Sports Therapy Community Streamed

Ep.11 Are you missing out if you're not using BFR? - Dr Warren Bradley

December 01, 2020 Kristian Weaver and Dr Warren Bradley Season 1 Episode 11
Sports Therapy Community Streamed
Ep.11 Are you missing out if you're not using BFR? - Dr Warren Bradley
Show Notes Transcript

In this episode I speak with Dr Warren Bradley about the benefits of blood flow restriction training and his new clothing brand, Hytro.

If you want to Become An Unstoppable Sports Therapist then visit: 

www.sportstherapycommunity.co.uk

To find out more about Dr Warren Bradley and Hytro:

Website: www.hytro.com

Instagram: @Hytro_ and @Warren_Hytro


Reference list:

  1. Scott BR, Loenneke JP, Slattery KM, Dascombe BJ. Blood flow restricted exercise for athletes: A review of available evidence. J Sci Med Sport. 2016;19(5):360-367.  
  2. Cook CJ, Kilduff LP, Beaven CM. Improving strength and power in trained athletes with 3 weeks of occlusion training. Int J Sports Physiol Perform 9: 166–172, 2014.  
  3. Luebbers PE, Fry AC, Kriley LM, Butler MS. The effects of a 7-week practical blood flow restriction program on well- trained collegiate athletes. J Strength Cond Res 28: 2270–2280, 2014.  
  4. Yamanaka T, Farley RS, Caputo JL. Occlusion training increases muscular strength in division IA football players. J Strength Cond Res 26: 2523–2529, 2012.  
  5. Libardi CA, Chacon-Mikahil MP, Cavaglieri CR, Tricoli V, Roschel H, Vechin FC, Conceicao MS, Ugrinowitsch C. Effect of concurrent training with blood flow restriction in the elderly. Int J Sports Med. 2015;36:395. 
  6. Vechin FC, Libardi CA, Conceicao MS, Damas FR, Lixandrao ME, Berton RP, Tricoli VA, Roschel HA, Cavaglieri CR, Chacon-Mikahil MP, Ugrinowitsch C. Comparisons between low-intensity resistance training with blood flow restriction and high-intensity resistance training on quadriceps muscle mass and strength in elderly. J Strength Cond Res. 2015;29:1071–6.  
  7. Lixandrao ME, Ugrinowitsch C, Laurentino G, Libardi CA, Aihara AY, Cardoso FN, Tricoli V, Roschel H. Effects of exercise intensity and occlusion pressure after 12 weeks of resistance training with blood-flow restriction. Eur J Appl Physiol. 2015;115:2471–80.  
  8. Segal N, Davis MD, Mikesky AE. Efficacy of blood flow-restricted low-load resistance training for quadriceps strengthening in men at risk of symptomatic knee osteoarthritis. Geriatr Orthop Surg Rehabil. 2015;6:160–7.  
  9. Segal NA, Williams GN, Davis MC, Wallace RB, Mikesky AE. Efficacy of blood flow-restricted, low-load resistance training in women with risk factors for symptomatic knee osteoarthritis. PM R. 2015;7:376–84.  
  10. Bryk FF, Dos Reis AC, Fingerhut D, Araujo T, Schutzer M, Cury Rde P, Duarte A Jr, Fukuda TY. Exercises with partial vascular occlusion in patients with knee osteoarthritis: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2016;24:1580–6.  
  11. Giles L, Webster KE, McClelland J, Cook JL. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med. 2017;0:1–8. 
  12. Tennent DJ, Hylden CM, Johnson AE, Burns TC, Wilken JM, Owens JG. Blood flow restriction training after knee arthroscopy: a randomized controlled pilot study. Clin J Sport Med. 2017;27:245–52.  
  13. Takarada Y, Takazawa H, Ishii N. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc. 2000;32:2035–9.  
Introduction :

Welcome to the sports therapy community streamed. The place where sp orts therapy practitioners can get useful and actionable advice from industry leading experts from Sports Medicine, to psychology to business. Here is your host, sports therapist, exercise physiologist and creator of the sports therapy community, Kristian Weaver,

Kristian Weaver :

are you missing out on not using BFR, which is blood flow restriction training? Hello, and welcome to this episode with Dr. Warren Bradley. Today we're going to be talking about the use of blood flow restriction training. And interestingly, a new clothing brand that incorporates the new technology. Okay, so Warren, can you just tell the listeners a little bit about you?

Dr Warren Bradley :

Yeah, no problem. So I spent the last kind of decade working in professional sports. And at the same time, I was completing a PhD in human physiology and nutrition. And when did I get the PhD 2017 I completed my PhD. And I was still working in professional sports. Up until this year, I worked full time with the business hytro, which we'll speak about a little bit later, I'm sure. During my kind of academia time, I published 12 papers and books chapters over the course of that period, on the subjects of performance nutrition. And that was how I got into the sport, I was really lucky to be afforded the opportunity to work with monster rugby, back in 2012, which is right at the beginning of my PhD. And since then, I've worked with many different football rugby teams of what England Rugby Sevens, Leicester tigers, Celtic grand devils, rugby league team hosts at Derby County, just to name a few. I guess it was during the time, you're working in a multidisciplinary team. So you're working with physios, it's for scientists and coaches. And I saw this kind of really strange methodology been using the players and it was blood flow restriction, which kind of stimulated me to think about this business. But yeah, that's kind of that's kind of my background, kind of why I've gone into restriction is because I saw the first using spark on every single team.

Kristian Weaver :

Yes, so quite an extensive background in sports. And obviously, you're now looking at this very specific area of training. So just tell us a little bit about what blood flow restriction training is.

Dr Warren Bradley :

Okay, so before restriction training other subjects used with a vise been used with every single sports team I've ever supported, I can't say conclusively, its use of every sports team in the Premier League Championship, etc. But I've seen it used in every team I've supported. And essentially, it's the methodology to rapidly enhance muscle physiology. So size, strength, endurance power. And it's typically used for rehabilitation after injury or surgery in professional sports. Now, this isn't the only way it can be used. But it's used in this way due to a few logistical barriers. And it's used with really great effect. And anecdotally, I've seen it used with a bit of great success. I've seen players maintain muscle mass when they've been in a boot, you know, six to eight weeks. To maintain strength somewhat, you know, there's probably been a 1015 drop in strength, which is crazy when you can send it normally 50 60% drop off strength, I'm sure you can give me some clarity on that. But anyway, the augmentation muscle physiology was just it was crazy. So I saw it while doing my PhD in forms of nutrition and human physiology, and it kind of really struck a chord with me the human physiology side of it. So wasn't particularly my area, but I really was intrigued. So once I finished my PhD, I just wanted to look into a bit further when I had more time on my hands. And I bought us a little bit of science, if I may just listen to just how it works exactly. So it works by applying a really strong circumferential pressure around the top of the arm of the leg. So it's got to be the most proximal part and then as well for safety. So that's to avoid any kind of nerve damage essentially from occluding blood flow to low on the muscle, so over the muscle belly of the bicep or the hamstring, for example. And what this does is it restricts the venous blood flow. So, arterial blood oxygenated blood flowing through the arm and the wrist the return flow of venous deoxygenated blood is stemmed essentially. So that's the blood flow restriction aspect. And this is accelerated with Lolo and exercise and you could even do walking, you could do a slow cadence cycle, or you could do you know 20 to 30% with one RM with high repetition. What this does is it gets more blood performance and obviously as your muscles contracting and what happens here is the oxygenated blood is used to fuel the slow oxidative fibres and the fast oxidative fibres which require oxygen obviously, to produce contractions. And because there's so much deoxygenated blood building up and not wanting, it creates a hypoxic environment, so a state of hypoxia, which is the listeners don't know it would just be a lack of knowledge. Essentially, and because there's a lack of oxygen, the slow twitch fibres or the fast populated fibres cannot produce energy, they cannot contract so they rapidly fatigue, which means that your fast twitch fibres are therefore recruited to help you contract. Now, obviously, under normal circumstances, your fast twitch fibres would only be recruited for strength power kind of movements. So you know, Sprint's once five rounds on a bench press type thing, but here we have an exercise modality where you're lifting, pretty much it kind of be in here lifting not very much at all. But because there's a blood flow restriction in place. Fibres are rapidly fatigue and all of your fibres in a contract come together to facilitate the lift. And it's not just the, it's not just the fatigue of infrastructures of the muscle fibres, it's also the hormonal effects that are quite significant. What happens is that the cascade of physiological reactions occur enough because of the metabolic stress that builds in the limb, so the limb is filling with muscle, there's a lot of cell swelling and a lot of lactate buildup and a lot of stress and metabolites building up. And what that does is essentially, it triggers something called the mTOR pathway. That's the mammalian target of rapamycin, and that is the central regulator for MPs muscle protein synthesis, which is obviously synthesising proteins in the body and building muscles. So because it's a central regulator, and it's heavily regulated, this is why we're getting really strong results for hypertrophy in athletes. So essentially, these two mechanisms is one is physical, were recruiting all on muscle fibres, in fact, most hormonal or increasing muscle person since it's even lifting very lightweight. And now, in terms of kind of use in professional sport, where I've seen it, the rehab is really important to understand that these athletes cannot necessarily lift anything, you know, when they're bed bound, or they're in a period of disuse, they cannot lift any weights, so they rapidly degenerate the muscle, it rapidly reduces in size and strength. So we now have a methodology where you can be in bed and you can apply a cough, apply a strong pressure for five minutes and do a few cycles a day. And you're getting all of these hormonal effects, even without the exercise without the physical structural kind of contraction, you still getting this blood filling, and this cell swelling in the muscle and all these hormones responsible for muscle growth. So the other implications of not it's not just for professional athletes to you know, post injury or surgery, it's the elderly, or people with degenerative muscle degeneration kind of diseases. So we can potentially get your granny walking again, essentially, because if you can apply a blood flow restriction cuff to her legs and get her to just try and stand up on a genogram and move around a few steps, or even just a still, we're now augmenting that physiological process and hormones responsible for muscle growth, and bone mineral density increases to all without exercise. So it is quite, it's quite amazing what what it can achieve.

Kristian Weaver :

Great stuff, so obviously there are processes going on there. In terms of, sort of throwing a bit of a curveball question here, Warren, in terms of what do we see an increase in muscle fibre number? Do we see an increase in muscle muscle fibre size? Or is it a combination of both? What's the literature sort of pointing towards the,

Dr Warren Bradley :

as far as I'm aware? So I would like to caveat this with I am not a BFR expert yet. So obviously, my background is in nutrition and human physiology, I'm learning all the time, I'm reading a lot of research. And my understanding is is the hypertrophy of the muscle fibre rather than treating muscle fibres as my understanding, but please don't quote me on I would read the research papers I've listed at the bottom of this document for your students.

Kristian Weaver :

Yeah, definitely, I will obviously pull up all the references from this onto the show notes. So so people can go away and have a little look at those and further read, because you've provided quite an extensive list of all the literature is supporting this kind of kind of intervention. So mainly, my next question is, as a practitioner, I just want to know, is it safe for us to be using? And is there anything that we need to particularly do before we start using this kind of implementation?

Dr Warren Bradley :

Yeah, absolutely. So blood restriction training has been around for a while now. It was known as katsu trading over in Japan. And it's been proven to be safe in the facts of life. You know, many, many research papers. I think there's over 1000 research papers on PubMed now, showing us safety and efficacy. But there are some pretty important considerations and you have to look into and the big one really is a specific placement of the tourniquet. It has to be the most proximal point in the limb. And that's to avoid nerve damage. And even if you applied 10 out of 10 as tight as you could possibly achieve comfort strap on that limb. Well, firstly, you wouldn't be able to lift anything because it means very uncomfortable to the point would be pretty painful. So you would take them off, but secondly, it wouldn't cause any damage because it's in the right place. And this is actually a really big feature of our sportswear garments, which again, we'll talk about in a minute but you do see people putting on the cuffs and in the wrong position. So I've seen bodybuilders using before in the gym, they're applying the cuff or mid bicep or just kind of just above the mid bicep. And this can be really dangerous because you're getting nerve damage that you're actually compressing the nerves. Whereas if you put it the most proximal point, that's where it's known to be safe and effective. And that's about all the research shows that it's safe and effective. So, yes, you have to make sure you apply the comfort strap or whatever device tourniquet you're using the most proximal part of your limb. And there is, there is quite an abundance of research now using something called practical BFR. And it was first presented by Linda key in 2010, I believe it's 2010. And he uses knee wraps basically like what you see bodybuilders using in the gym. And so they refer knees to avoid, I guess, stress and strain on the joints and do really heavy squats. So you can use these very same knee wraps at the most proximal point of your limb and use the subjective measures seven out of 10 times. Now, obviously a subjective measure, you have some videos looking at that. sure about that. But the research has shown if you, if you, if you use a subjective measure of seven out of 10, you are going to achieve somewhere between 50 to 80% of occlusion pressure, and 9900 cases. And as long as it's on in the right position, the proximal point that we're in, even if they went slightly higher than seven, it's not a problem as long as it's in a specific placement. And that's why I keep highlighting that it's very, very important to do. There are within medicine within clinical populations, we do typically use something called a limb occlusion pressure. So that's that setting the pressure, the percentage of the limb on the limb circumference all the systolic blood pressure. And that's to ensure consistency throughout our rehabilitation process. And that we know that every time this person where the cups are strapped, that they're applying the same amount of pressure or they're graduating the pressure properly. The problem with that, obviously works for professional sports, because you have athletes coming in every single day seeing the practitioners and be looked after. But when you've got the NHS dealing with it, for example, they present to my knowledge only provides 65 sessions in total over a 12 week period post injury. Now BFR is something that you have to do consistently and continuously, maybe three, four times a week to see our achieve any results. So to me, it's completely null and void to bring someone in as a clinician and applied BFR once every once every two weeks for the has to be a more practical method established. And because of the cost implications of the equipment in they use, it seems feasible to me that you would use a practical BFR as a method of practical method to get them actually doing this at home. Now again, as I did say, you will have physios looking at this thing I'm not sure about subjective measure, the research shows is safe and effective, we can't guarantee it will be the same every time. But the benefits of being able to do it daily, or you know, three or four times a week as opposed to something or once every two weeks, which will have no benefit. To me kind of makes sense. And also, when I go into my gear, I'll show you that we've actually we've got a numbering system around the around the tourniquet on the arm or the leg so that we can at least get it within a somewhat the same place or pressure as previously used to the other six of chemical pressure gauge, you go to six next five minutes should be very similar. And obviously there is one more thing as well, it's quite important. So due to the kind of the metabolic stress and the fourth cell swelling of the muscle, and the restriction of the blood flow, of course, there are a few contraindications that you need to be asking your clients about such as severe hypertension, no history of blood clots, and history of heart disease. Generally, if it's suffered from some kind of condition, or contraindication, the definitely best Arsenal physical therapists on GP before commencing this type of training, because there is stress involved in this training.

Kristian Weaver :

Yeah, I know that you mentioned there that you could potentially use it maybe in the elderly population. But obviously that obviously comes with that sort of side note that it does need to be in relatively fit and healthy populations at this moment in time. I presume the research isn't like that. And the evidence isn't there in order to support that use yet. And but obviously, with with increasing research studies which are going on in this area, then we might be able to get to that point at some time in the future. So where does that evidence really lie at this moment in time?

Dr Warren Bradley :

As I said there's probably around I think I've searched on PubMed earlier there was 1013 studies at the moment it for the search term blood flow restriction training, occlusion training and blood flow restriction exercise. So the research is coming along is lacking of course 1000 research papers is an extensive assault and most of the research has been done in the only to be found on for MSK rehabilitation. But there are you know, growing numbers of studies of professional athletes and healthy adults showing you know improved muscle physiology and then to book Yeah, you're completely right. It is quite a novel and new technique. I say it's quite novel and new, it's been around for a while, but the research is quite novel and new, it's only been since 2010, that has really been, I think 80 to 90% of the papers have been published. So we're not quite there yet, we do need to test all of this. And this is why we're actually doing some research studies with Queen Mary's in London, with our business Hytro, to try and progress this research. And so we're really underpinned by science, and we, you know, we want to maintain that credibility angle. So, we will be looking into, you know, use of different occlusion pressures and somehow, way to incorporate dye into clothing, like we have done with the straps as well, to make sure it's safe and effective for the elderly.

Kristian Weaver :

Excellent. So we have sort of come on to your new brand there. So hytro, and obviously, this is, and you've made a reference to it in some parts. Warren's actually sporting some of the some of the wear now if you're watching on the YouTube channel, on video, and so Warren do you just want to talk us through new clothing that is associated with blood flow restriction, essentially what it does.

Dr Warren Bradley :

Yeah, absolutely love to have few plugs within the previous statements. So yeah, I saw BFR used with great effect over a number of years. And essentially, I just thought, Why is this not being used in Gen pop, because it clearly works. I read the literature, it works in concrete, I didn't quite understand it. And I think this is very subjective again, but I think it's a lack of accessible information on basically the current logistical and safety limitations that prevent it from widespread use. And so logistically, it's quite difficult to setup, you know, you have to have it the most proximal part of the limb, as was stated about five times so far. And it's really important to achieve that for safety. So I think because of the safety aspect, it's just not been widespread, yet there's been people aren't plugging it because of that element. Also, if you consider how much sports teams are paying for equipment, can be anywhere from 2000 to 10,000 pounds when you have the proper machinery that dictate pressures, and it's manipulated over time. Now, of course, that would probably be the gold standard, if everyone can afford it. And if you could put it in your backpack and travel with it, etc. Well, the utility of it is just it's negligible, you're not going to be able to do that or use it. So the only other way you can possibly really do BFR is to buy the cuffs online. And the issues with the costs are pretty poorly made. To be honest, the materials haven't been considered within the research, to start with the bandwidth or the conference, whatever, whatever the devices haven't been considered in terms of the research as well. They're just kind of thrown together in a factory in China. And also without kind of support and use, you got to put them on the wrong place on the limb. As I said, bodybuilders have put them on the mid bicep in the mid thigh. And it's very, very dangerous. So what I did was, I basically thought, How do I make this safe and accessible for everyone? So I thought, okay, I boiled it down to its components, it's tourniquet essentially, that's applied to the correct place on the arm. So I just thought, Well, if I incorporate into clothing, and I put into shorts, or leggings for women, and tops for men and men and women, we ensure that with every single use, because of the specific anatomical placement, it will be used safely and effectively every single time because it's in the correct place already. circumvented that immediately. And that that has a kind of few, a few positives, really. So when you talk about professional sports, they can only do one player at a time due to the machinery that they have. And that's why they only use it for rehabilitation. Now we have the potential of a product, you can use it the whole squad, at the same time, it takes five seconds to deploy both arms, it is very, very quick. We know it's in the safe and effective position. So this is something that we can now use to augment muscle physiology at the end of a session in otherwise healthy populations, rather than just rehab. We can also do it game day plus one. Because there's no actual significant structural damage to the muscle tissue, it's mainly the hormones that are affected, we can actually, we can actually manage to improve their recovery by using BFR on game day plus one. So what we can do is we can give them top two shots to take home and say, five minutes of BFR and you're done. Recovery is done for the day. So it's a really effective way to enhance the recovery for an athlete as well. And obviously then, if we talk about medical, medical use, we can now describe, you know, we can send people home with this we can say okay, you've got a leg brace, you're going to be bed bound for two weeks or whatever. Go home with these shorts, hold them on, just apply the strap to get someone to help you you don't need to move, you can get the benefits of the hormones you can reduce the atrophy of the muscle, we can increase your bone mineral density if your bones broken. And then after that we can start to rehabilitate at home using only 20 to 30% one RM which means for not loading structures. So the structures are now realistically that aren't affected because we're lifting such lightweight or just walking. It's stuff you'd be doing anyway for rehab, but we're also getting the benefit Physical hormones were these two. And yeah, there's another, there's a few things that we've kind of considered with the top as well. So not just a specific anatomical location, but we provided the markers. And you can pretty much achieve a very similar occlusion each and every time I cannot guarantee will be exactly the same pressures applied, but it's going to be there there abouts. And also, the material blends used for the strap on the specific strap went have all been considered based on the scientific literature. So I've scoured the literature and looked at what the most optimal bandwidth will be for the arm, and then for the legs, and it's slightly larger on the legs due to obviously a larger muscle bulk. And this is important to understand because it is too thin if the strap is too, if it's not wide enough, the occlusion is going to hurt because the pressures obviously applied to a smaller area. So you're going to probably be more likely to get some damage within the muscle fibres. However, if you do too wide, you're probably spread over the bicep or spread over the muscle too far, which again, you'll need far too much pressure to be to be applied to achieve occlusion. So we've achieved a really optimal occlusion using specific bandwidth specific materials and in the city location, so everything is as safe as it can possibly be. Essentially, I would like to caveat this as well with the fact that we are working with universities and very well respected BFR experts to build a new device, which for the medical markets, which will include a device to assess limb occlusion pressure within the clothing. So we actually own the pattern for the flow restriction ` tourniquet, sorry, Incorporated integrated into clothing. We only in the UK, and we've got applications in for the rest of the world. And so we're just waiting on them to come through now. But we do, we've already had it granted in the UK, which means now we can work on it exclusively with the researchers in London, and bring it to the medical market, a limb occlusion pressures version of our demo garments coming down the line, which is really exciting.

Kristian Weaver :

Super, because I know that obviously that you said that research informed practices is one of your key sort of values in terms of ensuring that the clothing is sort of reaching that high research element and that level of what's the word I'm probably trust from and practitioners who use netball so that the people who are using it, and wearing those kind of garments. So that's actually a nice points are sort of finish on the that you're working on new things. And obviously the you've got the patients in for various different parts of the world, which is exciting. And where can we find out more about you, Warren about the height show itself?

Dr Warren Bradley :

Yes, you can head to our website, which just launched last week www.hytro.com. And there's also the Instagram page. So at hydro underscore, and shameless plug it you can also get my Instagram at Warren underscore hydro as well. But the other website I will be directing people to.

Kristian Weaver :

Great. So. And thanks very much for coming on board. It's been a pleasure. And thank you for coming on to the sports therapy community streamed. Make sure those contact details are within the show notes and also that extensive research list that you sent me. So I'll make sure that's also in there for our listeners, and anyone who wants to read it.

Dr Warren Bradley :

That's fantastic. Thank you so much for having me. Kristian. Can I just finish on sorry, on the website as well, there is a research section. So I've written a lit review on BFR. And kind of the rationale behind Hydro and why we've come up with this idea. Just a bit more detail based on what we've discussed today. So I might give you a link to that we're going to direct the students to

Kristian Weaver :

Yeah, exactly so send that to me and I'll make sure that it's all in our show notes.

Dr Warren Bradley :

Mate thats amazing. Thanks so much for having me.

Introduction :

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