Will, thank you so much for chatting with us. Could you start off by telling us about your background?

I worked in the NHS as a rotational physiotherapist after I finished my undergraduate degree.

I then got a job in elite sport with Hull City Football Club where I’ve been for the last 3 years as their first team physio, working as part of a multidisciplinary unit.

In what cases have you used BFR training before?

I have used it personally, although just in the short term to get used to the equipment.

The biggest capacity in which it’s used at the club is with injured athletes for rehabilitation. We’re pretty limited though as we’ve only got one BFR machine, so to try and roll it out to a whole squad would be very difficult.

What would you say the outcomes of using BFR normally are?

We had a player recently with a fracture in his foot, and he’d  been  immobilised in a boot for 6 weeks.

We used BFR  every other day, and when he came out of the boot,  his calf muscle mass was similar to the uninjured side even though he hadn’t been able to train his calf.

How much muscle reduction is usually expected?

When it comes to muscle girth and circumference, it’s extremely variable from person to person, but you can expect some quite significant reductions with disuse.

“BFR training is perfect in our current situation (COVID-19).”

Have you ever heard of any other way to use BFR?

I have read some literature that does suggest that BFR could improve recovery for performance. Obviously we try to use what’s the best bang for the buck really, and for that reason, it’s not for us right now but if we did have the facilities to use BFR with a lot more players,  then we probably would factor it into our training program.

I think BFR could be great for recreational use.  I think it’s perfect in our current situation (Covid-19 pandemic) because people haven’t got gyms at home or access to weights which makes BFR ideal.

In your experience using BFR, do you find it difficult or uncomfortable? How do you explain this to an athlete?

It’s definitely difficult and it should be difficult to create that adaptation. But it’s very much achievable, as well as modifiable because you can work very effectively between a range of 50-80% as suggested by research. So if the athlete is struggling, you can reduce the pressure and sometimes you’ll get better buy-in because it’s that little bit easier.

When talking about 50-80% occlusion, is the pressure required? Or will a tourniquet work?

In healthy populations, so long as you’re getting some occlusion between that 50-80% range, there is plenty of research to suggest that using a subjective measure of around 7/10 tightness is safe and effective for use.

I think you’ll probably get the majority of people working within that bracket of 50-80% occlusion using a subjective measure of 7/10. There will rarely be someone who misses out, but with the caveat that you must be careful not to apply it too tight and occlude the artery. In clinical populations though, such as athletes undergoing rehab, we use specific limb occlusion pressures so that we can continually monitor pressure and progress a protocol. So in terms of clinical application, if you can find a way to monitor pressure with your BFR sportswear you should explore it because it would make a fantastic medical product.