Share   Subscribe to RSS feed

Brian Schiff’s Blog

Injury Prevention, Sports Rehab & Performance Training Expert

Blood flow restriction (BFR) therapy/training is one of the newer and more exciting techniques being used in the sports medicine field. I received training with Owens Recovery Science and have been utilizing personalized blood flow restriction (PBFR) therapy in my clinic since November 2017 using the Delfi personalized tourniquet system (PTS).

What exactly is BFR?

It is the application of a specialized tourniquet system to the proximal arm or leg, which is inflated to a personalized and specific pressure to reduce blood flow to an exercising extremity. For the lower extremity, the occlusion pressure is 80%, whereas the upper extremity pressure is usually set at 50%.

The application is brief and intermittent, usually lasting about 6 minutes per exercise. For most clients, a total of 3-4 exercises are used leading to 24-30 minutes based on the specific exercises prescribed. Typically, to increase strength and hypertrophy a person would need to lift a significant amount of weight (greater than or equal to 60% of a 1 repetition maximum). With PBFR you can create significant strength and hypertrophy gains with loads as low as 20% 1RM.

We utilize the Delfi tourniquets as suggested with the Owens training course. You can see the PTS and tourniquets below:

img_e54641

What is the science behind this training tool?

The landmark study by Takarada published in 2000 revealed that significant hypertrophy gains are seen with occlusion and the use of lighter training loads. There is an increase in muscle protein synthesis as well as growth hormone secretion. Below you find some links to abstracts from Takarada’s work:

https://www.ncbi.nlm.nih.gov/pubmed/10846023

https://www.ncbi.nlm.nih.gov/pubmed/10642363

https://www.ncbi.nlm.nih.gov/pubmed/11128848

In addition to hypertrophy, there also appears to be an application for preventing disuse atrophy simply using occlusion. This may prove very beneficial for clients who are non-weightbearing after an injury or surgery, yet not able to perform much resistance training.


Continue reading…

It is that time of the year again. Everyone wants to lose weight and trim their waistlines. Abs, abs and more abs, right? I am all about some core training, but I am always concerned with some of the ab variations that I see commonly used at the gym and in group fitness environments.

Many exercise enthusiasts have tight hip flexors and poor abdominal control. Sprinkle in a history of low back pain or a prior disc injury along with straight leg abdominal exercises and now you have the perfect recipe for a possible back injury. Why is that? Well, the psoas originates from the lumbar spine and attaches to the lesser trochanter on the hip.

psoas

In the picture above, you can see how the muscle impacts the spine and hips. As you lower your legs toward the ground during an ab exercise, there is a reverse muscle action that takes place and resultant anterior shear force exerted on the lumbar spine. When the abdominal muscles cannot resist this motion, the lumbar spine hyperextends.

Many people will even report feeling a pop in the front of the hip while doing scissor kicks, leg lowering or throw downs. In many cases, this may be the tendon running/rubbing on the pectineal eminence. Unfortunately, long lever and/or ballistic abdominal exercises with inherently poor core stability/strength, fatigue and gravity working against you will create significant load and strain on the lumber spine. Ever wonder why you wanted to put your hands under your back while doing 6 inches? Your brain is trying to flatten the spine using your hands as it knows the hyperlordotic position is uncomfortable and threatening.

In light of this, I put together a little video for PFP Magazine revealing a safer way to work your abs and prevent undue stress and strain on your back. Check it out below.

Keep these modifications and progressions in mind the next time you hit the gym or a boot camp class focusing on core/ab training.

Many athletes and clients I work with lack adequate pillar and shoulder stability. Whether this is related to acquired laxity, inherent instability or simply a lack of proper muscular control, I think it is important to assess baseline stability in anyone performing overhead lifts, ballistic upper body training and in overhead athletes.

In my clinic, I work with lots of baseball players, swimmers and volleyball players. Most females tend to struggle with hyper mobility (loose shoulder joints) whereas many of my males tend to have soft tissue tightness and in some cases limited internal rotation (GIRD). Both males and females tend to have a need to improve dynamic shoulder and pillar (core) stability to reduce injury risk and optimize mechanics.

The following exercise is one I use to both assess anti-rotational control/stability as well as train the body to resist torsional forces. In the video below, you can see how to assess your baseline strength and stability.

This exercise is very effective in working improving glenohumeral and scapular stability as well as enhancing shoulder, torso and hip stability. In my opinion, athletes with poor stability in this assessment should not perform unilateral Olympic lifting or ballistic overhead training as they may lack the necessary neuromuscular control to execute the proper movement pattern.

I just returned from the Sports Physical Therapy Section’s annual conference in Las Vegas. There were plenty of great presentations from various industry leaders. I thought I would take a moment and summarize a few key points from the conference that may be helpful to clinicians and consumers alike.

The conference theme was the power of innovation. Hot topics covered were blood flow restriction therapy, cupping, dry needling, eccentric loading for tendiopathy, weighted ball training, and kinesiotaping and laser therapy to name a few. Below are some takeaways worth mentioning:

  • Blood flow restriction (BFR) training can be used to help reduce muscle atrophy after surgery, improve muscle protein synthesis and provide a way to increase strength with loads as low as 20-30% of 1RM for clients unable to tolerate heavy loading
  • BFR is not superior to nor a substitute for high intensity training (need to push weight to see best strength gains), but it can be used as an adjunct to training. It also produces an increase in IGHF1 after exercise.
  • BFR should not be used before higher intensity activities such as HIT, plyometrics, SAQ, etc.
  • Clinicians and strength coaches should consider Olympic lifting derivatives as an alternative to traditional lifts if there is concern with catch phases or biomehcanical/physical concerns. Examples include high pulls/snatch pulls instead of traditional cleans and snatches.
    Continue reading…

In my previous post, I outlined the history and findings related to my son’s medial elbow pain. Since publication of that blog post, I have since been given the results of his MR arthrogram and have further updates. If you did not read the prior post, you can click here to read it.

Initially, my concern was tendinitis or more of a flexor/pronator strain given his mild yet persistent soreness and response to rest. The imaging revealed that his UCL was pristine, the radiocapitellar joint liked good, no osteophyte formation or really any inflammation in the soft tissue. The surge told me he had to look closely, but there was evidence of mild fluid around the apophysis. So, in essence, there was some overload/strain being placed on the growth plate.

Given that my son’s growth plates are still open at age 15, he was experiencing some overload (apophysitis) rather than strain on the UCL itself. Had he been skeletally mature, there likely would have been more stress being placed directly on the ligament itself. So, this was good news for all of us.

We received the results on Tuesday October 31. With clearance to pitch last weekend as tolerated by the MD, I elected to have my son throw a bullpen last week. He threw 25 pitches on Wednesday night (one week ago) and was at 100% and pain free. As such, I let him throw 40 pitches in our showcase game last Saturday. He again threw pain free. Now that Fall baseball has ended, we will shut him down for some extended rest and focus on arm care and overall strength and conditioning as he continues his HS workouts.

Some key takeaway points for players, parents and coaches:

  • Never dismiss pain that occurs with throwing
  • Educate players about throwing related soreness/tightness (such as lactic acid build up that would be typical after a start on the mound) so they can differentiate that from true pain
  • If velocity, mechanics or performance in a player suddenly drops, be suspicious of a potential injury knowing that most players will try to throw through it (look for shaking/rubbing of the arm, grimacing or other body language that is outside the player’s normal routine)
  • If you suspect an injury, seek out an immediate assessment from a knowledgeable physical therapist and/or MD who treats baseball players as they will do a more comprehensive evaluation and uncover the root cause of dysfunction faster
  • Getting imaging in a higher level player will provide peace of mind for the athlete, parent and coach allowing for proper care and progression back to pitching as evidenced in this situation
  • Managing pitch counts, innings pitched and recovery between appearances will be instrumental in preventing or reducing injuries

In the end, we must rely on the athletes to communicate what they re feeling. Often, pitcher push through fatigue and pain in the spirit of competition. It is imperative that we advise against this in order to promote long term health and prevent more serious injuries. I know I feel fortunate that my son’s injury was not serious at all.

Moving forward, I will adjust his off season and in-season throwing to ensure he actually conditions his arm with more frequent throwing (not pitching) to ensure his endurance is better, as I feel this may have been a factor in his overuse scenario. While he threw a weekly bullpen this summer, he only threw on average 2 days per week on top of that. He threw daily in middle school ball last year and never had any arm related issues on the mound.

Each player is different in terms of their build, pitching capacity, arm talent, etc. With that said, I think it is important to analyze their performance over the year based on innings pitched, pitch counts, rest between outings, strength program, throwing programs and perceived fatigue to evaluate what works bets for the player. Educating players and parents about arm care and health management strategies will reduce injuries and facilitate long term success for pitchers that have a chance to play in college and beyond.