Dracula’s Guide to Blood Flow Restriction Training
If you’ve never done Blood Flow Restriction Training before, you’re bound to hear this sooner rather than later:
WHAT THE HELL ARE YOU DOING?!?
More than likely it will be hollered atcha by crazy old ladies getting their swole on in the weight room between cat petting sessions and soap operas.
But what’s this madness all about?
Maybe you’ve seen pictures of blood flow restriction training or heard about it through the grapevine but aren’t quite sure what the deal is with these crazies cranking out curls in the constricting cuff.
Is it all myths and monsters?
Is all tricks or is there a treat?
In this article we’ll be talking about none other than the often misunderstood but demonstrably good Blood Flow Restriction Training:
- What it is
- Why you should care
- Who’s it for ( and not for)
- How to do it
- Ways to work it into your training
…all to kick off the article posts here on the blog and spring some life into the October content like lightning bolts to Frankenstein. You’re gonna dig this one.
From the desk of Count Dracula:
What is Blood Flow Restriction Training?
Blood flow restriction training (BFR) – also referred to as occlusion training or KAATSU – is a method of training that’s been around for decades but has recently been circulating around a bit more due to the info flow of the internet and social media, as well as more studies being done and talked about in the evidence-based fitness community.
In essence, it’s simply lifting weights with a cuff around the top of the limb to apply pressure and impede veinous (away from) – not arterial (into)- blood flow at the muscle being worked.
This increases venous pooling, and the metabolite build-up in the muscle appears to be beneficial from a hypertrophy standpoint due to cellular swelling/signaling and increased muscle activation even at low loads (see next section).
Why should I care about Blood Flow Restriction Training?
We already know that muscle hypertrophy can be stimulated through light loads and high reps, but blood flow restriction training has been demonstrated to produce similar muscular adaptations to traditional heavier loading even at weights of 20-30% 1RM (!)
In fact, blood flow restriction training has even been shown to stimulate muscle hypertrophy when applied to subjects simply walking, and it has also been shown to mitigate muscle atrophy during periods of inactivity – such as post-surgery or during injury – even with NO exercise! However, the best results are seen in combination with lifting.
It doesn’t take a genius to see the value in that. Clearly, there’s something going on here that’s worth our attention either in pursuit of aesthetics or even as a coach or physical therapist, and this is going to continue to be an interesting area of research that will only continue to develop as time goes on.
But is blood flow restriction training safe?
Yeah, it looks pretty freaky, doesn’t it.
Tying your arms and legs up and then lifting weights intuitively sounds like a recipe for disaster, but the fact of the matter is, that isn’t the case.
IT IS SAFE
BFR has been heavily studied across numerous different populations with thousands of individuals. Despite it’s monstrous appearance, it has a good side and is only misunderstood. Blood flow restriction training is a safe method of training when applied correctly to individuals for whom blood flow restriction is not a contraindicated approach. The blood flow restriction is only acute – not prolonged, and arterial blood flow is not cut off; we are only slowing the venous return.
In fact, the argument could be made that because of the light loads employed, blood flow restriction training is safer than conventional resistance training with heavy loads – especially for certain individuals, however this is context-dependent, and we won’t go deep into that here.
Who is Blood Flow Restriction Training best for?
Lots of people hop on the occlusion train because it looks cool and they like the outrage and attention shot to their ego when people see them pumping away occluded at the gym, but if you learn nothing from my writing, learn that:
You do not pick your programs or methods solely because of your ego and the warm fuzzy feeling you get inside.
Blood flow restriction training is a tool – nothing more. A useful tool, if used correctly and for the right reasons.
So what are they?
Think about it.
Where can you see the value in getting similar gains in size and strength from doing 20-30% of your 1RM? You won’t have to look far.
Blood flow restriction is very useful for:
- Working around injuries/flare-ups
- Maintenance or increase of size without the use of heavy loads
- Elderly populations
- Buffer between rehab and normal training
- Vacations, home workouts, or travel
Essentially, all those situations where lifting heavy weights is not a practical or even available option but you still want to reap the rewards from resistance training.
Personally, I got involved in the world of occlusion when dealing with injury, and it’s been an invaluable tool for maintaining size and generating a training effect while recovering.
Since then, it’s been an interesting area of study and I look to continue to expand my horizons and experiment with it in training/programming applications when relevant and useful in generating the best outcomes for myself and clients.
CAUTION: Blood flow restriction is not for everyone. If you have injury or pre-existing medical conditions or a medical history that may be a bad fit for this style of training, check with your medical professional before considering utilizing occlusion training.
But is blood flow restriction better than regular training?
Such is the million dollar question.
I mean, you’re already making gains, so why do BFR? Is it any better than regular training?
No – it depends on your usage of it.
Blood flow restriction training won’t give you magical gains or any special effects compared to conventional training, so don’t get carried away in the romanticism and fall under Dracula’s spell.
It looks badass and trying new things is fun and can add some zest to training, but if your goal is maximal size and performance, I wouldn’t make it my first choice, so don’t explicitly look for excuses to do it “just cause”. It has its limitations and isn’t a magic bullet.
If you are healthy and have the work capacity to handle regular loads pushed for progression, stick to that and keep KAATSU locked up in Dracula’s castle until it’s worth your while to unleash it for battle. I’ll show you how to work it in your training later in the article.
In other words, use it where it’s useful and put it away when it’s not.
Just like most things in training and nutrition.
What you’ll need to perform Blood Flow Restriction Training
Blood flow Restriction training is actually very accessible and won’t cost you much to get the ball rolling. The only thing you’ll need besides your normal gym equipment and attire are some sort of wrap or cuff to apply to the limb.
There are several options here. You can use:
- Knee wraps
- Dedicated blood flow restriction bands
In the labs, they utilize equipment that can sell for thousands of dollars (they have to standardize the pressure), but you can secure the above tools for less than $20USD and still reap the benefits from blood flow restriction, so price is far from the limiting factor here.
The key here is to ensure that they’re not too wide, nor too narrow.
The cuffs on your arms should be thinner than those of your legs simply due to the size differences in the limbs. For arms, go for 1-2 inches (2.5-5cm) of width. For legs, 2.5-5in (6-13cm) of width.
Based on these figures, if you are using just knee wraps alone, they can be too wide for the arm (not to mention a pain in the ass to wrap), so I recommend cutting them in half longways. If you get actual bands, they often come in a leg and arm version with size differences already, so you won’t have to worry about that.
Practically speaking, I would opt for either:
Knee wraps (legs) + tourniquet/band (arms) or specifically designed bands of appropriate sizes for the legs and arms.
Material does not appear to play a huge role in the effectiveness of performing blood flow restriction training. Just ensure it doesn’t cause you irritation and you are good to go.
How to implement Blood Flow Restriction Training:
Now that you’ve got the basics of BFR laid out, it’s time to dive into the details on how to actually perform blood flow restriction training.
Once we get that right, I’ll show you how to incorporate it into your overall training routine. There are several ways it can be performed, but here I’ll show you a common protocol seen in the literature to be effective.
STEP ONE: Apply the cuff/wrap
Grab your cuffs/wraps/whatever of the proper size we addressed above and apply them right at the top of your bare arm or legs underneath any clothing that could get in the way (leggings or compression gear is fine).
Yes, even for calves. Nowhere else.
If having all eyes on you, getting blitzed with 100 questions from confused or outraged chest-flystanders, or being chased down by an angry mob with pitchforks isn’t your cup of tea, consider a pullover/hoody/sleeves that cover your upper arms to hide the wraps a bit.
For legs, your shorts will cover them, but for girls wearing leggings, a sweatshirt tied around your waste can cover them, too, so long as they don’t interfere with the proper execution of the movement.
Pressure for blood flow restriction:
The pressure of the cuff on the limb when doing blood flow restriction depends on several factors, but as a practical guideline, it should be ~ a 7 on a scale of 1-10 with 10 being the tightest you can go.
There should be NO pain or discomfort from this. That signifies they are too tight.
There does not appear to be any added benefit whatsoever from going tighter, so don’t put yourself through pain or at risk for no reason. That’s just stupid.
What about my chest or back?
There is no way for you to directly occlude these areas, so BFR is a better bet for the muscles of the limbs.
However, interestingly, muscle growth is still seen from neighboring areas when performing blood flow restriction training. For example, chest will still benefit from a bench press with your arms occluded. However, this may not be optimal (see next section).
Why is benefit seen? My purely speculative response is that in compound movements this is due to fatigue in the directly occluded areas causing more muscle activation in the others to continue moving the load.
What do you think? Chime in below.
STEP TWO: Grab 20-30% of your 1RM (1 Rep Max) for the exercise
For example, if your max on an exercise is 100lbs, you’d be doing 20-30lbs.
Given that most of your blood flow restriction training work is likely going to come from isolation movements, getting a true 1 rep max simply isn’t practical, so stick to an estimate instead. This can take some trial and error, but you should be aiming for a weight with which you can do about 30 reps with on your first occluded set.
Which exercises are best for Blood Flow Restriction?
You can conceivably do a wide variety of exercises with blood flow restriction, but naturally it lends itself best to single-joint/iso movements.
I would stray away from complex multi-joint movements – especially if you’re very strong. Things would just get ridiculous and/or potentially dangerous.
For example, squats or deadlifts.
These are very technical movements and performing the protocol can cause breaks in form, cardio drain, and other unwanted creatures in your workout when doing blood flow restriction.
Instead, I would opt for a leg press, leg extension, and leg curl to target the musculature effectively.
Recommended exercises for BFR
Here is a list of my most recommended exercises for BFR – this is far from exhaustive:
- Calf Raises
- Leg Extensions
- Leg Curls
- Leg Press
- Bicep Curls
- Tricep Extensions
As is to be expected, single joint movements dominate this area. Depending on your reasons for doing blood flow restriction training, if you need to target chest or back I may simply opt for isolation movements in a higher rep range if the individual is able to allow for more quality work to be done.
STEP THREE: Perform your first set with 25-30 repetitions
Your first set is going to get that ‘pump’ in the muscle and build up the metabolites. Simply perform 25-30 reps in good form.
Note: This may feel ‘easy’ but that’s to be expected. You’ll feel it in your rest period and on the next sets. If it’s too easy, consider adding weight your next time doing blood flow restriction after going through an entire session. This can take some experimentation.
STEP FOUR: Rest 30 seconds
After that first set, you’ll be resting about 30 seconds. Shorter rest times aren’t something I typically recommend, however with BFR, they are there purposefully because of the nature of the protocol and desirability of the metabolic stress in creating a hypertrophic response and increased muscle activation.
Keep your wraps on the entire time until all of your sets are done.
Unless you are experiencing pain or severe discomfort, do not loosen them or take them off during your sets. We want to keep that buildup in the muscle.
STEP FIVE: Perform 3 more sets of 15-20 reps
After the initial set, perform 3 more sets of 15-20 reps.
This will get the extra volume in and cause more of those good things to happen. By the end of this, you will definitely be feeling a large-scale pump and some discomfort, but there should be no actual pain. You may not get them all, but that’s okay – see next section.
Once you’ve completed them all, take the cuff or wrap off and go about your night of fright.
Progression on Blood Flow Restriction Training
As with all forms of resistance training, you want to ensure that you are adhering to the principle of progressive overload to continue challenging the muscle and making gains.
Therefore, when you hit 30 reps on your first set and the designated amount of reps for the following sets, increase the weight.
Because of the low % of 1RM used and more frequent application of single joint/isolation movements, opt for barbell/machine movements that you can microload instead of dumbbells where most traditional gyms only allow you to make weight increases of 10 total pounds (5 each side).
For example, let’s say your estimated 1RM for bicep curls with an bar is 100lbs and you’re using 20lbs. Once you can complete your 4 sets, you would increase the weight by 5lbs total to make 25lbs your new working weight.
Record your results!
As with all forms of training, record your results from your blood flow restriction sessions.
- Exercise used
- Weight used
- Repetitions performed per set
- Rest times between sets
- Subjective markers (how it felt, etc.)
…all along with any other work you performed in that workout and so on.
Example of Blood Flow Restriction Progression
To help you out, here is how you would progress on the aforementioned protocol:
20lbs x 30
20lbs x 15
20lbs x 13
20lbs x 11
Once you get to :
20lbs x 30
20lbs x 15 x 3 sets
Increase the weight by 2.5-5lbs total depending on the exercise for your next session.
Additional Tips When Starting Blood Flow Restriction:
If you’ve never done blood flow restriction training before, don’t jump in headfirst and get nuts with it.
It can be uncomfortable if you’ve never done it before, and you need to test the waters and see how you react to the protocol. The pump can be very intense and you may feel uneasy or light-headed if you jump the gun too quickly.
Therefore, err on the side of conservatism and pick lighter weights rather than heavier, less pressure rather than more, and so on.
Competition Prep/Special Training Cycles
If you’re using BFR sporadically or considering adding it into a program for the first time, factor in an extra week or two to allow yourself a “transition phase” so that you can make any adjustments or tweaks as needed to make it a mainstay in your programming. This will help you find your target weights and find the right pressures and so forth.
How to Work Blood Flow Restriction Training into your Workouts
Cool, so you’ve got how to do it. Now as to how would you go about actually working that into your training.
There’s a variety of ways that weaving blood flow restriction into your training can be done, but here’s some fuel to get you up and going:
Stand Alone Blood Flow Restriction Training
The first and most obvious way you can incorporate occlusion training is by choosing it as a stand-alone resistance training protocol.
This is going to be the case for injuries, certain populations (elderly), or during travel/home workouts where you simply don’t have the tools or mindset to go heavy.
After Main Work
A secondary viable option to incorporate some KAATSU in your workouts after you perform your heavier resistance training sets.
Depending on your program, the requirements thereof, and work tolerance, you might be too wrecked after doing your primary exercises to really be in it mentally or physically to push some heavy weight for your secondary exercises. BFR can help you to get that extra volume in without the extra wear and tear.
Despite this, let me make myself clear:
Factor in your total volume!
In other words, don’t just tack blood flow restriction onto the end of your workouts after already doing plenty of productive work. That defeats the purpose. There is a volume threshold past which you aren’t going to get any additional benefit but will dig yourself a hole recovery-wise, so don’t think more is better necessarily.
Third in line, we have taking a periodized approach. There is value to doing it across weeks, but here we’re going to focus on within a workout week as that’s where I feel it really shines.
Most people looking to gain size should be hitting each muscle group at least 2x/week, and more advanced individuals may be looking at 3 or even 4x/week sessions depending on their total volume requirements.
By periodizing your training through heavy/light days, you can work across different rep ranges and provide some variety in your training that also speaks well for recovery.
Therefore, blood flow restriction training can be utilized as a “light day” to still allow for a stimulation of the muscle groups without the heavier loading (even on light days, relatively speaking). BFR shows low signs of muscle damage and recovery is quick, so it can be a good option for higher training frequencies to allow for muscle stimulation without the other variables you’d have in the mix from conventional training.
This doesn’t even have to be planned per se, as not all days you’re feeling up to going hard and heavy and success can still be had for a more flexible, “reactive” periodization approach. This is still a very effective way to go and is a great benefit psychologically that can assist in several core areas within the context of a program.
I’ve not had enough of a chance to experiment with this as much as I would like to personally and in clients for whom it would be a good option just yet, but it is an area I’m looking to explore further.
Have you tried it?
Share your results and let’s grow the knowledge base.
Not at all
Lastly, guess what:
You don’t have to do it at all.
I’ve said it before in this article, but to reiterate:
Blood flow restriction training is not a must-do, and there aren’t benefits above and beyond regular resistance training. It all depends on you as an individual and how and why you want to use it.
And there you have it, ladies and gents, goblins and ghouls.
If blood flow restriction training is a useful addition to your routine based on the above, follow these tips and give it a shot. See? No tricks. Just treats.
I’ll leave you with a quote…
Do you not think that there are things which you cannot understand, and yet which are; that some people see things that others cannot? But there are things old and new which must not be contemplate by men´s eyes, because they know -or think they know- some things which other men have told them. Ah, it is the fault of our science that it wants to explain all; and if it explain not, then it says there is nothing to explain.
― Bram Stoker, Dracula
For more on training, nutrition, and more, check out my latest book, Architect of Aesthetics.
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Happy haunting, hypertrophites.
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