ASCA S&C Conference - Common (BFR) Questions and Reflections

Welcome to BFR Radio, a podcast dedicated to all things blood flow restriction training. This podcast is proudly sponsored by the BFR. co, where if you want to BFR cuffs, access online BFR training programs, increase your own BFR knowledge with the accredited BFR. co course, or you want more information about this type of training, this is your one place to go. And I'm your host, Dr. Chris Gaviglio.

Hi everyone, and welcome back to BFR Radio. Thanks for joining in today's episode. And, if you're listening on the audio podcast, whether it's on Podbean, Apple Podcasts, or Spotify, you won't notice any difference, but if you are watching snippets of this as a video, you'll notice that I'm sitting in my car and I've actually decided to create a segment called Questions in Cars because from time to time, I get questions, and I've actually been finding it easier, rather than typing the answer out. Especially if it's in social media, it just takes a while to explain it because I need to give a fair bit of context about how to use BFR with specific questions that I get asked.

It's actually easier for me to talk the answer through and why not share that to everyone as well because part of what I think is that if someone's got a question, that potentially someone else has a question as well. now I've actually pre recorded a few of these episodes already and I'm still to release them. And last ASCA.

We're at our annual conference down on the Gold Coast, I had an exhibition booth with the BFR. co, had lots of great conversations, and I thought afterwards, rather than just going home and recovering from a big weekend of interacting with lots of people, is to actually spend 30 minutes just reflecting on the few days I was down there, the great conversations that I had, what could I do better?

And some of the big burning questions. I just recorded these reflection points , and that's the idea behind Questions in Cars is spending my time when I'm on my commute, giving everyone answers to questions that, that they have and this is more of a practical, applied BFR episode and probably may resonate with a few people in that.

How do you take all this wonderful information? Let's pause the science for a little bit. If I can remember the science, I'll bring it in. But really, how do you apply it in specific scenarios? Well, yesterday I recorded my reflections on the ASCA conference. And, but what I didn't do is put context behind it because This will be my first, I guess, questions in cars

so, thought I'd give some context behind it. Now join me with the episode as I am on my way to work talking about the ASCA conference.

Hi everyone and welcome to BFR radio. This is questions in cars, but not quite a questions in cars. Last few days, I have been at the 2023 ASCA International Strength and Conditioning Conference. For those people unfamiliar with what ASCA stands for, it's Australian Strength and Conditioning Coaches Association.

I've been a coach or strength and conditioning coach for, oh geez, over 20, 25 years now. Working with everyone from general population through to elite athletes. I've been quite fortunate to be around the world and met some pretty cool people. And every year we have our strength and conditioning conference.

Fantastic speakers both locally and internationally come in and talk about all things S& C. And as with lots of conferences, you have a trade show, , where lots of exhibitors bring out their wares and products. And I've been there for a few years now and it's been really interesting to see. I guess the, the transformation, or perhaps maybe a better word is, how BFR has been evolving over the last few years.

If I. Rewind a few years ago, people used to walk past and I guess if they only really knew me, well, it felt like if they knew me as a strength and conditioning coach, they'd feel comfortable coming in and chatting. Whereas now there's, with the social media and just media in general, much more information being accessible to people.

I definitely see, a lot more people know about it. They may not know in depth about it, but they've definitely heard about it. And it was really great to see a lot more people, well, a lot of people that I do know come up and have a chat and, , thank you for coming up and talking. It's always great to reconnect and for some people, it's.

It seems to be our annual catch up, because we all live quite busy lives, but for some other people that I've never met before, it was really nice when they come and say, Oh, I've seen it, I've read it, , whether it's been my own posts or information that I put out more, more so probably on Instagram, it seems to have great attraction due to the video styles that I do.

I actually told them a lot of them about BFR radio and so some good reflection points at the end of the conference on how to improve the amount of information I have available to attendees so that when they come up, there's a QR code goes to this podcast, BFR radio. the QR code goes to my website.

There's a few resources. And, so, for example, in case people don't know, I have a free course which is called The Basics of BFR. It was a 40 minute video PowerPoint style presentation I did, oh, a little while ago. It has all the basic information if you don't know anything about BFR. It's a great way to, just to understand the basics, so that when you do have conversations with people sometimes, I've had large groups wanting to do workshops with me and they don't know anything about BFR and what I get them to do is to go through the course first so they have a basic understanding of the mechanisms and, and the different ways you can use it and which is, I'll allude to some of the common questions that I was getting to.

, because there are a lot more ways of using it than just for muscle hypertrophy, low loads. Just some random things, there's lots of different equipment manufacturers there, and the first night I actually had a workout, and as I do, I video it, edit it, and put it up to show all the wonderful things that you can do with BFR that goes beyond that really low load rehab style stuff.

And one of the attendees that I was chatting to said, Oh, if I would have known, I would have had a lift with you. And. As long as I get permission from the equipment manufacturers and get clearance per se. The question is, is that if anyone does listen to this and was at the ASCA conference, would you be interested in come and have a lift with me at the end of one of the days when the whole trade show Area's really quiet and there's no one in there. Be a great chance if you do use BFR or if you've never used it, we could actually do a session lift, put 'em on, and show you how I construct a session.

Be really interested if anyone did attend, does listen to this and comment. Be really interested to hear your thoughts and as to whether that would value add, for those people who are . Sitting on the edge, not quite sure. Who would just love it and just want to just lift some tin as well.

One of the questions that I was asking a lot of the attendees is, especially ones, people that were coming up , were looking at it, seemed a little bit unsure was , what's your one burning question that you have about BFR? Just to break the ice. And, aside from, what is BFR? And that's not what I'm going to get into.

in this short drive to work, but rather a One in particular was, how do I calculate the pressure and how do I know that I've got the right pressure? And I've actually gone through this in previous episodes, but I am going to review this very quickly, , for anyone that is catching this for the very first time and they can go back into other podcasts where I go into more detail.

So when we're calculating pressure of There are several ways to do it and mine's not the only way. If we look towards academic literature, which everyone falls back to quite heavily, is that we have this thing called Doppler ultrasound. And what you do is if you're doing lower body on your leg, and you put the ultrasound, which will essentially listen to the pulse, in this case it's down the inside of your shin, near your ankle, or if you're doing upper body, it's on your wrist.

And as you inflate it, you can hear the pulse, and as it gets tighter and tighter, we're occluding more blood, and you get to the stage where you can't hear the pulse at all. And that's where we're at arterial occlusion pressure. And then you multiply that by 50 or 80 percent. depending on the cuff width.

There's a bit of education around cuff width as well. If we have a thinner cuff, typically we would go a higher percentage of arterial occlusion because it's a smaller surface area. If you have a wider cuff, we can disperse that occlusive pressure. We're not totally occluding our blood flow and that's really important in the education.

So if you have a wider cuff, a lower overall pressure for the same arterial occlusion pressure. And it's a bit more comfortable as you can imagine if you have a thinner cuff, especially on the lower body, you have quite big limbs, you have to have high pressures and that can actually be really uncomfortable.

Therefore, given products a plug here, my lower body cuffs are 10 centimetres wide. And then my upper body are five and the reason why the upper body are more narrow is I want you to achieve a full range of movement. Be able to full range bench press, chin up, box, rope pulls, tennis serve, basketball shots, whatever sport or thing you're into.

Then we go into using limb circumference and blood pressure in a theoretical equation to calculate the limb occlusion pressure. And there's some great papers, more so on limb circumference being the major determining factor of how much pressure is required to create total occlusive pressure in a limb.

Some actually really good studies about the limb circumference related to co factors and using it even in surgery. And surgeons having no idea the difference between using a theoretical equation versus a process using Doppler ultrasound. When we start to think about, as practitioners, and I'm quite a practical type of person, a lot of us don't have access to Doppler ultrasound.

And a lot of us don't have that certain skill, but what we do have a skill is measuring the limb circumference and taking blood pressures and I just use an automated blood pressure monitor. And, and I've been using this process for over 10 years and the pressures work out really well. Uh, when I do all my cross checking, I talk about how do we know that the pressure isn't too tight.

And that's our main thing is we look at skin color. Is it that nice dark reddish color? If it's blue or purple, it's too tight. And then also capillary refill time where with that dark reddish skin, where capillaries are full of blood in our skin, and then we push it, we push all the blood out of the capillaries.

And then the refill time is how long does it take for those capillaries to refill? Around three seconds is pretty good. If it's six seconds or longer. It means that the capillaries are really struggling to refill full of blood and therefore the cuff is too tight.

And the other one is just the feedback as a coach, put it on, how's it feel? If we look at practical BFR, where they use lifting straps, 7 on an RPE scale. So you can incorporate that. How tight is it? You just say, Oh, it's pretty tight. And the first time they use it, what I do is the preparatory protocol where you would inflate, deflate the cuff in increasing pressures up to what would be the calculated training pressure.

So therefore if you would calculate at 140 for the lower body or any limb, inflate at 110, 40 seconds on deflate for about 20 seconds and then And repeat that for 120, 130, 140, deflate, re inflate, go do your exercise. Especially if they've never done it before, it's that nice little warm up leading into the first time they've ever used BFR.

And I'll also say that, in my opinion, especially if they're not well trained athletes or they're quite unsure about it, always start with the pressure a little bit lower, 20 mils lower than what we calculate. And then have a look for skin color, capillary refill time. Fatigue across the set is another really good one as well.

So, the big one is, is our first set is lots of repetitions. And we get that feeling of fullness, short rest. And our second set, if the pressure is correct, and we're doing the right loadings, and the right tempo. That we should see the second set falling in repetitions, third set falling again.

We have this nice dropping scale from our first, or if we draw a line it would drop from first through to third. Which we had some conversations about the 75 rep protocol, and I've advocated a lot on my podcast is that. If you have someone in an older age bracket, that's never exercised before, if you've had someone that's never exercised before, someone that's not used to doing high repetitions, I enjoy the low reps, and

what I've found is that Well, everyone talks about the 75 rep protocol. First set, 30 reps, followed by three sets of 15. Now, that's in academia, when we have to do a study, we want to be doing lots of repetitions in our first set, because we want to produce lactate at these low intensities, and that's the key to remember here.

So do you need to be doing 30 repetitions? I'd actually put it out there and say no you don't. There's been protocols at three sets of 15 that have been shown to be effective using VFR. I'd rather say you need to tailor it to the client or the athletes that you're working with and the sports they're working with.

The key though at low loads is the first set is lots of repetitions. But you don't need to be going to 30. 15 to 20. Or alternatively, doing as many reps so you have that feeling of fullness in the limbs. and you're going close to technical fatigue. So you might be one or two reps short of total failure because we don't want to exhibit poor technique and injure the client or the athlete or yourself that's training with.

Short rest, second set, and so the first set I would be aiming for around 15 to 20 reps. Second set, somewhere between 10 to 15, third set 10 to 15. And in the world of katsu, fourth set is totally optional. Now the other thing is, is that, in academia, they do one exercise only.

Whereas, when we train, we do several exercises. For example, if I'm bench pressing, I'll bench press, I'll finish that, and then I'll do a secondary exercise or an ancillary exercise that would help develop my bench press. And that could be... A dumbbell bench press, could be flyers, could be push ups, all the way through to ancillary, might be some tricep extensions.

Therefore, I'll be doing lots of exercises, lots of sets and reps, lots of opportunity to increase metabolic stress and therefore, I'm not worried about that full set because I know I'm going to get more sets later on. And 75 rep protocol for every single exercise that you're prescribing, it's pretty hard to do that full set, they're gonna be exhausted at the end, and then I would actually then start to question, will the people doing these type of protocols, will they actually want to stick with it? You're gonna have that level of reality with this type of training as well. Especially if you want to get true gains and I've been training like this for years with this type of methodology and because We aren't in academia.

We are in the real world It's sustainable over long periods of time and that's important to be able if you truly think this is a great training methodology You need to be sustainable. And how do you do that? And once again, i've had really great results Either from just a pure lifestyle point of view pain point of view performance point of view. Some people how it did work, and at a conference it's quite hard to quickly tell someone all the different mechanisms associated with BFR.

And one thing I did talk about was mechanical stress versus metabolic stress. Mechanical stress is our traditional strength training where we train it, loads of 60 70 percent of our 1RM or greater, we need to be lifting at that to create the responses, all the pathway responses, the molecular responses, the hormonal responses, that gives us the changes in our muscle tissue.

to improve either muscle strength, hypertrophy, performance, et cetera, et cetera. And the increase in metabolic stress from the BFR cuffs activates these same pathways, which is absolutely amazing. There's lots and lots of research articles in that. And therefore I was then talking about, a cup analogy.

So if we have a cup. And traditionally, we need to fill it up 70 percent with load. That's our mechanical stress and mechanical load for our cup to be effective. Now, if we're injured or we don't have access to really good facilities, our cup's only filled to 20%. That's our 20 percent 1RM. So how do we, how do we create enough minimum stress in our system or in our body or in the tissue to elicit positive response and that's where the BFR comes in.

By being able to top up the mechanical stress up to the top, we can create that using BFR and as I said, the different pathway, the signaling is exactly the same. In athletic populations, I do believe we need a greater percentage of our RM and as opposed to 20%.

So I do make sure I say if you're an athlete, especially a strength speed power athlete, you still need a left heavy. However, I've been speaking about this recently, is there's a fair bit of evidence around lifting at high loads. So 50 to 90 percent of our 1RM and the major positive response from this type of training is improvement in barbell velocity, that intent when we move.

And there is some evidence around if we train at greater barbell velocities that we longitudinally have greater improvements. In strength, but also in power outputs at various loads leading up to that 1RM. Very exciting. I've done a fair bit of work myself with that and, seen the positive responses.

However, because our cup is already pretty full with mechanical stress, we only need a little bit of metabolic stress. So it becomes an intermittent protocol. We inflate it, put it on for the period of time and deflate it.

Probably some of the questions that I was getting is now people starting to ask about how can this be used in an athletic population for improvements in neural type performance, such as sprint performance, jump height, barbell velocities. So I could see this shift in people's thinking saying, okay, we can use it in this rehab center.

But how can we use it for performance benefit? And at the conference they have a poster presentation, it's a competition, where you do a training study or some observation in the strength and conditioning world, and you write it up in a poster.

And one thing I did put was... It's low load BFR plus isometric strength training, and I wrote about how that improved barbell velocity in loads leading up to 87. 5 percent of 1RM, and also I had improvements in bench throw and light loads and also med ball throw, which indicates that this training is fantastic, especially isometric training with some load, light load and the addition of BFR.

However, if you're all into your 1RM like a powerlifter, you need to put that type of training in as well. Therefore, you can see that the knowledge or the awareness of BFR is out there and people are starting to think about how they can incorporate it in more ways than just in that rehab sense.

Some of the other points which I guess a little bit Less Known, which I have covered in these podcasts is around improvements in pain, decreasing pain in joint tendons, and that still amazes a lot of people. I had strength coach, has pain in his elbow when he benches and does ancillary exercise like skull crushes and so forth, and spends a long time warming up his elbow before he bench presses.

is just to try and decrease pain, so we just put the cuff on his upper body, did some basic movement, and then we started bench pressing. although he's 1RM's, , around 180.

We started 40 50 kilos, lots of repetitions and then from that point. You could really start to feel the positive effects of decreasing joint pain, joint and tendon pain in general. And so, well, it actually feels really good. So we're increasing muscle activation, we're decreasing pain, and we're actually cutting down our total warm up time, which is really great, because you can see the frustration on his face, is that he spends ages doing lots of repetitions, trying to get the joint going, trying to decrease pain.

Some real massive benefits just from training efficiency and, you know, it's frustrating when you're sore and you can't decrease pain and you can't get it going. Which then on to another coach who works with a tennis player and this tennis player had some in his knee and I actually might do a little questions and cars on that one. Because I feel that there is more benefits to him or to any tennis player to use BFR aside from just osteoarthritis or arthritic joints.

And just on that point, there's a paper which I feel I need to review now is on the use of hypoxia, for arthritis, which is really interesting, just hypoxia in general. But the pathways associated with that, we can produce using BFR, which is fascinating. The big point about that is, is you've got an athlete that, a tennis player, very strong for a tennis player, and loves to trap bar heavy, around 200 kilos, I think the strength coach was saying.

Does a tennis player need that? Maybe not, but you know what, you've got to find what floats an athlete's boat. And if they get a kick out of lifting something heavy in the gym. And you know, you need to play to that strength as opposed to saying, well, you know, we only need a certain amount of strength. If that's what drives him, gets him going, you need to find a way of supporting that but ensuring that not at the detriment to his performance on the court.

So my point with this strength coach is that we can put the cuff on, we can still go 150 to 160 kilos on the bar, but we don't have to go to 180, we don't have to go to 200 kilos on the bar to get that feeling of load, to get that activation, but also what I call satisfaction when you lift.

When I lift, I have this euphoria, it's my, it's my drug, I feel great after I finish lifting. And it's when I lift heavy, it's when I feel, feel good about what I do and about myself. And maybe this athlete gets a kick out of lifting heavy. But what we can do is just drop it a little bit. It's still pretty heavy.

And the effect on the musculature won't notice the difference. But there'll be a little bit less mechanical stress through the joint, which is a great thing. It's going to improve the longevity of the joint and it's actually going to leave a little bit of juice in the tank, as we say, for actually training tennis, which is really important.

And we just spoke about how you could incorporate that into a normal warmup. You come in, you put the cuffs on. And in the warm up it would be a continuous cuff pressure,.

You want that metabolic stress, you want the accumulation of metabolites, have all the activation of pathways, anabolic hormones. You can put 60 kilos on the trap bar, lots of high repetitions, 10 to 15. Short rest, then we go 80 kilos, then 100, , and if his first work set starts at 150 kilos. You might still do a set of four or five at 140, but the pressure is continuous and you'll feel by this stage, I can guarantee that you'll have that feeling of fullness in the body or in, in the musculature that that's working quite hard.

Now at this stage when we hit our main work sets, you can make that decision if the loading's getting too, too hard with the pressure on the cuffs. You could then use that intermittent protocol, taking advantage of improved barbell velocity. Put some VBT device on the bar, have a look at the velocity and get that intent There was another company that they actually do supplements and you can actually design your own supplement.

, they're a regulated company within Australia, really great concept, quality control, so you know what's going into your supplements. And then I thought, well, there's a bit of evidence around using BFR for joint pain. question to you is that Do you think there's an avenue to have a supplement that could partner with this type of training? You come to my website, you purchase the cuffs, and you have a supplement that, would help with the joint,

I produced a shirt this year, , produced my own shirt. I love , the concept of. Superheroes, , growing up I loved the, the comic books, the Marvel comics so I produced my own figures and, , had my superheroes with the BFR cuffs on.

And with the catch cry, not everyone's born a superhero. And that's why I think BFR is fantastic because you can get amazing gains without having to Do what we traditionally have to do , in the gym with high loadings , or, it might be as simple as you just want to be able to be functional and, walk without pain and get a little bit of muscle without having to go to the gym and I guess go crazy.

So that was kind of my little thing there and produce some shirts and that was a bit of a fun project as well. There was a couple of overseas. Delegates as well, looking at the product.

And where they saw value in this is that it's a pretty affordable product with some good tangible outcomes. Not only in the rehab space, but also in the performance space. And in some places So for example, Fiji, where they might not have an abundance of facilities, they have good facilities, but not everywhere, that you could be using BFR systematically in large squads to be able to train and increase your effectiveness, either at body weight, using lifty bands, or if you have light weights.

And that was another thing that, you know, that I... Keep talking about is that when you do travel you don't have great access to Facilities or you're at a hotel gym How can you maintain a level of performance and then the on shoot to that is that there were some physiotherapists that I was talking to And also some people that own private facilities as well, where they may be paying for one or two sessions a week. But ideally, you'd love them to be doing another two sessions, just little top ups, which would really accelerate their gains in whatever you're trying to do, whether it's shoulder rehab, or regain , some strength back after a musculoskeletal injury, or any kind of injury, really.

And, I told them that, you could educate them on how to use it. They have a set of cuffs at home and then they do little 10 to 15 minute sessions as well. And that being another benefit is that when you're doing high frequency trainings, that's lots of little training sessions over a week, is that it's really time efficient because the load is low.

You're not spending 15, 20 minutes warming up, getting up to really big weight. And you can do it in the comfort of your home, you could be waking up doing something before you go to work, or at the end of the day, you do it at home for 15 minutes and becomes something that everyone can achieve and I think that's really important is that when we do prescribed exercise, especially if we push that elite athlete population out for a second, we're dealing with people who have very busy schedules, Whether you're at school, lots of study, or you're at work, and you have lots of kids driving them around, is that you need something to be time efficient, but you also need it to be effective.

And I've proven time and time again that using BFR can be a really effective way to train easily. So overall, a fantastic conference. Lots of ideas on, how to improve education people in this area, but can definitely see that people are more aware of it. I guess for me, it's just improving that knowledge to highlight that you can be using it for more than just building muscle in that rehab sense and then , pain attenuation, also bone reformation and just on that actually, as I'm about to close on this podcast, spoke to a physio about, using it. Around, post surgery and, and I said, well, wouldn't it be great if that become the norm is you're going in for an operation and pre operative you have your BFR cuffs you get it tailored to what you can do and it could be as simple as.

Passive BFR, you're attenuating muscle loss because when we don't move a limb, we lose muscle, all the way through to that post operative care. So you have this tool that we educate the person that getting the operation, how to use it across that spectrum of pre op to post op back to full function.

And I think that could be a really powerful tool to compliment the therapist, to ensure that the benefits they get from the operation takes fully, which then you think longitudinally has less strain on, the medical system as well. And that the person getting the operation actually does it because a lot of time the surgeon does the good job.

It's unfortunate a lot of time is the client doesn't do the rehab that's necessary to get them back to full function,, because it is hard work. And it takes time to do that, and this is a fantastic tool. Anyway, there's lots of other little, things, but I thought I'd , while it's fresh just give you my thoughts and views and a bit more education on how to use BFR.

And if you do listen to this, and you were at the ASCA conference, thank you so much for coming up, and BFR. co. I do love the conversation. Uh, I do love to chat. And if there are any questions around BFR, that you do have, please let me know. , I love to answer them, and I've been really enjoying this format, where I can , Past time away on my way to work obviously concentrate on the road, but, , get some more information out to everyone because I do think that's really important is education is key to highlight.

There is lots of ways of using BFR. Anyway, thanks for your time. Thanks for joining me on my drive to work. Have a lovely day and remember to keep the pump.

And that's all today for this episode of BFR Radio. I hope you enjoyed it. Remember to catch up on lots of great BFR training content on our Instagram page which is at thebfr. co or alternatively on Twitter which is at thebfr underscore co. For more information and to order your own set of BFR cuffs please visit our website which is www. thebfr. co. Thanks for listening and remember to keep the pump.