April 20, 2021

26 - Blood Flow Restriction to Increase Recovery? with Johnny Owens

26 - Blood Flow Restriction to Increase Recovery? with Johnny Owens

Johnny Owens has been applying Personalized Blood Flow Restriction (PBFR) Rehabilitation Training clinically since 2012 and credits the modality with significant strength recovery in patients. 

He has taken part in numerous research projects involving regenerative medicine, sports medicine, and rehabilitation of the combat casualty.

Owens has been published extensively in the peer-reviewed literature and his work has been featured on 60 Minutes, Time magazine, NPR, Discovery Channel, and ESPN.

Today we are here to learn all about blood flow restriction. How it can be used and the effects it has on the body.

Claim your 14-Day Free Virtual Mobility Coach:

www.thereadystate.com/jase (Affiliate Link)

 

Johnny Owens:

Instagram: https://www.instagram.com/owensrecoveryscience/

Website: https://www.owensrecoveryscience.com/

Facebook: https://www.facebook.com/owensrecoveryscience/

Twitter: https://twitter.com/owens_recovery

 

Jase’s Information:

Instagram: www.instagram.com/jaecheese

Website: www.scienceofsportsrecovery.com

Youtube: https://www.youtube.com/channel/UC4cHv4ysGa6u3h22NjUkFEw 

Email: jase@scienceofsportsrecovery.com

 

 

Transcript

Jase Kraft: [00:00:00.36] Welcome to the Science of Sports Recovery podcast, I'm your host Jase Kraft, and today on the show, I am interviewing Johnny Owens. Owens has been applying personalized blood flow rehabilitation training clinically since 2012 and credits the modality with significant strength recovery and all of his patients. He has taken part in numerous research projects involving regenerative medicine, sports medicine and rehabilitation [00:00:30.00] of combat casualty. Owens has been published extensively in peer reviewed literature, and his work has been featured on 60 Minutes, Time magazine, Empire, Discovery Channel and ESPN. Today we are here to learn all about blood flow restriction known as Biffa. You'll hear us use that term multiple times throughout the interview, how it can be used and the effects on the body as well as recovery [00:01:00.00] and what this could mean for you and your training. Let's get into it.

 

Speaker2: [00:01:09.15] You're listening to the Science of Sports Recovery podcast. Each week, we explore how to recover more efficiently from training so you can work out harder and realize your full potential. This is the Science of Sports Recovery podcast.

 

Jase Kraft: [00:01:35.62] Hey, [00:01:30.00] Johnny, great to have you on the show, man Jase.

 

Johnny Owens: [00:01:38.44] Thanks for having me, man. Great to be great to be on.

 

Jase Kraft: [00:01:41.80] Well, I want to start with the sports kind of history of Johnny Owens, the athlete, prior to your professional career here. So where did sports start for Johnny?

 

Johnny Owens: [00:01:55.60] Yeah, well, I don't have a glorious sports history, I guess I'll say. But I'm [00:02:00.00] from Texas and I grew up in West Texas, so it's mandatory that you play football here. And it also kind of mandatory in my household, you played every sport and so I played them all. But soccer was really the one that I liked the most. I broke my dad's heart in high school and said, you know, I'm giving up football. I didn't want to get hurt because I was actually getting pretty good at soccer. So I made it up to play and we had a semiprofessional league that I was able to play in and then also played at [00:02:30.00] University of Texas. And then I hurt myself multiple times and multiple knee surgeries playing soccer. So maybe I should have stuck to football.

 

Jase Kraft: [00:02:39.19] Yeah, I hear that soccer is one of the highest injury prone sports when compared to all of them. And do find that as well.

 

Johnny Owens: [00:02:51.52] Yeah, you know, well, it was for me, unfortunately, but yeah. You know, it's football has what we call kind of high [00:03:00.00] energy injuries. And so these guys are just heat seeking missiles. So, if I think if you look at the spectrum from fracture cycles to tendon to concussions, I, I would gather that football's probably higher, but overall, maybe injuries. Soccer probably has a high incidence just from the amount of hamstring injuries and soft tissue injuries. That's a lot of playing time. And you're also cramming now in the leagues. You're playing multiple games a week, lots of times. So there's a lot of volume issues.

 

Jase Kraft: [00:03:30.88] So [00:03:30.00] when did you make the switch from football to soccer?

 

Johnny Owens: [00:03:35.53] Yeah, my freshman year in high school. Yeah, yeah.

 

Jase Kraft: [00:03:40.30] My so I'm up North and South Dakota here. My brothers went from football to cross country their freshman year and I was so mad at them because I like football is the way for me and I was their younger brother. I wanted to follow in their footsteps and then [00:04:00.00] ended up liking Cross Country better and that ended up being my sport was endurance running rather than if I had ever even played football. But I was so mad at my brothers for not doing it.

 

Johnny Owens: [00:04:12.50] They ruined the Dakotas, man. They put up some good football up there. So, yeah.

 

Jase Kraft: [00:04:19.32] So you you said you played some semiprofessional soccer. Like how long of a career and how that go for you.

 

Johnny Owens: [00:04:27.94] Yeah, I was short, so [00:04:30.00] I started my senior year in high school and so there was a new league that started up and it was my city which was Lovebug Denver had a team, Austin Phenix. So it's pretty cool. Like in high school my senior year, I'm flying around all over the place playing these games. Our coach was really rich. He's a German guy that played over there in the Bundesliga and he became like a really big grocery store kind of tycoon. So, yeah, he had his own, like, [00:05:00.00] jet that if we could ride on the busses, you know, we had to work or school or something, he would fly us out on that plane. So that was pretty fun. So then I went to Texas Tech here in Lubbock my freshman year in college and still played because I was still here locally. And then I transferred to University of Texas because I realized Austin was way cooler than Lubbock, Texas. And so, yeah, that's what it ended when I moved.

 

Jase Kraft: [00:05:23.48] So did you see any sort of like blood flow, restrictive [00:05:30.00] practices throughout your career as an athlete prior to your professional career?

 

Johnny Owens: [00:05:37.00] No, not at all. Well, I'm old, so, you know, I don't think it was really being used at all back in when I when I was doing sports and things like that. So I'm fifty now and really be a harsh kind of only taken off in the last few years. So there are some older papers where it was used more in the lab type setting, [00:06:00.00] you know, the oldest paper. And so I was with the Department of Defense and we really vetted this. The oldest paper we could find was actually from nineteen thirty seven, where they kind of did a modified version of it. So it's been around. But clinically or for her performance in America, it's really novel and fairly new.

 

Jase Kraft: [00:06:18.67] Sure, sure cool. So we're going to center this conversation around kind of the physiology behind BFR and what that can what it's supposed to do, [00:06:30.00] what it's been proven to do and also kind of. Drawing the line between theory and what has been proven through the kind of research and stuff, one of the first things I want to dig into is the production of mitochondria, because through the research I was looking at, it seems that BFR seemed has some promise to either increase the amount of mitochondria or enlarge [00:07:00.00] the mitochondria and the cells. Can you speak to a little bit like just give us a brief overview of what mitochondria is just in case somebody needs to go back to a science class with just 30 seconds and then like, why is this important and what have you seen?

 

Johnny Owens: [00:07:17.39] Yeah, sure. So I don't think I've been asked to describe mitochondria and in decades, maybe so, but my mitochondria are basically, you know, they produce energy. So it's a little organelle that's within our cells, takes, [00:07:30.00] takes are our food sources and moves it down its cell walls and what's called the electron transport chain. And it converts out to energy. Typically we use those ATP. It also spins off some of those electrons and creates the free radicals that that are sometimes not the best thing for us. So, yeah, that's mitochondria in a nutshell. It's it's a fascinating little little structure because it's got some of its own DNA. So it's we have this thing that lives in us that is probably [00:08:00.00] from something that was outside of our body. They think they think of cell. A big cell might have had a little cell a long time ago and the mitochondria started helping that big cell. And so now we've got this weird form structure in our DNA. Yeah,

 

Jase Kraft: [00:08:16.43] That's funny. So more or less, it's kind of the energy source, right? That's the cells are what leads produce the energy and stuff. So so what has like what is BFR. Well [00:08:30.00] maybe we should back up a little bit and say like what BFR is like how how would I know a BFR like workout or exercise compared to just a normal one.

 

Johnny Owens: [00:08:47.28] Yeah. So most of us are always going to exercise and what we say, free flow conditions. That means where we want to exercise and allow as much blood to move to our limbs as possible. And most people would say that's [00:09:00.00] a good thing so BFR kind of flip that on its head. And it essentially is we just block the blood from going into the limb. So that's what these cuffs on the proximal thighs, the proximal arm, and we reduce the arterial flow so that you limit oxygen supply and blood into your limb. And it takes very little pressure to block the venous return. So we we reduce arterial flow and we completely blocked venous return.

 

Jase Kraft: [00:09:28.18] So you're kind of pulling up [00:09:30.00] blood then?

 

Johnny Owens: [00:09:32.09] Well, yeah, so there is a cooling because you're not able to push fluid back into the tourniquets. And so, yeah, the limb will actually be swelling. The blood is getting pulled down there. And we we use a system that has a Doppler technology in it. So we really limit the amount of arterial blood flow that goes in lots of times when we're using this in the lower extremities. We're only allowing 20 percent of your arterial blood flow to go in. So it's a real hypoxic state. [00:10:00.00] And what it does is it allows you to to exercise that minimal to to no load. So typically, you know, the sweet spot is around 20 to 30 percent, about one rep max if we're talking resistance training. And you do that low load, but you do high volume. So we're typically exercising per kind of target muscle, about 75 reps worth. And so what we see from a resistance side is that gives [00:10:30.00] us similar benefits in muscle quantity and quality. So strength and muscle size two to lifting heavy. You can also. And so that's a beautiful offer for a rehab scenario. So if you just had surgery, you know, most patients can't lift heavy. Most of our guidelines say you should be lifting heavy if you're going to be able to increase muscle size and muscle strength. So this allows us to kind of hack that and work around it. So we also can do this from an endurance standpoint. And so what that [00:11:00.00] means is we do very low load, such as walking or cycling, and we'll use the same tourniquets on the on the limbs to reduce flow there. And that's where we can see adaptive changes not only in the muscle tissue, but also even in things like Co2.

 

Jase Kraft: [00:11:15.95] Ok. OK, so what, like application? Would you suggest for like BFR, what, have you seen it? Is it just in recovering [00:11:30.00] from surgeries and major kind of injuries, or have you seen it been used in some sort of exercise regimen in healthy populations as well?

 

Johnny Owens: [00:11:46.03] Yeah, yeah. We've seen it on both sides. I think if you look at the evolution of BFR, you know, it was initially it was this kind of benchmark type stuff. A lot of physiological labs looking at it early on and trying to understand even what [00:12:00.00] we call fast, which muscle fibers just to make the term easy anaerobic versus aerobic metabolism know. One easy way to do that was just, OK, let's split up, turn it on and reduce the blood flow. So if it was done a lot in the labs and people were starting to see some really interesting kind of changes that were happening there and then next kind of moved into the clinical setting. And so I think that was the next transition and made the most sense. We in the DOD started to apply really that twenty ten to twenty twelve time frame as when we started [00:12:30.00] really tinker around with it, started doing quite a few trials, published some papers and trials all over the world going on in a clinical setting. And now we're seeing it's really getting a lot of question of how can we do this for performance or is this a way you recovery is kind of a catch all term, but maybe people could recover faster. And so that's probably the most unknown. But we're maybe in the most questions on that right now.

 

Jase Kraft: [00:12:54.43] For sure. For sure. So let's go, you know, taking the concept of [00:13:00.00] eliminating the blood flow into the specific body area that you're working and then limiting it going out. So you're kind of getting that the blood that's there is doing the work essentially. Like what type of physiology, surgical applications should that entail?

 

Johnny Owens: [00:13:25.83] Yeah, so there's a lot there, so you can look at it from, OK, what's [00:13:30.00] the muscle having to do? And also even like what's the what's this hypoxic event doing as well? And so if you want to go back to mitochondria, so mitochondria, you know, you think from an enduring side, you know, that the more mitochondria have, the better they're there continually to turn it over ATP. So you're able to maybe go longer and use that that energy source. So there's two things you look at. There's either you increase mitochondria and contents the density of [00:14:00.00] them or do you change the biogenesis of the mitochondria. So maybe you make it work a little bit better. And so the hard part is a lot of that isn't isn't measured directly. So you'll use these markers to measure mitochondrial kind of respiration or gene expression and say, well, it's up. So we think there's change in mitochondria, but sometimes it's hard to say, do we have more mitochondria there? But the mitochondria live within your muscles, your muscle cells. And [00:14:30.00] so, you know, one  just really landmark paper and you think of Nelson's group in Denmark is they did three weeks of BFR training and showed that the muscle stem cell, we call it a satellite cell, really increased a lot compared to work match control.

 

Johnny Owens: [00:14:44.65] So they use this 30 percent one rev max. They were just doing the leg extensions and and then they on muscle biopsies, they showed that there was more muscle cell content. And so if you say, well, there's maybe several hundred mitochondria on one muscle cell, if you're showing that [00:15:00.00] I can make these these muscle stem cells come out by this hypoxic event and then they become new muscle cells themselves, then you're increasing mitochondrial density as smart as far as we know. And so there's continued quite a few papers to just show that we see improvements in things like CO2 whenever you wear the tunicates and ride a bike at a low pace or just walk on a treadmill. And so some of those changes could be. Yeah, or maybe increased mitochondrial density. It could be that that [00:15:30.00] little bit of stress. So lots of times cells like some stress, it makes them perform better. The stress of reduced oxygen might also be improving the mitochondrial abiogenesis mitochondria uses oxygen to to do what it does. And so it's having to look for other substrates that maybe, you know, make that happen so it gets a little bit tougher. So that's a physiological response.

 

Johnny Owens: [00:15:53.88] There's other things that can also be I mean, I'm just kind of rolling with your recovery type kind [00:16:00.00] of flow here is, is that there's things that happen when you're in this hypoxic state. So won the Nobel Prize in twenty nineteen was for three physiologist who showed that if you reduce the oxygen level around cells, you can really manipulate gene expression. And so when you put the limb into hypoxia, that hypoxia releases the thing called hypoxia and do factor 1A. And what if one does is it basically [00:16:30.00] releases this whole kind of downstream effect that creates angiogenesis so you increase capillary beds within the muscle as well. And so the more your perfusing muscle with capillary beds, that's great. From a recovery perspective, it's really great from an athletic perspective. It's great from a clinical patient perspective as well. And even the stress of reducing the oxygen, reducing the blood flow into the artery and then letting all of that release and you get the shear stress that [00:17:00.00] also has this effect to help with the endothelium of the arteries or the inside lining the arteries and also creates this angiogenic effect. So just that alone, you know, just that hypoxic say we're increasing potential capillary beds and we're also maybe driving more mitochondria.

 

Jase Kraft: [00:17:17.58] So, yeah. So what it sounds like you're saying and correct me if I'm wrong, but really the the sweet spot are what's really happening with BFR as we're limiting [00:17:30.00] the oxygen flow, which then provides all of this different benefits because your muscle has to work with less oxygen. So improve the efficiency all around, not just mitochondria, but also in capillaries. And that kind of is that kind of what you're saying there?

 

Johnny Owens: [00:17:48.57] Yeah. Yeah. And it's a short acute bout typically of reduced oxygen. So short amount of stresses like this, again, it's called or misses the body responds to that. So [00:18:00.00] the resistance exercise itself, we know when you're doing is typically about a six minute hypoxic kind of event. So really actually pretty acute. But yeah, that drives all sorts of things. And one also thing to think about is you're exercising at low, low intensities or low loads, but that reduced oxygen forces your body to have to use the anaerobic pathway and use fast twitch fibers. So you're tapping into those fast rich fibers without actually having to to do an intense exercise or heavy [00:18:30.00] loads, and we tap into the fast rich fibers, there's a whole just kind of benefit you start to see from the anabolism that happens. Even things like muscle protein synthesis we've seen over and over in the lobby of our studies is driven up significantly higher, sir.

 

Jase Kraft: [00:18:46.01] So does this then, like you're talking about fast twitch fibers, is this only beneficial for speed and power athletes or is there an endurance component to [00:19:00.00] this as well? Knowing that, I'm assuming you want to put on some BFR cups on your legs and go on for a 10 mile run? I'm assuming maybe that's been done. I don't know.

 

Speaker3: [00:19:14.00] No,no if it is. You shouldn't do it ever again. Yeah, you might only do it once. Yeah, well, what's interesting is that when you look at some of these biopsy studies, you get both fiber types. There are works of slow and fast work. So it's kind of force your body to make sure and your body [00:19:30.00] uses both anyways. But we get to really kind of maximize both of them. I think from an endurance standpoint, the endurance protocols might be the best way to go. And so that would be, you know, either going at a low load or a low, steady state, like something on a bike, you know, doing something 30 percent VO2 max type thing with the cuffs on. Or if you want to, you know, do like some sprint interval work, it's been shown that that's been beneficial too where you do spray minimal work. And then on your rest period, [00:20:00.00] you put the cuffs on and you cause this kind of trapping of all those muscle metabolites. And so that's that's another way if you kind of want to work high intensity and also get this extra benefits. So, yeah, you know, elite rowers, there was a study where, you know, they did BFR or the control group did the exercises without BFR, VO2 max change. They move the needle pretty. I think it was like seven seven to nine percent or something of the attacks in elite individuals, because that's the thing that we're kind [00:20:30.00] of really interested in that with this, because the more well-trained you are, the harder it is to make adaptation

 

Jase Kraft: [00:20:37.14] And seven to nine percent an elite population, it's way different than seven to nine percent to Joe Schmoe.

 

Johnny Owens: [00:20:45.86] You can take Joe Schmo any day and just put them on a protocol and train them up. And you can see some changes. But yeah, these other folks and you try and add more of with them. And it's still a fairly busy today. And then when you add more volume, that's when you start to get into this kind of injury [00:21:00.00] spectrum potentially. So this looks like it could be an interesting extra stimulus that you maybe your body isn't used to to to make this adaptive changes, even when you're reducing the venous return or blocking venous return, that that cardiovascular does things to individuals because the cardiac output equation is cardiac output is heart rate time, stroke volume. And so when you block the fluid going back to your heart, that [00:21:30.00] reduces the stroke volume side. So you're even though you might just be walking on a treadmill, your heart rate is up significantly higher because the cardiac output equation always wants to maintain itself. So you can take individuals work at really low intensities and it's forcing their body to actually feel like they're working out much, much harder from an endurance profile.

 

Jase Kraft: [00:21:51.80] So you mentioned that six minute round as far as the length of exercise on the on the [00:22:00.00] cuff, is that like maybe just what I'm trying to get at is walk us through kind of what a VFO workout may look like compared to a free flow. Is that what you call the.

 

Johnny Owens: [00:22:13.28] Yeah, you just say regular workout. 

 

Jase Kraft: [00:22:15.02] Regular workout, yeah. 

 

Johnny Owens: [00:22:16.21] Yeah. But well, and we put a position stand or we have to change the title on a paper with a bunch of our researchers from around the world and from its frontiers in physiology. It's open access, anyone can get it. And [00:22:30.00] so we kind of put these parameters out that we see that are used the most and seem to work. So most people, when they're doing a resistance exercise, they want to try and get to around 20 to 30 percent of a one rep. Max, if you can figure out what that is, let's say you're on a leg press or something. So you you would work in that twenty to thirty percent, one hour zone and then the most published and just seems to work kind of sets and reps scheme as a set of thirty, followed by three sets of fifteen with thirty second rest periods in between. [00:23:00.00] And so if you're doing that one to up one, you're down on the press for four thirty, thirty second fifteen, 30. Second guess that that equals around six to six and a half minutes total in time for that exercise.

 

Johnny Owens: [00:23:13.82] Then you deflate it, get a little bit of a rest period and then if you want to do another targeted muscle group, you inflate and go again. If that's the resistance side. And again, we're basing the. A reduction in blood flow off the artery, so we typically do that between 60 to 80 percent of [00:23:30.00] reduced arterial flow. The endurance side can either be done, steady state. And so those have gone anywhere from 15 to 45 minutes of just spinning on a bike or walking on a treadmill and trying to get these these kind of VO2 changes. Or it can be done in a normal fashion where you're just putting the cuffs on and doing low load intervals. Or it can be done in a restricted fashion where you go to a more high intensity than you put the cuffs on in the restrooms and kind of all over the place. We've [00:24:00.00] seen VO2 from Division one probably college basketball players to liner rescuers to healthy individuals has been increased whenever you do BFR in these aerobic capacity to get a little lower,

 

Jase Kraft: [00:24:12.36] OK, yeah, it gives us a good kind of overview of strength and power versus endurance there. I'm curious to know, and I don't know if this has been studied. I didn't see many articles on it. But you might be able to tell just from your history [00:24:30.00] of working with tons of athletes and rehabilitation patients, do you notice, like if somebody does a regular workout and then versus a Biffa workout, is the recovery time relatively the same or is one quicker than the other?

 

Johnny Owens: [00:24:52.20] Yeah, so if you're saying a regular workout, so let's just talk strength again, if I want to go in, kind of follow these axman guidelines for [00:25:00.00] lifting. And so I'm going to go, whatever you say, 70 percent, one hour around like squats or something that causes muscle damage. And so that's that's what happens. And it's not a bad thing, but there is muscle damage that occurs. And so that's the soreness you're going to feel to three, maybe four or five days later as your body's trying to repair the damage that that load put across the muscle fiber BFR is low load. And so because the load is so low, you're not put in the mechanical [00:25:30.00] stress across the skeletal muscle tissue. And so we don't get the muscle damage typically. Now, there there are some some oddballs out there and there are some cases where it does, but typically you don't. So you're going to feel really maxed out when you're done doing BFR because it's kind of just like takes everything out of the muscle and you're going to feel fatigue usually for an hour or two. But then later that day you'll feel just fine. You can go. We do it twice a day. So [00:26:00.00] that's that's a really interesting kind of way to look at it, because the recovery is really quick. And so if I'm an NBA player and I'm traveling a ton and I've got three or four games in a week, this is something that you can work in to try to kind of do the same stimulus, potentially those lifting heavy without the downsides of a reduced power. Whenever I'm going to play,

 

Speaker4: [00:26:19.50] If you stick around and listen to enough of our episodes here on The Science of Sports Recovery podcast, you'll notice a common theme of importance of mobility in recovery [00:26:30.00] and injury prevention. That's why I recommend checking out the The Ready States Virtual Mobility Coach to help you improve your mobility, recover ability and injury prevention. The Red State is a brainchild of coach and athlete Dr. Kelly Starrett, who you can learn more about on Episode 13. His Virtual Mobility Coach program helps athletes understand the importance of recovery, pain relief and self care. In other words, it helps fix the recovery side [00:27:00.00] of training so you can keep seeing results from your workouts. His program will guide you through the same mobilizations use on athletes in the NFL, NHL and MLB provide custom tools for pain relief to give you customized pre and post exercise mobilizations based on your training and sports schedule and deliver daily mobilizations to keep you on track to achieve your goals. You put your heart and soul into your workouts. Make sure you get the [00:27:30.00] most of them by going to the red state dot com Jase again, that's the red state dot com slash jase The link will also be in the show notes. Now back to the show.

 

Jase Kraft: [00:27:44.64] So you had mentioned, like you do with your patients or clients twice a day. I'm curious to know and like that the studies that show low load with BFR versus haloed regular kind of workouts [00:28:00.00] and the the strength gains were relatively the same. Do you know if those like the workout sessions or the same amount of workout sessions or do you need to do more sessions with BFR versus just a regular load?

 

Johnny Owens: [00:28:19.92] Yeah. So if you're loading with BFR, you know, in this twenty to thirty percent range, no, we don't think you need extra sessions, you know, so you can kind [00:28:30.00] of follow this two to three times a week type of schedule. And, and so we used to always feel. That, well, lifting heavy is always going to be better than BFR, just it seems like you're going to get more strength adaptations. There was a systematic review. That analysis came out and said, yeah, lifting heavy get you stronger than doing BFR for the hypertrophy BFR is oftentimes similar to often heavy, but it's probably a better system. [00:29:00.00] I hypertrophy with that analysis from a really well known lab in Europe just came out this year and they kind of took the best of the best papers that were well done and also controlled for what we call double dipping. When you look at these analysis and showed that there was no difference in strength gains when they looked at that far compared to the to the folks who lifted heavy. So that's that's new. And that's very interesting. Kind of exciting to me.

 

Jase Kraft: [00:29:24.04] Yeah. And then just curious, like if in those studies they had the same amount of sessions. But if you're able [00:29:30.00] to do by far more often, theoretically, I mean, you should be able to make gains faster. I would think,

 

Johnny Owens: [00:29:39.10] Yeah, that's that's an interesting thing. But sometimes more volume isn't always good. You know, it's like I can cook my pizza in the oven at three fifty. If I put it at eight hundred, that's not necessarily better. The body the body needs a kind of adaptation time to go through muscle protein synthesis to make the changes that it needs. So [00:30:00.00] all that extra volume might I don't know what we've seen. Probably you don't need it. It it matters to us in rehab because some of the studies have really shown that if you really don't lift any load at all would be BFR. So that's what we would call passive BFR or you might see a cold cell swelling. You probably need to do that more frequently because they're just not as much of a stimulus for an adaptive response. So early postop, if you know these pro and college teams or the DOD where we can see the patients as much as we want, we [00:30:30.00] we really like to get them in almost daily because we're not increasing strength and size. And those cases were just slowing the muscle loss train.

 

Jase Kraft: [00:30:40.16] Sure, sure. Have you seen or used BFR in like a taper type of phase for athletes where, hey, I don't want to lose strength, but I also don't want to be sore for this high up important race or competition? And [00:31:00.00] if so, is it just as simple as taking the workout that they would have done reducing, you know, by 80 percent and then putting in some blood flow cuffs on, or is there more of an art to it?

 

Johnny Owens: [00:31:18.40] Yeah, I know we've seen it for sure with a lot of the teams we work with and maybe some of your veteran athletes that want to be you know, they got they got a bum tire in their knee and they just want to be at 100 percent [00:31:30.00] when the game or season starts. So. Yeah. And so you would taper and choose if you're like, I want to maintain my strength of hypertrophy games and maybe you are doing more of the BFR resistance exercises as you taper down. Or if you're an endurance athlete and you've got a big event coming, then yeah. Then you would want to maybe just to beat off our cycling in a little load to maintain your CO2. And these endurance gains are really fascinating study. Denny Christensen did it. And [00:32:00.00] what he looked at was if you did BFR and low loads on a bike or the same exercise without BFR on bikes and individuals three times a week for six weeks, what does that do for basically how much glucose you would put in your thighs? And so they showed that during that six week intervention, the BFR actually kind of perfuse their thighs with more glucose. And then they did a basically exercise test to exhaustion [00:32:30.00] in both groups and compare that to their baseline. And the BFR group performed better. So it could also be, OK, I'm going to taper. And this is also I'm not getting muscle damage. I'm working on this angiogenic response, maybe mitochondrial density, and I'm forcing more glucose into my thighs. So when you're ready for that event, you're just rocking and ready to go,

 

Jase Kraft: [00:32:53.26] Yeah that's really interesting.

 

Johnny Owens: [00:32:56.20] I it's a crazy study. I mean, biopsies and and measuring blood [00:33:00.00] flow coming out of the femoral artery. And that was a that was a big time study, but it's very interesting.

 

Jase Kraft: [00:33:05.68] Yeah. I'm curious to know as we kind of get close to the end of our conversation, what's like the most exciting like to you personally? Why is by BFR like exciting to spend all this time on?

 

Johnny Owens: [00:33:27.80] I've been a physical therapist for over 20 [00:33:30.00] years. It's one of the first things that just blew my mind when we started applying it in the DOD of just the changes we were seeing in individuals. If you're a therapist and you get someone to post surgery or post injury, it sucks because you're just watching the muscle waste away and you can't do anything because you can't load them. And so to be able to to get this on early and just see sometimes the muscle not go at all or sometimes even see it improve, that that was just crazy because we were using [00:34:00.00] it on a limb salvage and amputees. So I was with head combat casualty care down here at our base. And so we were seeing it on the worst of the worst injuries. Now, I think I'm really kind of getting the most excited for the older comorbid things like diabetes and Parkinson's and things like that. You know, if you think about you can just drive more glucose into the muscle just by doing BFR and some exercise. From a diabetic standpoint, that's huge because all they have is too much [00:34:30.00] glucose or sugar just running through their system. So we have a trial we're helping with in Germany where we're looking to see can this help diabetics so that the older those older patients, they really tolerate it well, and they show really some fantastic gains.

 

Jase Kraft: [00:34:47.63] So and then from a sporting side, where do you think needs to be more research done to what's the next step as far as research [00:35:00.00] and BFR, what should we explore?

 

Johnny Owens: [00:35:04.10] Yeah, so I think multiple things for one is all these kind of things that we're seeing physiologically, do they translate over into improved performance? So that's kind of a missing piece on a lot of this where we're getting these measures and saying, yeah, they're getting their strength back faster or we're increasing muscle protein synthesis rates. Now, are we going to see does that do things like keep the velocity on MLB [00:35:30.00] pitcher's fastball? Does that translate into soccer players ability to to move faster? And so we're  moving in that direction. We do have an MLB funded study where we're looking at things like pitchers and velocities with it. I just submitted a giant grant to see how we can apply it for hamstring injuries in the NFL. Hopefully it gets funded. We'll see. And so there's a lot in a performance space that we really are getting to figure out.

 

Jase Kraft: [00:35:57.20] Cool, cool. And then I do want to clarify this just [00:36:00.00] for anybody listening. If you if you're thinking like, hey, I want to try BFR, is this something that you can just go on Amazon, buy something and then to try it out at home or whatever kind of risk if you go with this.

 

Johnny Owens: [00:36:20.00] Yes, yeah. Well, there's always a risk, and especially when you start to reduce blood flow and exercise with it. And so we're we're starting to get a lot more comfortable as [00:36:30.00] we do this. We're right. We're using on some very integrative disease populations now what we use in the clinical side and what we use with all the teams and stuff. It's a really pricey unit, this medical device. It's got a Doppler. It's got all these kind of bells and whistles, FDA listing and all of that. The buyer beware with everything that's on the market right now. You know, when we were first looking at this, there was no BFR cuffs or anything in the United States. Now you go to Amazon [00:37:00.00] or Alibaba and there's fricking nine hundred different ones. And some of them are dangerous. The more narrow the cuff is, the more potential that you can have nerve damage. So the really the number one injury that you see from use is is damage to the nerves. And so you don't want to strap something really tight and really narrow and actually, you know, is you can't feel your your fingers anymore because you did myelinated of nerve. So everybody's had a blood pressure cuff put on them. Blood pressure cuffs are FDA listed devices. [00:37:30.00] So if it was me and I'm like, hey, I just want to sample around with something, a blood pressure cuff is an easy thing to do. It won't meet the levels of what we use. The blood pressure cuffs are made to drift to all the pump up. The kind of BFR things you see. Eventually they start to just drift. They lose their pressure. But that's at least a kind of safe way to double your toes in it.

 

Jase Kraft: [00:37:50.75] To try and see how. Yeah, kind of feel and then seek out a professional to help you really, like, fine tuned, not only [00:38:00.00] the delivery of the workout, but also like what you said to work out at.

 

Johnny Owens: [00:38:06.20] Yeah, yeah. Now either.

 

Jase Kraft: [00:38:08.27] Cool, cool. All right. Well if if if anybody is listening and they're like, hey, I need to follow Johnny wherever he's at, I need to get into his business, what he's up to, where should people go and follow along with you?

 

Johnny Owens: [00:38:24.77] Probably the easiest one is we have a website. So injury recovery scientists, dotcom and [00:38:30.00] so we have podcasts on there. We just did a one with Dr. Birx that's going to be coming out here soon where we talk a whole lot about performance enhancement with this. We also have blogs on there. And if you're a clinician, we do teach our courses for clinicians that are looking to do this in the medical space. Yeah, and then I'm on social media. I'm not the biggest social media guy, so I'm probably a pretty boring fellow. But I think my Twitter @johnnyowens so I'm on there. Sometimes [00:39:00.00] I get stuff. Yeah. Usually I just try to be funny and no one really thinks it's funny.

 

Jase Kraft: [00:39:05.35] It's I have to tell and the digital landscape what's funny and because they laugh at things and then just scroll by you know, it could be.

 

Johnny Owens: [00:39:15.94] I had something, I had like 20 something like I told my wife I'm tredning. Oh my God I'm trending

 

Jase Kraft: [00:39:23.33] Cool, cool. And then the name of your podcast. And just so anybody [00:39:30.00] listening if listening to this podcast or probably it into podcast. So,

 

Johnny Owens: [00:39:34.09] Yeah, let's give it a shout out.

 

Johnny Owens: [00:39:35.11] Really creative its own recovery science podcast. Same thing as our business. Yeah. We we if you really are into BFR, that's all we do. And we talk with a bunch of my friends and colleagues from around the world who are doing research in this space. And we also have we've had the NFL guys on MLB, MLS, so we have some of the teams and they talk about the ways they're doing it can be a as well. So if you're looking at it from a team [00:40:00.00] perspective, it's kind of cool to listen how they're using it.

 

Jase Kraft: [00:40:04.93] So if you want to go down the VFR rabbit hole, then check out his podcast. Johnny, it was great to have you on the show. Thanks so much for being on.

 

Johnny Owens: [00:40:15.16] Thanks for having Jase. Stay safe.

 

Jase Kraft: [00:40:17.80] All right. Episodes over. If you found value in this episode, please consider giving us a review on iTunes. And if you haven't already yet subscribe, do so now. Say don't miss any important topics [00:40:30.00] in the coming week. If you have any questions or suggestions for the show, please send them my way. I am most responsive on Instagram. That's at Jase. Cheese Jay E. Cheese like the food or email me directly at Jase Jayce at Science of Sports Recovery that Tom tocsin.

 

Johnny Owens

Physical Therapist

Johnny Owens has been applying Personalized Blood Flow Restriction (PBFR) Rehabilitation Training clinically since 2012 and credits the modality with significant strength recovery in patients.

He has taken part in numerous research projects involving regenerative medicine, sports medicine, and rehabilitation of the combat casualty.

Owens has been published extensively in the peer-reviewed literature and his work has been featured on 60 Minutes, Time magazine, NPR, Discovery Channel and ESPN.