At Complete Physio we are always looking at new trends to remain up to date with the latest research and techniques to ensure that we are providing our clients with the most effective treatments. Occlusion training is a relatively new exercise technique that has recently gained significant attention in the research literature.

The American College of Sports Medicine (ACSM) recommends lifting a resistance of at least 65% of a 1 repetition maximum (1RM) for 6–12 repetitions to achieve muscle hypertrophy (muscle fibre growth) under normal conditions. This load and the associated joint compression may not be possible in certain injuries, following an operation or in certain populations such as the elderly.

Figure 1. The client using occlusion therapy on the leg extension machine following an arthroscopy for early onset OA

Occlusion training can provide a unique beneficial mode of exercise in the clinical setting because it produces positive training adaptations, at 10–30% of maximal work capacity. Occlusion training was originally developed in Japan where it is better known as KAATSU training. Occlusion training is the act of using a blood pressure cuff or similar light tourniquet to restrict blood flow to an exercising muscle (see figure 1).

In clinic we have utilised occlusion training for clients following knee arthroscopy, ACL reconstruction and post Achilles repairs. Helping to build muscle without putting excessive strain on the joints, soft tissues and/or the surgical repair. We have also used it to back fill capacity in season with athletes as it results in a positive training adaptation, whilst causing little or no delayed onset muscle soreness (DOMS).

More recently we have used it with excellent results for a 38 year old client with early onset knee osteoarthritis (OA). The technique allowed the client to build the quadriceps muscle with no pain whilst avoiding excessive joint compression. Using it everyday for 14 days resulted in a significant increase in muscle strength.

How does it work?

Under normal conditions slow twitch muscle fibres are recruited first and as intensity increases fast twitch fibers are recruited. Occlusion training causes a restriction in blood flow so the fast twitch fibres are recruited at a lower intensity. Fast twitch fibres have a higher capacity for hypertrophy. It has also been shown to cause a metabolic build up producing a positive physiological reaction, specifically a significant increase in growth hormone.

How do we use it in practice?

For the calf muscle we have used heel raises on the leg press and for the quadriceps we favour leg extension or the leg press machine but have also used single leg squats if the client has limited gym access.

We have generally used two different protocols over the past few years. Recently, we have been using 4 sets of repetitions to failure with 30 seconds rest in between each set, with the occlusion cuff inflated throughout. We select a weight that allows the client to reach approximately 40 reps on the first set. We encourage a 2-3 second concentric and eccentric phase. This number of reps will reduce on each set. The client carries this out everyday for 7-14 days. We have also used this protocol every other day. It is worth noting this is not a comfortable technique and causes considerable burning and ache in the muscle. It has been shown that pressures as low as 50 mm Hg have showed a positive effect. In practice we use a pressure of 120-150 mm Hg.

Occlusion training is considered to be safe. However, there are some contraindications and precautions with this type of training. It is important to build up the pressure and the intensity slowly and gradually.  If you would like more information on Occlusion Training or would like to discuss if occlusion training is suitable for you, please email chris@complete-physio.co.uk