESC_Heart_Failure

(33) Centner et al 2019 – Low-Load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared to high-load resistance training

(34) Amani et al. (2019) BFR During Futsal Training Increases Muscle Activation and Strength

(35) Bowman et al. (2019) Proximal, Distal, and Contralateral Effects of Blood Flow Restriction Training on the Lower Extremities: A Randomized Controlled Trial

(36) Velic & Hornswill (2014) KAATSU Training and Handgrip Strength

(37) Paton at al. (2017) The effects of muscle blood flow restriction during running training on measures of aerobic capacity and run time to exhaustion

(38) Hughes & Patterson (2019) Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect

(39) Nascimento et al. (2019) Effects of blood flow restriction exercise on hemostasis: a systematic review of randomized and non-randomized trials

(40) Rush University Medical Center 2020 – in progress – Blood Flow Restriction Following Hip Arthroscopy

(41) Clarkson et al. 2019 – Chronic Blood Flow Restriction Exercise Improves Objective Physical Function- A Systematic Review


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