Let me introduce you to one of my “secret weapons” of athletic performance: Blood Flow Restriction training (BFR). It is not new, but it is certainly making its way into every sports team, every progressive injury rehab clinic, and every results-driven gym in the world.
Take a quick tour on PubMed with “blood flow restriction” as your key search phrase and you will get well over 10,000 results to peruse. If you are into that sort of thing, I would suggest starting here and here, then work backward, if your interest is piqued.
My devotion to the technique is more a simple story of results. Most of my time spent working in pro hockey was wedged in the basement of the American Hockey League with no shot at the playoffs. Our most inspirational post-season event was having the bulk of our guys called up to support the big club on their annual playoff run.
This year our captain defenseman was dealing with some knee issues and the most problematic issue on the ice was pivoting from backward to forward on the side of the bad knee. Needless to say, he was pretty vulnerable out there, but he and his partner had figured out a puck retrieval strategy that allowed him to keep logging big minutes.
As we approached the end of the season and it was time for him to get ready to go up and support the big club, the team decided it would be in his best interest to address the meniscus and cartilage damage in his knee with a few months or so to heal up before he reported to the NHL. With best intentions in mind, the results of the surgery were poor and he was in significant pain post-op.
One of the more surprising things we saw after surgery was our inability to restore his range of motion to the knee. He was prescribed a ball-supported wall squat to “resurface” the joint. Just above a quarter of the way down, he would suffer this horrific pop and shift in his knee, then he could get through the rest of the motion. He would do this for sets of 10-15 repetitions and the pain he endured was obvious by the fear on his face every time he would approach the joint angle of the pop.
He was an absolute warrior both on and off the ice. He continued to suffer through the rehab program for two days. On day three, I literally could not watch him do another rep. As many of you know, my place was not to step in on the rehab program; I was given the job of trying to keep him strong and as conditioned as possible.
We worked the uninjured leg and every other body part that would move, but on this day I could not watch him suffer any longer. His face was green with pain and agony after just the first few reps…enough was enough, I could not see how this was going to make him get better any faster!
I asked him to stop, acknowledged his savagery, and asked him if he would be open to trying something different. I had told him how I liked to use BFR on the bike to maximize the efficiency of a simple five-minute ride. We discussed how this would check several boxes for us: he would get in some much-needed conditioning, we could set the seat height so that he could use the range of motion that was comfortable for him, and more importantly we could stop doing an exercise that both made him feel worse and elicited a fear response in him.
This fear response was not something that was normally in his nature. He would take a puck in the mouth if it meant giving his team a better chance to win. Why continue to steal his power? We started with five minutes of bilateral compression on the Assault Bike. It was brutally hard for him but, in a way, that promoted his warrior spirit. Forget all the awesome physiological adaptation we just stimulated in his body; mentally, he was back in the game!
Each day after that we were able to manipulate the seat height on the bike to restore and improve his range of motion. There, the plot thickens. Now was time for him to get ready to join the “Black Aces” in the NHL and we had been going off-script for at least two weeks. I was freaking out to say the least.
While in my private practice, I had rehabbed post-op knees my whole career, but in this organization, this was not my lane. Even worse, I didn’t have the official FDA-approved Delfi unit. I was using bro science and two ace bandages…not good!
I quickly jumped on the Owens Recovery website to look for the closest course that I could register for so at the very least I could say that I was scheduled to take the official class, which was the precursor to purchasing the unit. It seemed like the best “CYA” move I had at my disposal and even that was a bit risky.
To my surprise they were presenting that weekend a mere two hours away. Literally the same day he reported to the team for the playoff run, I was sitting in class with Dr. Zack Long, getting schooled on the science of BFR as well as taking a brutal ride on the slide board while under bilateral lower limb occlusion.
Thankfully, I never had to defend my decision to go off-script and even more gratifying was seeing a Delfi unit in the rehab room of the big club only two seasons later during an ACL rehab. I am not always an advocate of asking for forgiveness versus permission but, in this, it worked out for me and our captain.
Without question, I would put BFR in the category of game-changing techniques. It is something that can be added to your practice or something to look for in a rehab or performance provider if you need these services. It is most valuable in the post-operative space, but the improvements on performance are being researched all the time and a growing body of research supports its use.
The science speaks for itself, but the versatility in its application is where it seems to rise above all other methods. My story speaks for itself, but since that time I have never looked back on the application of BFR for rehab and performance. Check out what other practitioners have to say as well.
