Blood Flow Restriction Training: Science, Safety & Gains

[0:00] What if cutting off your blood flow could actually help you build muscle? Yeah, sounds like something out of a horror movie, but it’s actually one of the coolest rehab tools we have. That’s the secret sauce behind blood flow restriction training. Or BFR, as we call it in the industry.

Jason: Industry, okay, all right.

Kathy: It sounds totally backward, but it’s one of the most powerful low impact ways we can get your muscles stronger, faster. Okay, I like powerful and low impact. Coming up in this episode of the PTCH,

[0:31] we’re diving deep into the science of the squeeze. We’ll break down how BFR works at a cellular level, who it’s safe for, and how we’re using it to rapidly rebuild muscle after an injury or boost performance for athletes. This is the PTCH. What happens when a chiropractor and a physical therapist get together to make a health and wellness podcast?

Jason: But chiropractors and physical therapists don’t like each other.

Kathy: Oh, think again. I’m Dr. Kathy Lynch, physical therapist who likes to help people move and get stronger.

Jason: I’m Dr. Jason Young, an evidence-based

[1:02] chiropractor who uses humor just as much as adjustments to help people get better. Welcome to the PTCH podcast.

Kathy: Remember, there’s no I in PTCH. All righty, everybody, welcome back to the PTCH podcast. I’m Dr. Jason Young. I’m Dr. Kathy Lynch.

Jason: Yes, you are. Okay, good. I like that you checked that though. I did. That’s one thing you can count on here is that our information, we’re fact-checking. You might have noticed she pulled out her driver’s license real quick. Am

[1:32] I? Mhm. Mhm. Sure are. Yes. Glad to have you here, Kathy. Just a little quick podcast update before we jump into the topic. We’re still killing it. Like the podcast is growing. We’re now getting thousands of views per episode.

Kathy: Yes. Whereas like we were partying over like a dozen, right?

Jason: Pretty happy. Yes, and you know our viewership is actually — we expected to do this for our local community.

Kathy: Mhm. And maybe a few people in other

[2:04] states if we had like extended family there.

Kathy: Yeah.

Jason: Yes, and once the money dried up, we expected that there was going to be no more, but we have an international audience.

Kathy: It’s unbelievable.

Jason: It is, yeah. And actually we are big in Australia.

Kathy: What?

Jason: Which I didn’t expect that, right? Hello to our mates down under. We love the Aussies.

Kathy: Yes, we do. We do. And also the UK.

Jason: Yep. Yes, in fact we have one

[2:34] dedicated fan in particular. I think I’ll shout her out. I got to remember — the name is ZZZSU8PH. I don’t know if I’m supposed to say something, but hello. Thank you so much for your comments. It’s been great. So she’s commented on a couple episodes and she is the president of the PTCH podcast fan club in the UK. So mhm, yeah. So

Kathy:

Jason: All right, and then one other thing too is the PTCH podcast swag store has been

[3:08] getting it done. I want to share this actually. This is my shirt. Look at this. The HVMS stands for Highland View Middle School, which no longer exists, okay? This guy right here, this is your very own Dr. Jason Young, but like age 14. Notice the high top fade.

Kathy: All of the high top fade.

Jason: The two-tone here — I did not dye my hair. This is just kind of more of a skin fade. Little artistic license here. And yeah, can I just say though

[3:40] that besides this shirt being epic and saying things like “sit and reach champion,” it’s really comfortable. I’ve been wearing this today and I’m like yeah, I could probably sleep in this shirt. So

Kathy: Yeah, so whether on the streets or between the sheets — no, that’s something different.

Jason: No.

Kathy:

Jason: It’s a great t-shirt.

Kathy: Our way. This is PG-13. Come on.

Kathy:

Jason: So yeah, great shirt, very comfortable. Thank you to our friends at Corvallis Custom for hosting the swag store. And

[4:11] there’s a whole bunch of other good stuff there. Can I say one more thing about this though, because today I got a text message from another one of our listeners. What’s up, Leoni? She sent me — yeah, you know Leoni, so

Kathy: Yeah, so she sent me a picture from a bulletin board at a school and they had the results of their middle school sit and reach. The boys results and the girls results. And so what do you think the first thing I did when I got

[4:41] that?

Kathy: I’m guessing you tried to beat that.

Jason: I didn’t try. I didn’t try. Girl, I’m a professional, okay?

Kathy: Yeah.

Jason: So I got out the tape measure right there in the clinic and I sat down and I dominated those kids.

Kathy: Okay.

Jason: Yes, I had the highest marks. I think the highest one was 8 inches. Okay, who’s judging this? Like who’s taking the —

Kathy: Oh, this is done scientifically. My wife was there. My wife was there, yeah. So yeah, there was a fair impartial judge.

Jason: Yeah, yeah. She even took video. Maybe

[5:11] maybe I’ll post it sometime. You know, if we get enough people that we could do like a subscription service —

Kathy: Oh, yeah.

Jason: — and we get some of those like little behind-the-scenes tidbits, that will be one of the videos — scientific evidence that I still dominate. I beat the top mark by an inch and a half easily without first stretching.

Kathy: You didn’t warm up?

Jason: No, I didn’t even warm up. No. I’m going to need to come see you because I think I tore both of my lats doing it, but I still got it done. Um but

[5:41] okay, that’s enough. We should get to the topic.

Kathy: Wait, I thought we’re done.

Jason: Yeah, well —

Kathy:

Jason: That’s our episode today, folks. But no, maybe you can share something that will help me rehab my lats after I tore them trying to beat an eighth grader.

Kathy: Stronger, faster.

Jason: Okay, good. So yeah, so we’re talking blood flow restriction.

Kathy: Yes. And I got to be honest, the first time I heard about this, I think it was actually from you. I think you mentioned it like a couple years ago and so what I did naturally is I pretended like I knew

[6:12] what you were talking about. Like —

Jason: Oh, yeah.

Kathy: BRF. No — BFR, yeah, yeah.

Jason: That’s the best. But when you’re talking about it, it sounded really interesting and frankly impossible. And so I went right out, I did a little bit of research and I was like, oh my gosh, I think I should try this and I kind of love it. So yeah, so kick it off. Tell us about this. Like how did you even find out about it?

Jason: I am a big scanner —

[6:43] on social media. I follow a lot of physical therapists on social media. And so that’s — I actually first learned about it on Twitter. Okay, that’s a great source of information, folks. Twitter, now X, but yeah. We’re calling it — we’re going with Twitter. Uh-huh. It’s one step above Wikipedia. Yeah, so I don’t know, is it? Is there — I don’t know if there’s much space up there at the top. Right? That’s — this is true. Well, when I see these things on Twitter, I go to like peer-reviewed

[7:13] articles, okay? Yes. This is evidence-based physical therapist right here. Well, but I think there’s no problem with that because I think I do that a lot too. So I’ll go through and I’ll see something on Instagram, something like that. I’m like, no. And so then it prompts you to get into the research. Which thankfully these days you have like better, easier access to peer-reviewed journals than ever, which is so cool. So yeah, so you ran right out to the research. I did.

[7:43] Well, but when I first saw it, right? You see it in the video and basically what it looks like is a blood pressure cuff. Yeah. And they were strapping it around this person’s thigh, which looks very dangerous. Doesn’t look like — — it feels — no. Mhm. And this person did not look like they were comfortable. Okay, yeah. And they were just doing squats, no weight. Mhm. And so that’s when I was like, what is this BFR thing? Yeah, what is this BSR? I mean BFR, right? This looks very dangerous.

[8:13] Right. When in fact it’s not. Yeah, it’s pretty amazing actually. So the idea is you’re tricking your body into thinking it’s working harder than it is. Yeah. Right? So how do — let’s go back. What is it — what does it do? So with that blood pressure cuff — and there’s special ones. Yeah, so this isn’t just like — no. You can’t go to like Rite Aid — get your — yeah, hey, give me an Omron

[8:43] blood pressure cuff, please. Do not do that. Yeah, okay. You know, we bought the professional style at Encore Physical Therapy. Okay, very good. Yes. And they’re called Smart Cuffs, so maybe Smart Cuffs wants to — I think that — I think I have a set of those too. Yeah, and it’s kind of funny. I think they should, first of all. I think everybody should sponsor us. But Smart Cuffs would be a good one. I actually bought myself some Smart Cuffs for Christmas.

[9:13] Oh. Yes. Merry Christmas. From the clinic. Don’t tell the IRS. Don’t tell Mandy. And well, Mandy found out. Like I’m opening Christmas gifts. I’m like, oh, what is this from Body of Health? I was like, oh, wow, this is great. And she’s like, is that what you spent all that money on? Yes, they’re Smart Cuffs. Yes, yeah. So — so what does it do? So basically it cuts off blood flow into the muscle, but also blood flow out of the muscle.

[9:44] And how and why does that work? Well, and I guess the bigger question is how and why would anybody even think — that’s right. Who tried this? I know, it’s like somebody wore some shorts that were too tight to the gym — like, oh my gosh, the gains. Yeah, the gains. Okay, so what does this actually do and how does it build muscle quicker? So basically like I said it traps the

[10:14] blood in the muscle. So who cares, right, if the blood is trapped in there — but what it does is it traps the byproducts. Yes. Of exercise — the metabolites, as they say — in the muscle. And so what does that do for the muscle and why does that build muscle? Well, it causes metabolic stress. And what is metabolic stress?

[10:44] It sounds like stress, but — of a metabolic nature. Is it okay? It is — so the metabolites we’re talking about are like lactate, hydrogen ions, phosphate. Wait a minute. I’m from the 80s. Yes. I thought that lactic acid was the enemy. No. I thought that — I thought that was the purpose of all like healthcare, stretching, warming up, everything like

[11:14] that — because otherwise the lactic acid will just eat you alive. Okay, all right, okay, educate me. Okay, we’re learning. All right, we’re learning. I just bring that up because I’m so tired — so tired of hearing people say, yeah, you got to get the lactic acid out of there. Yeah, that’s why you’re in so much pain — yeah, it’s the lactic acid. Yeah. So in general, intense exercise, weightlifting, things like that, produces these byproducts in your muscle. Just regularly, right — so but with the

[11:46] blood pressure cuff we keep it in there in the muscle, that then triggers cellular and hormonal responses to build muscle stronger. And so what’s the hormonal response to that? Have you ever heard of anabolic steroids? Oh my gosh. Is this a cheap way to get ripped? It is. Nice. Yeah. So this metabolic stress increases the

[12:16] release of anabolic hormones that are organically made in your own body. Oh, they’re organic, so it’s fine — there’s no pesticides. These are not the ones you get from A-Rod. Sure, yeah, okay. Yeah, A-Rod, if you’re listening — no. There’s the cream and the clear. That’s right. Yeah. That’s Barry Bonds, right? Yeah, oh yeah, that’s right, that was Bonds. Oh, I had the cream and the clear, yeah. See, yeah, okay, so what you’re saying is by kind of —

[12:46] this is sort of like hacking the system, just getting those things to hang out there, the body responds. And you’re going to start pumping in some stuff that’s helping to clear out those metabolites. Because normally that’s the response — that’s the response you’re getting — is these hormones are coming because you get the buildup of this stuff that normally would just be flushed out, to help kind of resolve that inflammation or whatever, but it just happens to be our good friend anabolic steroids. Yes. Yes. It’s the good stuff — and growth hormone. Yes.

[13:16] Blah. Yes, love it — blah blah blah. Yada yada yada. That’s it. That’s the episode, yeah — should we — play a game? No. Yeah, it’s pretty — it’s a smart little trick though, it’s a smart little trick. But here’s the hack. Okay. When we — so we put the blood pressure cuff and we use it a lot, mostly for lower extremity, so we usually put it on the thigh like right around the hip. And what we’ll have the patient do is

[13:46] usually squats with zero weight. So we’re talking body weight squats. So we’ve used this with high school athletes who are used to squatting, you know, 200 pounds. Jason: Yeah. You know, and we’re like, okay, let’s do this exercise with this blood pressure cuff on. And that’s the hack. Kathy: Yeah. Jason: Is that your body thinks you’re lifting whatever 200 pounds, your one rep max, when in fact you’re not. Can you explain one rep max? Kathy: Oh. Because, you know, of course I

[14:16] know what it is. Jason: Do you? Kathy: Yeah, and we got a lot of meatheads listening to the show. But what’s a one rep max? Jason: So a one rep max is literally the weight that you can only lift one repetition of, so it’s the heaviest thing that you could lift one time. Right, and it’s useful to know because Kathy: Jason: whenever you’re putting together any sort of exercise plan, you’re doing things relative to that one rep max.

[14:46] And then so how would one figure out their one rep max? Jason: Well, there’s a lot of different ways. Kathy: There are. Some of them are safer than others. There’s a lot of testing. One of the ways — well, one of the ways is to try to pick up the heaviest thing you can, but that is not encouraged. Kathy: Right, because you might hurt yourself. Jason: Yeah, you might find out the hard way. Kathy: That’s right. This is how much you can’t lift.

[15:16] Uh-huh. What we do at Helix is we’ll usually do a five rep max, and we’ll start with a lower weight. We’ll have somebody, you know, pick up something that they’ve normally picked up and say how many reps can you do, and then on our testing day we’ll usually do that exercise to the point where it’s like, okay, this is my — I can only lift this amount of weight five times, and that’s their five rep max, and then we’ll do the math backwards to figure out what their one rep max is.

[15:46] Kathy: Good, safe way to do it. I like it. And why do we want to know one rep max in relationship to blood flow restriction? Jason: In general, if you want to get stronger — progressive — Kathy: Okay, good. Jason: I’ll sign up. I’d like to get stronger, please. Kathy: Yes, all right, then you’re in the right place. Jason: Okay, good. Because you want progressive overload when you are lifting weights. Kathy: Okay. Jason: And so you don’t want to stagnate at one weight. You want to know

[16:16] — at least at Helix — like, this week we’re doing 90% of your one rep max, last week we did 80% of your one rep max. Your muscles need to be challenged, and when they are challenged, then they grow and they adapt. So right, once you know what your heaviest is, then you can scale it down depending on what part of your training cycle you’re in. Kathy: Yeah. Yeah. So here’s the other thing about BFR that’s

[16:48] great, especially in a PT clinic. The early fatigue that you get with BFR is intense. Kathy: Yeah. Jason: Yeah, and so it’s those trapped — it’s that lactic acid there. That darn lactic acid. So your muscles feel much more fatigued sooner than usual. When your muscles are fatigued that early, this is the other great hack to it, is

[17:20] that when your muscles are fatigued that early, now your body has to recruit all the muscle fibers, including the fast-growing type two fast twitch. Kathy: Yes. Those are the fast twitch fibers that we need. Jason: Right, those are the ones that are associated with performance. Kathy: Exactly. All right, whereas a type one would just be things like — boring things like posture. Jason: Right. Boo, posture. Or endurance — you know, I guess if you

[17:51] wanted to be like a distance runner or something like that, you’re going to need some type one. But type two — I mean, that’s a pretty dope muscle type, I think. Kathy: Yeah, and you’re not going to get — if you’re doing body weight squats, you’re not recruiting your fast twitch fibers. Jason: No, probably not, because — unless, like, you’re me, your body weight — your body weight is probably too far below that one rep max in order to do it. Like, I — you know, what would you say, what’s

[18:21] your kind of threshold for what the average person should be able to squat relative to their body weight? Does that question make sense? Kathy: Oh, what is there — what’s that — how much should they be able to squat in relation to their body weight? Jason: Yeah. What would you guess? I don’t — and I don’t think that there’s any hard and fast rule where it’s like, you must be able to do this. The average person — yeah. So

[18:53] 50% to start. Kathy: Yeah, so they’re like — yeah. Yeah, well, yeah, to start out. Right, so if I weigh 200 I should be able to, you know, load up 100. Okay, yeah. I mean, you’d be able to work up to your 200 if you wanted to. But I think it’s pretty darn good if you can squat your own body weight, or, you know, one and a half times, and I think once you start getting into kind of some of the elite categories, there’s people up there doing twice their body weight and more.

[19:23] Kathy: Yeah, so that’s really good. But with BFR, what you’re saying is that even without having to add weights, I can still get some of the same benefits that I would with weights. Jason: Exactly. For example — we’ll go to me — say I weigh 200 pounds, and I think it would be pretty darn good if I could squat 300 lb.

[19:55] I can maybe get those benefits without having to get anywhere near the 300. Kathy: That’s right. Jason: Oh. Yeah. Tell me more. Have you — have you seen the guys out there? This first started with the straps. Kathy: Yeah. It sounds like bro science. Jason: Yeah. Yeah. I think — — originally what they were trying to do was make the muscles swell. Kathy: Okay. That’s where the whole “swoll” comes from. Jason: Yeah. And I think they kind of stumbled

[20:25] into, oh hey, this might be a thing. This felt like a damn workout. Yeah, my muscles are more tired quicker. Kathy: Yeah. Well, I think the people that are looking to do some entry-level BFR — I mean, there’s a ton of those straps out there available. Jason: Right. I wouldn’t recommend the straps if you’re amateur, though. Kathy: Yeah. I — well — Jason: Well, I mean, they’re like — strap — that’s not the — Kathy: They’re not comfortable. Jason: No. Number one. Kathy: Yeah, I know. Found that out the hard way. Because honestly, when I was — when I was

[20:56] getting into this, I was like, okay, what’s the cheap way in here? Because we talked about the Smart Cuffs. And I mean honestly, Smart Cuff, we haven’t seen a check from you guys, so we are going to talk about how expensive the cuffs are, right? If you want us to stop talking about how spendy Smart Cuffs are, like start writing us checks. Anyway. Yeah, but Smart Cuffs are spendy. It’s like $400, right? For a set. And so when I was like, oh let me try this out, I went out and I got straps, right? 20 bucks on Amazon.

[21:26] Jason: Yeah. But there’s an issue with the straps.

Kathy: Yeah. Because there’s a little bit of a science to this, because there is some thoughts about the amount of pressure that is appropriate or necessary to be creating.

Jason: Yes.

Kathy: So that’s why those kind of blood pressure style cuffs work better is because you can measure the exact amount of pressure that you have that you’re working against. Whereas straps — I mean, it’s like we could be preparing for a

[21:57] limb amputation.

Jason:

Kathy: That’s the scary part. Yes. Yeah. You can overdo it with straps.

Jason: Yes. And it doesn’t adapt as your body changes and grows. And so it’s a little more difficult, I think, that way. So. Yeah. And so what the Smart Cuffs do — so it’s called — so the pressure the cuff puts on the limb,

[22:27] what you want to be able to calculate is called the limb occlusion pressure. Mhm. LOP. Mhm. The lopper.

Kathy: The LOP. Mhm. And so that is the lowest — excuse me —

Jason:

Kathy: — that is the lowest pressure at which you can no longer feel the pulse in that limb.

Jason: Right. And that’s what the Smart Cuffs do — the set that we have, we’ll put it on the patient and

[22:58] we’ll have it automatically figure out what that LOP is.

Kathy: Mhm. And so that’s probably the most — well, that’s — I was going to say that’s an uncomfortable part of the —

Jason: Yeah.

Kathy: — of the process.

Jason: Because it squeezes a little tight. It has to, right?

Kathy: It has to. And then it gets up to where like I can no longer feel this pulse.

Jason: Yeah. And then it can calculate — because then you don’t want to train at 100% LOP. That is not where we want to be. Well, let me just put it this way. Even if you want to, you can’t for

[23:29] long.

Kathy: No. Are you speaking from experience?

Jason:

Kathy: Shush.

Jason:

Kathy: Yes, definitely. So with our patients, we’ll usually start at 50% on the leg, and that’s low, but it’s the first time they’re doing it.

Jason: Yeah. Because sometimes this — this is uncomfortable. I’m not going to lie. This is not a comfortable situation. But that’s kind of the hack with BFR, is that we can use it

[24:02] and it’s not a long process. Like it’s not an hour workout. It’s literally like 10 minutes at the most.

Kathy: Yeah. And so you can get those gains in those 10 minutes versus an hour workout.

Jason: Yeah. And that’s what’s great about it.

Kathy: It seems too good to be true, right?

Jason: It does. Because you’re working out for less time with less weight, yet you’re getting a lot of the same bene— And so I guess here’s the real question.

Kathy: Yeah. Is it true? Like, has there — have

[24:32] there been studies that show that this is actually the case, or is it bro science where people are like, oh yeah, I’m feeling the pump, you know? Like, what kind of research has shown that this works?

Jason: There’s a whole bunch of peer-reviewed articles out there.

Kathy: Mhm.

Jason: And this one that I have is a case study. But this was one of the ones that — this was for

[25:03] a woman who was 35 and she was training for a triathlon and she had knee pain. Mhm. Bilateral patellofemoral —

Kathy: Yeah, you said she was training for a triathlon and I was thinking, there’s her first mistake.

Jason:

Kathy: Right. And then you said the thing about the knee pain and I was like — there’s my proof.

Jason: This is what —

Kathy: Right. Mhm. Is that anecdotal? That’s anecdotal evidence at its finest, actually. Continue with your anecdotal case study.

Jason:

[25:34] All right, so she’s training for a triathlon, gets some knee pain.

Kathy: Yeah. And so she was getting tons of knee pain. By the way, let me give credit to the author.

Jason: Oh.

Kathy: The author was physical therapist Michael DeSimone, and he presented this at the APTA Combined Sections Meeting in 2023. And so I just wanted to give him credit for that.

Jason: Shout out, Mr. DeSimone. Dr. DeSimone.

[26:05] That’s right. So basically when she first came in to the clinic, she was operating at like 50% of what her baseline was.

Kathy: Mhm.

Jason: She was only able to run about a mile and a half without tremendous knee pain.

Kathy: Okay. And so what they did for her protocol — and this is a standard protocol for BFR to start with — they do 30 reps, 15 reps, 15 reps, 15 reps

[26:36] with 30 seconds in between. So that’s four sets of 30 reps, 15 reps, 15 reps, 15 reps. And that’s it.

Jason: And out of curiosity — you might be getting to this — but what percentage of a one rep max are we working at? Is she working at like 100% of the one rep max, or like —

Kathy: 20%.

Jason: 20%.

Kathy: 20%.

Jason: Okay. She did single leg press — so it’s a machine at the gym — with the BFR, and she did 20%

[27:08] of her one rep max. And she did four weeks of training. So after four weeks of training, she returned to weekly running and triathlon training.

Jason:

Kathy: And she increased quadricep strength — on the — was it the strength? Yeah. 166%.

Jason: Oh, that’s all?

Kathy:

Jason: That’s it. Oh, that’s all? Yep. And then 183% increase in hip

[27:39] abductor strength.

Kathy: Yeah, see that’s —

Jason: — in four weeks. That’s amazing.

Kathy: Yeah. It’s amazing. So okay, back to our body weight example. So if I weigh 300 lb —

Jason: Mhm.

Kathy: — and I’m doing BFR — now instead of — like, this is why I can do a body weight squat, because if I’m doing a body weight squat, that’s roughly 200 lb of squat that I’m doing. However, if my one rep max is 200, which is

[28:11] Actually, my body weight — or let’s say it’s even 300 — now I only need to be doing like realistically 20 to 40%. And so that’s 40 to 80 lb.

Kathy: Mhm. And now I’m working well above that. And so huge gains just off body weight.

Jason: Right. Dope, isn’t it?

Kathy: I like it.

Jason: Yeah. Yeah. It does sound too good to be true until you actually do it.

Kathy: Yeah.

Jason: And then you’re like, okay, now I see

[28:41] why this —

Kathy: Okay, yeah. And here’s — here’s where I come to the 10 minutes. It freaking burns.

Jason: Burns. It does.

Kathy: Burns. It is not comfortable. But I will say, after you get done, when you take those cuffs off —

Jason: Yes.

Kathy: — it kind of feels amazing because you get an endorphin rush, too. Because that’s one of the other things that are called to that area whenever you can’t get rid of these metabolites — is you not only get the hormones, but

[29:12] you also get the endorphin rush. So you get to sprint to your pump, to your runner’s high, to whatever it is. It’s like —

Jason: Mhm. This is stupid. Why — like, why don’t more people know about this?

Kathy: Mhm. Mhm. So — we’re keeping it a secret.

Jason: Yeah. Well, now that we put it on the PTCH Podcast, there’s going to be hundreds of people.

Kathy: Hundreds.

Jason: Slightly over a thousand people.

Kathy:

Jason: But they know about it now.

Kathy: A hit in the UK now.

Jason: Yeah, I know. If

[29:42] they’re not doing it — well, no, they’re going to be doing it now.

Kathy: Hey, listen, I don’t want to offend anybody in Australia. But, you know, the Olympics were maybe a little rough for you. Just one specific sport in particular. But could you imagine — could you imagine the breakdancing performances

Jason: after BFR?

Kathy: after BFR? Come on. Yeah, I mean, who’s going to compete with that?

Jason: Who’s going to compete with that?

Kathy: Yeah. I mean, God save the queen — or whatever you all are saying down there — but, you know, we love you.

[30:14] So, okay. Remember, this is — we’re not giving out medical advice right now, okay?

Jason: We need that disclaimer right now. So, please don’t run out and do this. I did like — I was doing some YouTube research. And it’s like, hey, one of the reasons YouTube might hate your show is because you’re not giving out disclaimers every time. So, yeah, this isn’t medical advice.

Kathy: Yeah, no, this is not —

Jason: We’re nerds.

Kathy: This is — yeah, exactly. We are nerds.

[30:44] And it’s not safe for everybody. It definitely isn’t. So, do you want to jump to that? You want to talk about who should not be doing BFR?

Kathy: If you have an active — sorry, but this is obvious, but maybe it’s not obvious. If you have — if you have no limbs —

Jason: Active thromboembolism right now.

Kathy: Okay, yeah. Yeah. It is also not indicated — should not be indicated for people that have peripheral vascular disease.

Jason: Right. Right. And I think any sort of —

[31:14] like if you’re working with a cardiovascular condition — yeah — check with your doctor first. Or if you have any other condition, anything that comes up with a question mark — well, I’ve got this, maybe I should check in first — the answer is yeah, you should. Yeah, just talk to your medical doctor. Chances are they might not know about this either, but one of the things that they will find when they go to look at the research — and, you know, there’s a lot of pressure on healthcare providers to pretend like

[31:44] you’ve already heard about everything, but no, you know, we learn about things too. First thing you do is you go to the research. One of the things that’s kind of interesting about BFR is when you go and you look for it, you’re going to find high-quality evidence supporting it. And the average person thinks that there’s high-quality evidence supporting everything, but that’s not the case. It’s not very common to find high-quality evidence that supports something, and this is an

[32:14] exception. So I think that even if your doctor has to go out and do a little homework on it, they’re going to be pretty impressed that there’s some high-quality evidence out there.

Kathy: Right. And then figuring out if it’s safe is the next thing. So, can an old person do BFR?

Jason: Yes.

Kathy: Can a young person do BFR?

Jason: Yes. But not really young people. Yeah.

Kathy:

Jason: Yeah, like, listen, don’t you BFR with your infant.

Kathy: No. Right.

Jason: Give them some time. Let them learn how to crawl first.

Kathy: Crawl first.

Jason: Figuring out that one rep max. But

[32:45] you mentioned doing this with high school athletes, okay? And you would do this with a Medicare patient?

Kathy: Absolutely.

Jason: All things considered — like, if they have a healthy cardiovascular system. The people that we like to do it with mostly are people that have had a knee surgery or a lower extremity surgery or injury. People that need to get their quads stronger. Yeah.

Kathy: If people that know me —

[33:16] my friends that are physical therapists — know that I think strong quads are the key to a happy life.

Jason: Yes.

Kathy: Like, my — only come in with neck pain, we’re doing squats because your quads are probably weak. I kind of feel like that warrants a shirt, you know, just one that says “Strong quads are the key to a happy life.”

Jason: Yeah. In quads we trust. In quads we trust. I love that. We’ll put that on the back of it. All right, coming soon to the PTCH Podcast swag store. You know, sadly, I can’t do BFR.

Kathy: Yeah?

Jason: Mhm. I have this

[33:49] condition called fibromuscular dysplasia, which makes my arteries more fragile. It makes them thicker, and they’re brittle.

Kathy: Mhm.

Jason: And so I don’t want to raise my —

Kathy: Darn it.

Jason: I know, darn it. It temporarily raises your blood pressure. Yeah. So if you already have a high blood pressure situation, it’s not that you can’t do it, but you got to check with your doctor first, and — well, you’d probably want to do it under supervision. Your physical therapist would check. Because I think that’s another thing, too — if you have a condition

[34:20] that would make you prone to, like, passing out or something like that, this can do it. And so, not a great idea to maybe work out alone. So, yeah, I’ve had some times when I’ve done it and I get a little lightheaded, right? And it’s like, oh, okay. But, yeah, so here’s a question for you. Why do you think that this is not more popular? Like, why aren’t more people doing this? Because I would guess the majority of people out there could safely do BFR.

[34:51] So, why is this not a bigger thing? It’s uncomfortable. Okay. Number one. Yep. Mhm. But also number two — well, I’m pretty cautious, but I wouldn’t do it with a strap. I would want one of these fancy machines. And those are costly. Yes, they are. Yeah. People do it with the strap, but they’ve probably been trained — yeah — how to do it. Yeah. And so, it can be done, but I would not suggest it

[35:23] for the average person. Yeah. Do it under supervision. We also use it for people — for example, people with, like, a tendinopathy. Mhm. Achilles tendinopathy. Right. So, those tendinopathy injuries are usually overuse injuries, or what we call training errors — because we don’t want to hurt people’s feelings. Sure. Training oopsies. Yeah. And so, basically, what has caused

[35:54] their injury is the load that they’ve put their tendons under — the tendon couldn’t handle the load that they asked it to bear. It exceeded its capacity. Yes. And so, you don’t — error. That’s right. Training error. Training error. And so, you don’t want to put more load on — when you’re rehabbing somebody, you don’t want to put tons of load back on it. So, this is again another easy hack to build the muscle

[36:24] without putting as much load through that tendon. Yeah. I mean, this reminds me — so, my son sprained a ligament in his knee in football last Friday. So, we’ve been rehabbing it. And this is the one thing that I’ve been forgetting. This is a good way to get him back to it. So, look out, son. Come home. When I get home, you better have my strap. Your older one or younger one? It’s the older one, Austin. He’ll be able to handle it. Not that

[36:55] Griffin would, but Griffin would try it once and run. Well, no, Griffin — if he’s listening to this episode, he’s like, ooh, 10 minutes of working out? That’s a really good point. Dad, why have you been holding out on me? That’s what he’s saying. So, if I could jump back to that question a little earlier about why aren’t more people doing this, I actually went to — ooh — studies because — okay — like I said, there’s high-quality evidence out there. And so, in some of this evidence, when they’ve

[37:26] looked at studies, they’re not only looking at the mechanics of it, the chemistry of it, and everything like that. They’re looking at who’s implementing it and why and why not. So, it gave really four reasons that more people aren’t doing this. Number one —

[37:57] Okay, so number one is some concern about safety and cardiovascular risk. And so, because there is some increased risk, that’s one of the reasons. The other reason is that there’s a lack of standardized protocols with it. So, you talked about that threshold in terms of how much pressure is too much pressure. And I think that what you shared is an approach, but there are people that have

[38:27] other opinions, and they’ve tested other things. Like, what if we have 80% occlusion or 50% occlusion? And so, I think that there’s still some getting that dialed in. And then there’s just the knowledge gap — like, there are just people that don’t know about it. I mostly, when I do this, I do it at home, because if I go to the gym and I have those on, people are like — who’s this guy? Look at this bro. What are you, Iron Man? Yeah. And so, in some of those settings, a lot of times we

[38:58] see it more in rehab than we’d see it in the gym. Yeah. Which you could do at the gym. There’s no reason why not. Yeah. And then the discomfort is the other thing. Yeah. So, some safety concerns for some people, some discomfort, lack of standardized protocols, and just some awareness of it. Like, 10 years ago, I didn’t know about this. 10 years ago — did you know about this 10 years ago?

[39:28] No — you were just getting started 10 years ago, I forget. Yeah, just baby PT. Yeah. But, yeah, so it’s kind of cool to be able to spread some awareness about it. And so then maybe if you try it out and you like it, people are like, “Oh, what are you doing?” You say, “Well, first of all, I listen to the PTCH Podcast and you should, too.” Yes. On Spotify, YouTube, or Apple Podcasts, right? And then you tell them — “I’m sorry, what was the question again?” Oh goodness gracious.

[40:00] Well, probably time for a game. Yeah, all right. Let’s see. You know, because we love these — can you guess what we’re going to do today? That’s right, we’re going to do a Mad Lib. Oh yeah, the Mad Lib. Yes, we’re going to do a Mad Lib, okay? Mad Lib, just for people who grew up on some other planet — I’m going to ask Kathy for some words, some particular words, like nouns, adjectives, things like that. We’re going to plug it into this story,

[40:30] and I’m going to read it back. If it’s funny, then it worked, and if not, then it still works, because Mad Libs always work, okay? All right. So, Kathy, are you ready? Ready. All right, give me a body part.

Kathy: Knee.

Jason: Oh, okay, that’s good. I just wish that my pen actually worked. All right. The knee, good. How about an adjective?

Kathy: Green.

Jason: Green. What about an animal?

Kathy: Zebra.

[41:01] Jason: And a food.

Kathy: Pizza.

Jason: Mhm. Okay, how about a plural noun? That’s more than one person, place, or thing.

Kathy: Trucks.

Jason: Okay. And how about an object?

Kathy: Ball.

Jason: How about a liquid?

Kathy: Gatorade.

Jason: Mhm. What about a celebrity’s name?

Kathy: Jackie Young.

Jason: Jackie Young?

[41:32] Oh my gosh. Who — who’d you say?

Kathy: Jackie Young.

Jason: Jackie Young? Okay. I don’t — anybody who’s a WNBA — oh, okay, I will know. Okay, Las Vegas Aces.

Kathy: I’m a WNBA — Irish. Okay, okay. All right.

Jason: You’ve been exposed.

Kathy: I’ve been exposed now, yes. Just like BFR, now I’m going to go look her up. What about another body part?

Jason: Ankle. Ankle, and a plural noun.

Kathy: Buildings.

[42:03] Jason: Almost there. A number.

Kathy: Seven.

Jason: Exercise.

Kathy: Squat.

Jason: Of course. An adjective.

Kathy: Blue.

Jason: Okay. Plural food items — more than one thing that you would consume.

Kathy: Apples.

Jason: Apples. A verb.

Kathy: Running.

Jason: Another verb.

[42:33] Drive. Okay. Another animal. Wow, lots of animals. Kathy: Lots of animals. Jason: Uh-huh. Cheetah. Okay. An emotion. Love. All right, we got five more here. A fictional character. Harry Potter. Okay. Of course. Wait, that’s fictional? Oh, sorry. Kathy: Jason: What are you saying, Kathy? No. He’s real. How about a noun?

[43:04] Carpet. Okay. Well, I lied about five, here we go. An adjective. Kathy: Everybody now. Jason: Yeah. Plump. Okay. Noun. Wood. Tune in next time. Give me a verb and a catchphrase. Verb. Jump. Okay.

[43:36] And the catchphrase. In quads we trust. All right. It’s going to be that. IQWT. All right, here we go. Today, I decided to try blood flow restriction, BFR, training for the first time. My trainer said it would make my knee look like a green zebra stuffed with pizza. First, I wrapped my thighs with a cuff

[44:07] that felt tighter than Jackie Young’s jeans. I could feel the Gatorade pooling in my ankle like a traffic jam of buildings. Then I started doing seven reps of squats while trying not to run. I do that successfully all the time, yeah. After the first set, my muscles looked like blue apples ready to drive. My workout partner said that I resembled a cheetah experiencing

[44:39] Kathy: I — I skipped one. An emotion. Jason: Experiencing love. Kathy: Experiencing love, okay. For the first time. By the end, I couldn’t tell if I was building muscle or just slowly turning into Harry Potter. But I’m told this pump increases carpet and releases human growth hormone, which basically means that I’m a plump wood now. Okay. Tomorrow, I might be able to jump, but that’s just proof that in quads we

[45:11] trust. There we go. Very good. Okay, Kathy, what are the take-homes from today’s episode? Kathy: Today’s episode is there is a hack. Jason: Yes. Kathy: And it’s real. It is. About building muscle. Yes. High quality evidence. Jason: High quality evidence, BFR. Yes. Yeah. I think that my take-home was I need to get back to doing this. I don’t know why I stopped. It is a hack, it totally works. You feel it in your bones and in your muscles. So, for all your

[45:41] preparation for this — I thought that you shared really great information, and so it’s fun. Kathy: Yes. If somebody is interested in doing BFR, like what’s your advice? How should people get started? Jason: They should call On Core Physical Therapy. Kathy: Mm-hmm. Yes. Jason: Get an appointment with me. Kathy: Yeah. Yeah, if you’re local, that’s really great. She’s got the smart cuffs, y’all. Jason: Got the smart cuffs, I got the good stuff. And then of course, discuss it with your physician. Kathy: 100%. Discuss it with your physician. If they don’t know what it is, tell them

[46:13] to send you to me. Jason: Yes. And I think also quit making fun of me for wearing these things. Kathy: That’s right. And then maybe I’ll come back. Jason: All right. Well, as always, make sure to like, subscribe, share this episode with a friend who maybe just hates spending time lifting weights and they would love a good shortcut or a hack. Usually we’re like, “Don’t take

[46:43] the shortcuts,” but this is one. Take this shortcut. Kathy: Yeah, this is a pretty good one. And I think that the other thing that’s really important that we need to tell people is there’s no I in PTCH.