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Does In-Season Training with BFR Improve Strength or Performance? - #AMR397 · The Ask Mike Reinold Show

• 0:50
  SPEAKER_01: On this episode of The Ask My Crinal Show, we have a journal article review discussing the effect of low load blood flow restriction training in season on strength and performance of basketball players.
• 1:01
  SPEAKER_01: Great study.
• 1:02
  SPEAKER_01: The Ask My Cryndal Show.
• 1:07
  SPEAKER_01: Helping people feel better.
• 1:19
  SPEAKER_01: Before we get to the podcast, I wanted to make sure you knew about my free online course on the introduction to performance therapy and training.
• 1:27
  SPEAKER_01: If you want to learn how to get started optimizing and enhancing performance, this is the course for you.
• 1:32
  SPEAKER_01: Head to micrenned.com slash performance to sign up today.
• 1:36
  SPEAKER_01: Welcome back, everybody, the latest episode of the Ask Mike Realmshow.
• 1:39
  SPEAKER_01: We are here champion PT Performance, answering your questions, actually reviewing an article.
• 1:42
  SPEAKER_01: We're going to review another article today.
• 1:44
  SPEAKER_01: We got a great article today.
• 1:45
  SPEAKER_01: Dave Tilley, Anthony Videtto, Noah Sprinkle, Lenny McCrina here for you today, along with Brendan Gates, who will be taking the lead on our article.
• 1:54
  SPEAKER_01: So let's see, what do we have for an article?
• 1:56
  SPEAKER_01: We have, I'll I'll help, I'll start it off for you, Gates.
• 1:59
  SPEAKER_01: The article is from the Journal of Sports Sciences.
• 2:02
  SPEAKER_01: And the title is Low Load Blood Flow Restriction with Elastic Bands, Elicit Superior Gains in Sprint and Jump Performance compared to heavy load training in season with college basketball players.
• 2:14
  SPEAKER_01: So good.
• 2:15
  SPEAKER_01: I like that.
• 2:15
  SPEAKER_01: I think that was just like a nice, you know, strict kind of study.
• 2:18
  SPEAKER_01: Uh, but check out that article.
• 2:20
  SPEAKER_01: There's a link to it in the show notes.
• 2:22
  SPEAKER_01: Brendan, what do we have for a review of the article today?
• 2:25
  SPEAKER_02: Appreciate you taking the title on that one.
• 2:27
  SPEAKER_02: That was a uh melt pull.
• 2:29
  SPEAKER_02: Um, but yes, so good study.
• 2:31
  SPEAKER_02: Uh it was a randomized control trial.
• 2:33
  SPEAKER_02: They looked at 18 NCAA Division I male basketball players uh during an eight-week competitive season.
• 2:40
  SPEAKER_02: Um, the question that they were looking to answer was can we improve or maintain athletic performance during the season while reducing mechanical loading?
• 2:49
  SPEAKER_02: Um and so the authors, they they kind of mentioned how they know heavy resistance training is great for strength, uh, but it can also create quite a bit of joint stress and fatigue.
• 2:59
  SPEAKER_02: Um they wanted to know that uh excuse me, they wanted to know if squatting with low load combined with PFR could produce similar or better performance adaptations than traditional heavy loaded.
• 3:12
  SPEAKER_02: Um and so what they did was they basically took uh two groups.
• 3:16
  SPEAKER_02: Um they had these two groups randomized and they trained twice per week for eight weeks uh while continuing their normal basketball practices in games.
• 3:24
  SPEAKER_02: So I think highlighting the fact that this is an in-season study is good context.
• 3:29
  SPEAKER_02: They had the first group uh use BFR and they used a lower load squat.
• 3:35
  SPEAKER_02: So they were doing 30% of their one rep maps.
• 3:37
  SPEAKER_02: They called it a set reps give of one set of 30 reps, followed by three sets of 15 reps with 60 seconds of rest in between.
• 3:45
  SPEAKER_02: The BFR cups were inflated to 180 millimeters of mercury, uh, and that came out to about 60 to 80 percent swim occlusion pressure.
• 3:55
  SPEAKER_02: Um they just standardized that pressure for every athlete when it fell somewhere within that range.
• 4:01
  SPEAKER_02: The heavy loading resistance training group squatted uh 75% of their one-rep maps.
• 4:06
  SPEAKER_02: They did four sets of eight to ten reps, and they had three minutes of rest in between.
• 4:10
  SPEAKER_02: Um interesting wrinkle is both groups had back squats, was the main thing that they looked at, and they had uh bands to them as well.
• 4:18
  SPEAKER_02: So they calibrated the bands to have about 10 kilograms of resistance at the bottom of the squat, and then 25 kilograms of resistance at the top of the squat, and then they loaded the barbell with uh normal weight so that the total resistance averaged either 30 or 75 percent of their one rep max based on the group that they were in.
• 4:35
  SPEAKER_02: Um they then looked at over the season how their counter movement jump, their squat jump, their RSI, their 30-meter sprint time, their squat run rep max progressed.
• 4:45
  SPEAKER_02: Um they also quantified the total mechanical loading uh over the eight weeks.
• 4:50
  SPEAKER_02: So what did they find?
• 4:51
  SPEAKER_02: Uh they highlighted the difference in mechanical loading as the biggest one.
• 4:56
  SPEAKER_02: Um the BFR group accumulated roughly 12,500 kilograms of total squat volume over the eight-week period, uh, where the heavy load group accumulated roughly 44,500 kilograms over the eight weeks.
• 5:09
  SPEAKER_02: So that's about 3.6 times more mechanical loading in the heavy group than the BFR group.
• 5:14
  SPEAKER_02: Um they looked at jump performance.
• 5:17
  SPEAKER_02: Um squat jump and RFI did not differ between the two groups, but uh there was an interesting difference in the counter movement jump.
• 5:25
  SPEAKER_02: So the counter movement jump improved 3.4% in the BFR group and 1.8% in the heavy load group.
• 5:33
  SPEAKER_02: Um when they looked at the sprint times, the BFR group improved their 30-meter sprint by 0.8%.
• 5:40
  SPEAKER_02: Uh the heavy loading group increased um by 0.2%.
• 5:44
  SPEAKER_02: Uh so the BFR group improved significantly more compared to the heavy loading group.
• 5:51
  SPEAKER_02: Uh strength wise, both groups got stronger and roughly about the same amount.
• 5:56
  SPEAKER_02: So they said that both groups improved their squad room one rep max by roughly seven to eight kilograms.
• 6:02
  SPEAKER_02: Um so both got stronger.
• 6:04
  SPEAKER_02: Uh just one had to lift lighter weight.
• 6:07
  SPEAKER_02: Um an interesting part was perceived effort.
• 6:10
  SPEAKER_02: Uh so you might think that the BFR group, because they're lifting less weight, might make it easier.
• 6:14
  SPEAKER_02: Um, they reported that the RPE was the same between the two groups.
• 6:18
  SPEAKER_02: So even though they were lifting less weight with the DFR on, the athletes reported feeling like they were working just as hard despite the substantial reduction of mechanical load on their body.
• 6:29
  SPEAKER_02: Um so what does this mean?
• 6:32
  SPEAKER_02: I think um essentially, if we want to see a decrease in mechanical load and joint stress, training in season for athletes can be a viable option.
• 6:41
  SPEAKER_02: Um can also reduce some of that systemic fatigue, you know, that we want to manage as we are playing, you know, high-level games, practices, conditioning sessions, which might be a way to minimize that while you have stress from other parts of your sport.
• 6:56
  SPEAKER_02: Um the paper points out that this does not replace heavy loading.
• 7:00
  SPEAKER_02: Uh it actually touches on the benefits of it and they talk about how it's important for tenant fitness, phone health, and long-term athletic development.
• 7:07
  SPEAKER_02: But uh it gives us some evidence to say that VFR in season instead of traditional heavy loading could help with um a high volume schedule with a lot of games.
• 7:17
  SPEAKER_02: It could be helpful in D-load weeks, maybe certain athletes who are playing heavy minutes and we want to make sure that we're not overloading them.
• 7:23
  SPEAKER_02: Maybe athletes with irritable joints, we have less stress on them.
• 7:26
  SPEAKER_02: And it could potentially help in the return to sport progression uh of not overloading uh from a mechanical perspective.
• 7:33
  SPEAKER_02: So uh interested to hear your guys' thoughts on this.
• 7:35
  SPEAKER_02: Um let me know what you guys think.
• 7:39
  SPEAKER_01: Awesome.
• 7:39
  SPEAKER_01: Thanks, Brendan.
• 7:40
  SPEAKER_01: Great review of that article.
• 7:42
  SPEAKER_01: And again, I like how you know this answered some very specific questions, not broad strokes, which is really cool.
• 7:47
  SPEAKER_01: Like in season, I actually like how it was basketball.
• 7:50
  SPEAKER_01: If there was one sport where I think mechanical loading of like ankles, Achilles, knees is like super important, it's probably working with basketball players.
• 8:00
  SPEAKER_01: So I I thought this was really cool.
• 8:02
  SPEAKER_01: The part that I was excited about, I guess, is that not only did they have similar like strength maintenance, but the BFR group actually showed improvements in performance too, which I thought was pretty cool to see.
• 8:14
  SPEAKER_01: So um I I think this is really cool.
• 8:16
  SPEAKER_01: I think we're gonna start seeing this more and more.
• 8:18
  SPEAKER_01: But um, what do you guys think?
• 8:20
  SPEAKER_01: Who wants to jump in?
• 8:21
  SPEAKER_01: Anybody anybody play with this a little bit?
• 8:23
  SPEAKER_01: Anybody like have any concerns?
• 8:25
  SPEAKER_01: Anything they want to do different?
• 8:26
  SPEAKER_01: What do you guys think?
• 8:29
  SPEAKER_04: Yeah, I thought it was a uh an interesting study because as a you know, as a PT and as a clinician, I feel like we're we're using BFR when patients can't tolerate load, right?
• 8:40
  SPEAKER_04: So that's like the main reason that we use BFR champion at least.
• 8:43
  SPEAKER_04: So to see it used in a healthy population for performance benefits, I think that's super exciting and uh, you know, really curious to see kind of where this takes us in terms of kind of that whole sports performance realm, especially in season if we are trying to manage workload and all that type of stuff.
• 8:59
  SPEAKER_04: Um the only I guess question I had like was that you know, when we're looking at the protocol in terms of the rep set and reps team for you know the heavy load group, doing four set to ten is super fatiguing, right?
• 9:12
  SPEAKER_04: So I think if we asked any sports coach or you know collegiate strength coach out there, they're probably not dosing four set to ten for squats in the season.
• 9:21
  SPEAKER_04: I think that's gonna be probably you know detrimental to their sports performance.
• 9:25
  SPEAKER_04: So it is interesting to see that they you know got stronger throughout the course of the season, but I'm curious to know like, were there any other metrics that we could look at in terms of like fatigue?
• 9:35
  SPEAKER_04: Um, you know, we talked about jump height, you know, I think we would see maybe a decrease in jump height over time if if we were doing a four set to ten for these, you know, all these exercises.
• 9:43
  SPEAKER_04: So I thought that would be you know, curious to know in the future if we could go from four set to ten to maybe a more specific in-season protocol, like probably like four set to five, you know, a little bit less volume in total.
• 9:54
  SPEAKER_04: Um, but yeah, overall, I thought this was super exciting in terms of the fact that BFR might have more use than just you know for someone who's injured, but we might actually use it for sports performance at some point in the near future.
• 10:05
  SPEAKER_01: Yeah, that's great, Anthony.
• 10:06
  SPEAKER_01: That's a really good point too, because you know, I I think we could say that, you know, BFR is helpful.
• 10:12
  SPEAKER_01: Like we like we like the outcome.
• 10:13
  SPEAKER_01: So you can use BFR.
• 10:14
  SPEAKER_01: I think we're excited about that.
• 10:15
  SPEAKER_01: Uh, but to your point, like saying maybe there's a more optimal way to do heavier load, you know, maybe we can't rule out that heavier load is is bad.
• 10:22
  SPEAKER_01: Maybe just four sets of 10 is is is bad based on that, which is which is really good.
• 10:26
  SPEAKER_01: But uh awesome.
• 10:27
  SPEAKER_01: Len, what do you think?
• 10:29
  SPEAKER_03: Yeah, I mean, overall it's interesting paper.
• 10:31
  SPEAKER_03: Um the N is very small, only 18 total, so probably nine per group, I would guess, is what they uh is what it was.
• 10:38
  SPEAKER_03: Um so you gotta take that with a grain of salt.
• 10:41
  SPEAKER_03: I think also using a standard cuff pressure of 180 for everybody.
• 10:47
  SPEAKER_03: Um, you know, who knows what that means for each person is one thing.
• 10:53
  SPEAKER_03: I think also um the 30, 15, 15, 15, that's 75 reps.
• 10:58
  SPEAKER_03: That's a lot of effort for somebody to do.
• 11:01
  SPEAKER_03: So just from that, they could get changes.
• 11:04
  SPEAKER_03: Um, and then also uh one final thing.
• 11:08
  SPEAKER_03: I wish there was a better control group, meaning like somebody who did nothing or just did body weight or something would be a better comparison for my you know uh understanding of the of the conclusions that they that they drew from this.
• 11:20
  SPEAKER_03: Um I think we're onto something, but I think we need more data than just what they are providing in this paper.
• 11:25
  SPEAKER_03: But overall, and any study that is performed, I I I applaud them because it's an effort and it's not easy.
• 11:31
  SPEAKER_03: And so good job helping us understand it a little bit more.
• 11:35
  SPEAKER_01: I I like that.
• 11:36
  SPEAKER_01: And anytime they change the set rep schemes and the two groups have different set rep schemes, to me, that always bothers me in a research study because was it really the BFR or just that they did 75 reps, right?
• 11:47
  SPEAKER_01: It's a lot of reps, you know.
• 11:48
  SPEAKER_01: So I always wish they did that.
• 11:50
  SPEAKER_01: But again, at least we're comparing like two protocols, right?
• 11:53
  SPEAKER_01: And in in and at least we have one that was effective.
• 11:56
  SPEAKER_01: And I think that's why we kind of like the study.
• 11:58
  SPEAKER_01: If if things were you know ineffective, maybe we'd be more critical in saying, like, well, I wonder if there's a better way to do it.
• 12:04
  SPEAKER_01: But uh, what else?
• 12:04
  SPEAKER_01: Dave, what do you got?
• 12:05
  SPEAKER_00: Yeah, my two cents, I really like the article.
• 12:07
  SPEAKER_00: I think it was cool to see again in season how you can maintain or build some power, even when someone's, you know, uh, you know, taking quite a high workload.
• 12:14
  SPEAKER_00: Um, I think the big thing for me is like BFR, I think is an amazing tool and it's great, but you have to have the right context for what you're trying to do.
• 12:21
  SPEAKER_00: So early to Anthony's point, early post-op, like, you know, we're two, three weeks out of ACL or like a knee injury.
• 12:26
  SPEAKER_00: And we like BFR because it allows us to maintain or increase strength of muscles in the leg while we're intentionally trying to limit mechanical loading through a bone drill site, a graph site, a patellar tendon harvesting site.
• 12:38
  SPEAKER_00: So, like in that context, we're intentionally trying to strengthen the quad because we don't want to stress the tissues that are healing, right?
• 12:45
  SPEAKER_00: But it never replaces good old fashioned loading, right?
• 12:49
  SPEAKER_00: Because you need you can't just strengthen someone's quads and like their leg muscles, but send them back with a patellar tendon or you know, bone stress that has not been Wolf's Law adapted to load if you expect them to jump and run and take force.
• 13:01
  SPEAKER_00: So that's like one context.
• 13:02
  SPEAKER_00: But in this context, it's great because kind of the opposite is happening is that we want to maintain or grow hypertrophy and intentionally not overload joints or things that maybe are already on the brink of high workload-based overuse injuries, right?
• 13:14
  SPEAKER_00: So think about like patellar's tendon, jumper's knee is like the most classic basketball in-season injury that somebody has.
• 13:20
  SPEAKER_00: The patellar tendon is screaming because it has too much of a high workload, or maybe it didn't have enough prep and ramp up in the off-season.
• 13:27
  SPEAKER_00: So if we're in season and we're trying to maintain sports performance, explosive power, but limit stress to the patellar tendon to not push it over the edge.
• 13:35
  SPEAKER_00: This is a great example of when it's good.
• 13:36
  SPEAKER_00: And BFR is the opposite, right?
• 13:38
  SPEAKER_00: We're intentionally trying to spare the passive structures, the tendonist tissues, the cartilage to get a train training effect.
• 13:44
  SPEAKER_00: Whereas early BFR, we're doing the quad without loading the tenants or the structures that we're worried about.
• 13:50
  SPEAKER_00: So it's cool to see the application of a tool in very different situations based on the goal.
• 13:54
  SPEAKER_00: And I agree with Lenny.
• 13:55
  SPEAKER_00: I think I read that like global six to eighty.
• 13:57
  SPEAKER_00: It was like, oh, it's correlated to like this amount of pressure.
• 13:59
  SPEAKER_00: I'm like, yeah, but like there's a reason that Dopplers exist to get a very specific Luma Cruz.
• 14:03
  SPEAKER_00: You have one dude who's 180, one dude who's 210, 5'4, you know, 6'4.
• 14:07
  SPEAKER_00: It's completely different to make sure they're all occluded the right way.
• 14:10
  SPEAKER_00: So that I agree with that in small sample study, like Lenny said.
• 14:13
  SPEAKER_01: You know, especially in a research study, right?
• 14:15
  SPEAKER_01: Like if you if you can't, like, I think there's some debate out there right now, like how how important occlusion pressure is.
• 14:22
  SPEAKER_01: And I guess it just depends on how you define important, but I would define a research study as important, right?
• 14:28
  SPEAKER_01: Um, you know, I I think that's the one you have to be really strict.
• 14:30
  SPEAKER_01: You know, they also use the katsu bands, you know, which I I think do not fully occlude, if I'm correct, based on that.
• 14:37
  SPEAKER_01: I've I hope I didn't speak wrong on that one here, too.
• 14:40
  SPEAKER_01: So, you know, using maybe uh a different type of band might have been different too.
• 14:44
  SPEAKER_01: But like again, these are quality bands with a lot of evidence behind katsu.
• 14:48
  SPEAKER_01: So, you know, those those have some evidence behind it.
• 14:50
  SPEAKER_01: But yeah, you know, important.
• 14:52
  SPEAKER_01: Dave, what one last thing you kind of alluded to a little bit, but like, you know, we talked at the very beginning of BFI when it first came out that we were concerned maybe that people wouldn't be mechanically loading.
• 15:02
  SPEAKER_01: Um, you know, this again is a really good example of basketball players, right?
• 15:06
  SPEAKER_01: If they're jumping on court for skill training as well as competition, and you can you can remove that load, like that's amazing, right?
• 15:13
  SPEAKER_01: Like any thoughts on like I assume it's a good thing workload-wise, but remember when we first talked about BFR, we were worried that we weren't putting enough load.
• 15:23
  SPEAKER_01: If we take load off in season from tendons and joints and bones, uh, that's a good thing, right?
• 15:29
  SPEAKER_00: Yeah, I think yes and no.
• 15:32
  SPEAKER_00: I think you're trying to, you know, the workload world of things is you're trying to just like find the optimal dose that maintains a really high chronic workload without pushing someone over the edge, right?
• 15:41
  SPEAKER_00: That's Tim's big thing.
• 15:42
  SPEAKER_00: And I think it's really important to know in the workload world is that like the best thing that predicts hamstring injury in season is how much high speed running you did off season and how long you ramped up.
• 15:52
  SPEAKER_00: Did you do a four-week sprinting program and get a little bit of volume because you were scared season was starting and you missed, you know, you were on the beach too much this summer?
• 15:58
  SPEAKER_00: Or did you do a 12-week graded overload program when you really ramped up slowly, you've got a really high speed chronic workload, right?
• 16:05
  SPEAKER_00: That's gonna help you.
• 16:06
  SPEAKER_00: And the same thing here as well is like BFR is a great tool as an accessory piece, regardless of what you're doing.
• 16:12
  SPEAKER_00: Like, even in like the rehab world, we don't just come in, do soft tissue range of motion and do BFR for 45 minutes.
• 16:17
  SPEAKER_00: We want to load somebody as much as we can with force plates and like go kettlebell deadlift if they're after post op or whatever.
• 16:23
  SPEAKER_00: Like we're trying to load mechanically because you need that.
• 16:26
  SPEAKER_00: You need bone, cartilage, ten, and stress.
• 16:28
  SPEAKER_00: But in this situation, if you're in season, you're not only doing BFR jump squats to try to maintain your mechanical load.
• 16:35
  SPEAKER_00: You're playing basketball, you're doing drills, you're playing, you're doing warm-ups, you're doing a two-day per week probably strength program with a lot of accessory work.
• 16:41
  SPEAKER_00: You're just trying to, you're playing with fire in season because you can't build more strength and you're trying to slow the rate at which somebody's declining because you know, the tendons only take so much over the course of a season.
• 16:50
  SPEAKER_00: So good workload management is about measuring and understanding what someone's going through and how they're responding, but also using all the things that we know can maintain someone's athletic ability, you know, to keep them in the game.
• 17:02
  SPEAKER_00: That's the goal.
• 17:02
  SPEAKER_00: They want, they want to play.
• 17:03
  SPEAKER_00: You want to have the most available players possible.
• 17:05
  SPEAKER_00: And if you can have something like this that maintains their power, but doesn't put extra stress on the tendant load, that's probably good because they're probably playing basketball six days per week.
• 17:14
  SPEAKER_01: Awesome.
• 17:15
  SPEAKER_01: Yeah, love it, Dave.
• 17:16
  SPEAKER_01: And, you know, again, just uh another reason why this is such an important study that we continue to learn some best ways for in-season management because that that's how you enhance performance.
• 17:25
  SPEAKER_01: I think that's that's amazing.
• 17:26
  SPEAKER_01: So, Brendan, thank you so much for that review.
• 17:28
  SPEAKER_01: I think that kind of came out great.
• 17:30
  SPEAKER_01: Um, really good article.
• 17:31
  SPEAKER_01: Uh, check it out in the show notes below uh in the or on the website.
• 17:35
  SPEAKER_01: If you're listening to this on a podcast, you can check out the links in the show notes there.
• 17:39
  SPEAKER_01: And uh yeah, we're gonna keep doing it.
• 17:40
  SPEAKER_01: We've gotten some great reviews um from our listeners on doing these journal article reviews.
• 17:45
  SPEAKER_01: So let's keep pumping them out because I think we all like them, right?
• 17:47
  SPEAKER_01: We're learning, we're growing.
• 17:48
  SPEAKER_01: I think it's been helpful.
• 17:49
  SPEAKER_01: So uh great job, Brendan.
• 17:51
  SPEAKER_01: Appreciate it.
• 17:52
  SPEAKER_01: And we'll see you on the next episode.
• 17:53
  SPEAKER_01: Be sure to subscribe so you get a notification when it comes out.
• 17:56
  SPEAKER_01: Thank you.