A One-Two Punch for BFR and Tendinopathy: Part 1


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A One-Two Punch for BFR and Tendinopathy: Part 1
Nicholas M. Licameli, PT,DPT



I know, I know…tendons respond to heavy load training (HL), so low load BFR (LL-BFR) training wouldn’t be effective in the treatment of tendinopathies.  While seems reasonable to suggest, we have two studies from Centner and colleagues from 2019 and 2021 that say different!  Do these studies prove that low load BFR training is a cure for tendinopathies?   No.  Do they allow us to think more deeply about our thinking around tendinopathies?  You bet.


In 2019, Centner and colleagues performed a study that examined the effects of 14 weeks of LL-BFR and HL training on Achilles tendon adaptations in healthy male adults.  Subjects performed sitting and standing calf raises using either HL or LL-BFR.  The HL group trained at 70-85% 1RM with a 3x 6-12 set/rep scheme.  The LL-BFR group applies 50% LOP and used 20-35% 1RM in a 30, 15, 15, 15 set/rep scheme.  The load was progressed every 4 weeks for both groups after 1RM testing.  The HL group started with 70% 1RM and ended the study with 85% 1RM and the LL-BFR group started the study with 20% 1RM and ended the study with 35% 1RM.


The results showed increases in Achilles tendon CSA in the HL group (+4.6%), which is consistent with the current body of evidence, as well as the LL-BFR group (+7.8%) with training loads well below those that have been used previously in the tendon research.


The results also showed that Achilles tendon stiffness was substantially improved after HL (+40.7%) and LL-BFR (+36.1%) training, with no changes in the CON group (+3.6%).  The authors suggest that “strain and stress are not the only factors influencing mechanical tendon adaptations and that the number of loading cycles and/or concurrent tissue hypoxia might mediate this response.”


Both the HL and LL-BFR groups experienced similar gains in hypertrophy (HL: ~8%; LL-BFR: ~9%), which is to be expected from what we know about LL-BFR and muscular adaptation.  The HL group demonstrated greater increases in strength (~14%) than the LL-BFR group (~10%), which is a bit more of a discrepancy than expected.  The authors postulate the discrepancy could be due the fact that HL training mimics 1RM testing more so than LL-BFR.


The authors concluded that, “The overall findings revealed that, despite a much smaller training load, LL-BFR caused adaptions in Achilles tendon CSA and mechanical properties as well as in muscle mass and strength comparable to HL.”


…To be continued in Part 2!



Centner C, Lauber B, Seynnes OR, et al. Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training. J Appl Physiol (1985). 2019;127(6):1660–7





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