What’s The Deal With Proximal Hypertrophy? 


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What’s The Deal With Proximal Hypertrophy? 
Nicholas M. Licameli, PT,DPT


Before we go any further, let’s quickly define two terms:

Proximal: near the trunk of the body

Distal: away from the trunk of the body

Example: The glutes are proximal to the quads and the quads are distal to the glutes.

Great!  Let’s get rolling!

As we know, blood flow restriction (BFR) training involves the use of a cuff applied to the proximal most part of the arm or leg with the goal of inducing a training effect in the muscles distal to the cuff (i.e. wrap near the shoulder and impact the biceps).  BFR training is most commonly used with an applied pressure that is personalized to the individual such that they are never exercising above full occlusive pressures.  

While BFR training can produce significant gains in muscle strength and hypertrophy in the muscles distal to the cuff using less load than traditional training (20-50% 1RM), there is also the observation that unoccluded proximal muscles (i.e. the glutes, pecs, and shoulders) undergo hypertrophy from BFR training, as well. This is known as proximal hypertrophy. 

While we may be unclear as to the exact mechanism of this phenomenon, some have suggested it may be due to hormonal effects from the intensity of training, which is likely false.  There may be a simpler explanation – simply fatiguing the muscles distal to the cuff produces a significant increase in proximal muscle fiber recruitment that, over time, leads to muscle growth.  Short, simple, and a logical interpretation of the current evidence. 

Important to note!  Proximal hypertrophy should be considered a BONUS to BFR training, not something we should directly try to elicit. If we want proximal hypertrophy – train the muscles DIRECTLY and HEAVILY! That is – unless there’s an injury or a contraindication to heavy loads, of course.  As is the theme with BFR training, if you can lift heavy, LIFT HEAV

Adopted from: https://www.instagram.com/p/CIEARSlDCJ4/

****Remember, the use of BFR training should not be based solely on a success story.  The decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.

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