Occlusion Training

Josh Miller

 Occlusion, AKA BFR, has been a strategy used in an attempt to enhance the effectiveness of the work you were doing for a long time. Having its roots in Japan, and also having been utilized in both the USSR and US during the 80s and 90s, it was also utilized for decades before its recent ascension into being trendy. The basic concept is that something is placed around whatever muscle group you aim to train so that it reduces blood flow, then you train it. Although this may sound weird, it worked well for those who applied it correctly.

Here in the US, the first time I am aware of it becoming a meathead trend, it was referred to as tourniquet training. As time went on, the understanding of what was happening improved, and subsequently the application followed. I first learned about it in 2009 from a tnation article, and used it on my legs and biceps for funsies. I typically just did a few supersets of hams/quads or bis/tris for sets of 10-15 on these at the time, and I used wrist or knee wraps to occlude the target area. It seemed to work pretty well, although I was not too concerned with aesthetics at the time so I do not know how much my thighs or arms gained at that time.

It turns out, what happens when you restrict blood flow with the right amount of pressure, you can increase the response to training with respect to both the strength acquired and the amount of muscle gained. There have been lots of studies over the years showing this by this point, some of which are listed in the citations below. In general, occlusion training allows you to get more “bang for your buck” which makes it ideal in several applications. This makes it particularly applicable to some needs in the weight room.

Special populations stand to benefit the most from occlusion training. The ability to get so much progress from lighter weights in comparison makes it a great application for those who are injured and limiting load. Likewise, the elderly also stand to benefit greatly from occlusion training, as the risk of handling higher weights is mitigated while many of the benefits remain. Another less talked about application is in those who are demonstrating extreme muscular weakness. Sometimes people teeter on a tipping point of being able to gain traction to open up the tool box to more strength training tools. It was shown in the study listed by Hylden below that in participants with extreme thigh weakness occlusion was an effective intervention. Occlusion is not just for special populations though.

In those who are healthy, occlusion still allows you to get more bang for your buck! In fact, we often discuss training volumes relative to your MRV and the minimumum effective dose and we want to aim between that. For the most part, occlusion training can be considered as “costing less” from your MRV checkbook, and in fact depending on how you apply it, it can be a recovery modality. In ‘The effect of intermittent lower limb occlusion on recovery following exercise-induced muscle damage: A randomized controlled trial” referenced below, occlusion/BFR was utilized after training, and it was shown to improve recovery. This aligns with my practical experience since roughly 2012 utilizing it as a recovery modality at times.

So, why does it work for all these different things? To keep it relatively simple there are a few mechanisms that are at play.

Reduced venous return without impeded arterial flow means blood goes in, but not back out. This means that locally a few things happen.

  • Waste byproducts of muscular contractions end up at higher concentrations than normal. This is “noticed” by sattelite cells in the area which stimulated by exercise anyway when it realizes the muscle is being damaged,. Because the waste byproducts are at a higher concentration than they would normally be from that exercise, a larger response is illicited than would otherwise, with the end result of the body “overcompensating” for how much muscle damage actually occured by releasing more growth factors than would have been released if you had not, in a sense, tricked the body into thinking there was more damage than there actually was.

  • Increased mechanical tension on the fascia. Trapped blood=stretch with illicits a hypertrophic response.

  • Creates a low oxygen environment which taxes metabolic pathways related to oxygen consumption. This yields potential benefits to aerobic training as it was shown to improve oxygen consumption and reduce fatigue in only a week.

When it comes to practical application, if you are able to handle heavy loads and high force production movements, you still should, as there is some potential that BFR is more beneficial to hypertrophy of the type 1 muscle fibers, and that type 2 still seem to respond better in terms of strength and hypertrophy to heavy training. That being said, overall strength and hypertrophy were also shown to benefit from occlusion/BFR, and would also lend to greater strength endurance at a given force output.

This means BFR can fit into almost anyone’s program, but it may make sense to push the volume and frequency of application more for people who value overall hypertrophy for aesthetics, such as bodybuilders, or for those who highly value strength endurance such as those in sports such as mma, soccer/football, lacrosse, basketball. That being said, in practical application I have also found it highly beneficial for strength athletes, either as a means to illicit hypertrophy, bounce back from an injury faster, or bring up a weak muscle group without having to detract from other work as much to stay within the budget for recovery requirements.

So how to we apply this? There are tons of ways to apply it. Lots of studies I have read over the years have suggested lower weights such as 30% of one’s max for roughly 3 sets of roughly 30 reps. Some suggest lower rep ranges and some suggest rep ranges up to 75 reps. This means, even if we are going to go by the literature strictly there is a pretty large range of applications that have been tested.

In practical application, there are a few methods that I find the most beneficial.

  • Standard 3 x 30 does the trick pretty well to keep it simple. 30% seems to be a pretty reliable suggestion here. This is a reliable and easy to apply method.

  • Antagonistic supersets of 2-4 sets of 15-25 reps at 25-40%

    • Lots of ways to do this, but an easy way is to just pick one movement for a target muscle, say barbell curls for biceps, and pick another movement for the antagonistic muscle, so maybe cable pushdowns for triceps.

  • Drop sets. This is my personal favorite and what I feel is the most effective for strength, hypertrophy, stimulating recovery from injury, and aerobic adaptations. It is also how I would put something in to cover all those bases + get more while writing a smaller check from the MRV if I was to have my choice and know someone will push it to where they need to. In general, I start with a weight I can perform 6-10 reps and go to RPE 9, drop the weight 15% and perform reps ro RPE 9, drop the weight 15% and repeat. In practice those numbers may be just a little off. Leg press and dumbell curls (separately, not on the same day or paired up of course), are two of my favorite movements for this, and I will typically just drop a plate per set on leg press, or drop down one set of dumbells and run the rack on curls.

  • Pairing a target movement up with a compound movement that also utilizes the target muscle. For example, pairing up band triceps extensions with a pressing movement to bring up the triceps.

What can you occlude? Your biceps/triceps, quads/hams, adductors/abductors, forearms, and if you dare your calves/anterior tibs are all easy fair game.

How do you occlude yourself? Nowadays there are fancy cuffs you can buy, which personally although it is more objective, its logistical impact and convenience seems to balance out to being less than my favorite way. Totally cool if that is your way though, it is more objective. Practically, the little bands available on amazon with a slide and lock work really well, and personally I just use broken “monster walk bands”. They seem to work the best.

When you apply the cuffs, you want to pump up until you reach full occlusion (stop hearing the pulse or seeing the needle jump) then let it to 70-80% of that. For the bands just put it on so it dents into your arms about .5 inches if you are normal body composition, a little less if you are really lean, and up to about an inch if your body composition is currently higher bodyfat. For the legs for most people it is about .75inches. If you find your limbs going numb loosen it a little. If you are not getting more of a pump than normal to a degree it is noticeable then tighten it a little.

Check out the program below that incoporates occlusion training for even more info on how to include occlusion into your training for strength, size and performance! This is a program I would suggest running 1-5x a year to reap the benefits maximially in the big picture.

Stay strong, lift shit, and do cool stuff!

Josh





Citations:

Bazgir B, Fathi R, Rezazadeh Valojerdi M, Mozdziak P, Asgari A. Satellite Cells Contribution to Exercise Mediated Muscle Hypertrophy and Repair. Cell J. 2017 Winter;18(4):473-484. doi: 10.22074/cellj.2016.4714. Epub 2016 Sep 26. PMID: 28042532; PMCID: PMC5086326.

Bobes Álvarez, C.; Issa-Khozouz Santamaría, P.; Fernández-Matías, R.; Pecos-Martín, D.; Achalandabaso-Ochoa, A.; Fernández-Carnero, S.; Martínez-Amat, A.; Gallego-Izquierdo, T. Comparison of Blood Flow Restriction Training versus Non-Occlusive Training in Patients with Anterior Cruciate Ligament Reconstruction or Knee Osteoarthritis: A Systematic Review. J. Clin. Med. 2021, 10, 68. https://doi.org/10.3390/jcm10010068

Bunevicius K, Grunovas A, Trinkunas E, Poderienė K, Silinskas V, Buliuolis A, Poderys J. Low- and high-intensity one-week occlusion training improves muscle oxygen consumption and reduces muscle fatigue. J Sports Med Phys Fitness. 2019 Jun;59(6):941-946. doi: 10.23736/S0022-4707.18.08672-3. Epub 2018 Jul 9. PMID: 29991216.

Cook CJ, Kilduff LP, Beaven CM. Improving strength and power in trained athletes with 3 weeks of occlusion training. Int J Sports Physiol Perform. 2014 Jan;9(1):166-72. doi: 10.1123/ijspp.2013-0018. Epub 2013 Apr 23. PMID: 23628627.

Early KS, Rockhill M, Bryan A, Tyo B, Buuck D, McGinty J. EFFECT OF BLOOD FLOW RESTRICTION TRAINING ON MUSCULAR PERFORMANCE, PAIN AND VASCULAR FUNCTION. Int J Sports Phys Ther. 2020 Dec;15(6):892-900. doi: 10.26603/ijspt20200892. PMID: 33344005; PMCID: PMC7727422.

Hylden, Christina, et al. "Blood flow restriction rehabilitation for extremity weakness: a case series." J Spec Oper Med 15.1 (2015): 50-56.

Loenneke JP, Pujol TJ. Sarcopenia: An emphasis on occlusion training and dietary protein. Hippokratia. 2011 Apr;15(2):132-7. PMID: 22110294; PMCID: PMC3209675.

Will Page, Rachael Swan, Stephen D. Patterson. The effect of intermittent lower limb occlusion on recovery following exercise-induced muscle damage: A randomized controlled trial, Journal of Science and Medicine in Sport, Volume 20, Issue 8, 2017,Pages 729-733,ISSN 1440-2440, https://doi.org/10.1016/j.jsams.2016.11.015.

Reece TM, Godwin JS, Strube MJ, Ciccone AB, Stout KW, Pearson JR, Vopat BG, Gallagher PM, Roberts MD, Herda TJ. Myofiber hypertrophy adaptations following 6 weeks of low-load resistance training with blood flow restriction in untrained males and females. J Appl Physiol (1985). 2023 May 1;134(5):1240-1255. doi: 10.1152/japplphysiol.00704.2022. Epub 2023 Apr 6. PMID: 37022967; PMCID: PMC10190928.

Schoenfeld BJ, Ogborn D, Piñero A, Burke R, Coleman M, Rolnick N. Fiber-Type-Specific Hypertrophy with the Use of Low-Load Blood Flow Restriction Resistance Training: A Systematic Review. J Funct Morphol Kinesiol. 2023 Apr 27;8(2):51. doi: 10.3390/jfmk8020051. PMID: 37218848; PMCID: PMC10204387.

Sumide T, Sakuraba K, Sawaki K, Ohmura H, Tamura Y. Effect of resistance exercise training combined with relatively low vascular occlusion. J Sci Med Sport. 2009 Jan;12(1):107-12. doi: 10.1016/j.jsams.2007.09.009. Epub 2008 Feb 20. PMID: 18083635.

Yamanaka T, Farley RS, Caputo JL. Occlusion training increases muscular strength in division IA football players. J Strength Cond Res. 2012 Sep;26(9):2523-9. doi: 10.1519/JSC.0b013e31823f2b0e. PMID: 22105051.