Nicholas Rolnick, The Human Performance Mechanic

Our (@mscerquiera) Letter to the Editor on a recent BFR training study (Bordessa et al. 2021) that aimed to assess comparative effectiveness has been published online ahead of print. This letter was necessary because as BFR training continues to grow, it's important that the researchers themselves design studies that actually help make clinical decision-making easier when deciding between different manufactured devices. In short - researchers need to be familiar with cuff des...igns before attempting to make comparisons between different devices. Further, use of muscle activation is a poor indicator of acute stress when fatiguing exercise is used. Better designed studies can help clinicians/coaches/fitness professionals understand how the BFR stress influences acute- and long-term outcomes. However, this study just wasn't a design that helps us understand all too much about "comparative effectiveness." Thoughts on the paper? Our response? Post below!!

Everything fits just a bit tighter than it used to....

UNDERSTANDING COMPARATIVE EFFECTIVENESS A recent article was published attempting to draw comparative effectiveness between a Delfi device, Bstrong device and heavy load training. It is awesome to see new research like this published as BFR training continues to grow and more people begin to use it in their practice. However, the design of this study was not set up to really conclude much of anything (unfortunately). This is likely because of the over-reliance on surface EMG ...to determine hypertrophic potential and a misunderstanding of the different types of BFR devices out on the market. This letter to the editor describes some of the shortcomings of the design while offering suggestions to improve these study designs in the future. Thanks to @msccerqueira for the collaboration on this letter. We hope that this is the beginning of an amazing sub-topic in the BFR literature and thank the authors of Bordessa et al. for their preliminary dive into this area. Hope this letter drives some discussion and furthers better research designs so we can understand BFR even more!

JUMPING IS NOT (LIKELY) BUILDING MUSCLE Jumping aka plyometrics can 100% improve athleticism. Want to jump higher? Jump more! Want to jump faster? Jump more! Want to burn more calories and get a great workout? Jump more! But build muscle? Not so fast! This is a quite simple concept but often lost on a lot of people. Due to the high movement speed and the intent of the movement, alot of muscle fibers are recruited but due to the force velocity relationship (second image), thes...e muscle fibers are not undergoing enough mechanical tension to increase hypertrophy (especially with respect to traditional resistance training!). There was a recent systematic review ("Effects of plyometric vs. resistance training on skeletal muscle hypertrophy: A review") that concluded in untrained and recreationally trained individuals, muscle hypertrophy was similar (which is a SHOCKING finding) between lifting and plyometrics, but I would strongly argue that these findings would not be close to traditional training in more experienced lifters. With that being said, many of the included studies added weight to the participants while few included bodyweight jumping exercise alone... Last but not least - plyometrics can increase injury risk! Risk vs. reward!! Regardless - plyometrics are a great tool when used appropriately in a context that makes sense. But don't anticipate equivalent muscle growth and if you're LOOKING to build muscle, my advice would be to avoid plyometrics and focus on resistance training. What are your thoughts here!?

CHANGE MY MIND With all that is going on in rehab and fitness, nothing is as hot right now as BFR. Not only that, but the evidence continues to support its use in MULTIPLE different types of client/patient populations. Unlike modalities like IASTM, BFR is not going anywhere. There are hundreds of studies supporting its role in the rehab and fitness setting to accelerate PERFORMANCE & RECOVERY! This includes low-load strengthening options as well as recovery from strenuous exe...rcise using passive BFR protocols. With that being said.... Today is the last day you can get this course for $199.99 by using the code SAVE150 at checkout on our link in bio. As of 3/7 (tonight at 11:59pm EST), the course will increase to $349. We're doing this because of the amount of times we've read in our course feedback that the value this course provides (along with all the bonus materials included free of cost) is second to none. So we've listened and are raising the price $50 as of TOMORROW! As of 6pm EST, we've had 15 people take advantage of this deal. BFR - Not IF - But WHEN! Don't be left behind. Learn how to grow your practice and help change lives.

Yeah, someone missed something here. With the right education, safety and outcomes with BFR Training can be maximized. BFR 101- apply the cuff to the proximal most portion of the limb! This- along with so much more is covered in our an online on-demand course that goes over how to integrate BFR safely and effectively into your training so you don't end up doing silly things like this! Check it out by clicking on the link in the bio! Today is the last day you can get this cou...rse for $199.99 by using the code SAVE150 at checkout on our link in bio. As of 3/8 (tonight at 11:59pm EST), the course will increase to $349. BFR - Not IF - But WHEN! Don't be left behind. Learn how to grow your practice and help change lives.

Chill (and take the rest day).

You’re bending your back too much. You’re going to get hurt!!

Minimal to no weights? No problem. These exercises will roast your quads and glutes and get you the gains you desire. I absolutely love the bulgarian splitsquat for rehab and fitness purposes because you can't hide from this exercise. Not to mention, the numerous avenues you can take to progress it to much more harder (and effective) variants. Volume 1 are the staples. Volume 2....well, post below if you want to see more of the variations I use with this exercise! Included ar...e one isometric variation, the full range exercise, and three ways to integrate kettlebells - one for loading, one for hip mobility and one for shoulder stability! I use these exercises with almost all my clients. Post below if you have other variations you love with this exercise. PS: In celebration of 30,000 followers, I'm discounting my online on-demand #bfrtraining course by $140 to bring the price down to $159.99. This willend TONIGHT at 11:59pm EST! Use code BERNIE140 at www.bfrtraining.com or click the link in bio. Hope to see you in our private community and thanks for following me! #squats #lowbackpain #lowbackexercise #corestability #legdayexercise #exercise #strengthening #bodybuilding #lunges #splitsquat #bloodflowrestriction #strengthtraining #hypertrophy #physicianassistant #physio #fisio #physicaltherapy #rehabilitation #kneepain #backpain #nycfitness #crossfit #glutegains # #gluteusmaximus #fisioterapie #exercisetips #exercisetip #physician

FLASH SALE Learn how to optimize your outcomes and get people better, quicker with BFR training. As a THANK YOU to all my followers OLD and NEW, we're having a FLASH sale of $140 off my online on-demand (finish at your own pace!) BFR training course. Until tomorrow night at 11:59pm EST (1/23/2021), our $299.99 course will be $159.99 with the code BERNIE140. This 4 1/2 hour CEU approved course has been created with a specific goal in mind - to allow fitness and rehab professio...nals (and anyone looking to learn about BFR) an easy to navigate, super engaging and informative learning experience. Not to mention, in the BONUS materials include everything you will need to start your BFR training journey, including discounts from all of the major players in the BFR training space....at this flash sale price, the discounts alone pay for the course! Check it out and don't forget - BERNIE140. May God bless Bernie to keep us all entertained with new memes in this coming year! Www.bfrtraining.com #meme #memes #memesdaily #memestagram #squatting #physio #physio #physiotherapist #physiology #PHYSIOTHERAPIE #physioterapy #physiolife #physiostudent #physiotherapystudent #physiogram #bfrtraining #bloodflowrestriction #bfr #occlusiontraining #chiropractor #fisioterapie #physiohumor #physicaltherapy #Physiotherapeut #newyorkcity #midtowneast #nycfitness #strengthcoach #sportschiro #rehabilitation

SORE, NOT DISABLED Sometimes, even with the best of intentions, clients get sore from their exercise session. I do my best to inform them of the potential soreness following any new exercises or increases in volume, but sometimes you just can't win em all. The ultimate buzzkill is that last minute cancellation because they haven't recovered from the last session. BUT - did you know, muscle soreness (aka DOMS) is not indicative of muscle damage? It is most closely correlated with repair and regeneration so there's no need to NOT train!! Modify!...and inform of the repeated bout effect! What have you done in situations like this?

IT'S NOT MAGIC. IT'S A PLAN AT WORK The secret to success is hard work and consistency in implementing a plan. I can't tell you how many times I've heard that what I do is "magic" (MDT, graded exercises, BFR) but in truth, it's having an underlying systematic framework to approach everyone that walks through the door. Just having that isn't enough though, because the client/patient still needs to put in their part and enact the plan. What they do outside of our sessions isn't so much a bonus, but a necessity if they want to change their life and get back to the activities they love as quickly as possible. It's not magic, it's a plan at work.

EXERCISE IS MEDICINE Literally. Lift weights and work hard. Guaranteed results. Do your damn squats people.

SPECIAL TESTS AREN'T "SPECIAL" Special tests are those that clinicians use to help assist in the diagnostic process for injury. Some are pretty useful, like the Thompson Test (for Achilles Rupture) or Lachman's for ACL tears, but most are pretty near useless. In fact, use of most special tests alone don't tell us much. I have used many of the "shoulder rotator cuff tear" clusters as part of a test-intervene-retest model to show just how malleable these tests can be. If the po...sitivity of these tests can be modified with cervical movements for example, how good are these tests really! Ideally - in my opinion - these tests are useful for eliciting pain or exposing a dysfunction that could be helpful for a retest procedure. For example, using a subacromial impingement cluster (groups of multiple special tests) could help increase buy-in following an intervention to show some degree of cause and effect of the interventions. I would not hang your hat on the vast majority of these special tests and they seem to largely be a relic of a pathoanatomical diagnosis-based system of rehabilitation and not movement-impairment based. What are your thoughts on using "special tests" to diagnose pathology given the unclear relationship between pain & tissue pathology? Are some special tests more "special" than others and whywhy not?

Limb occlusion pressure (LOP) has been recommended as a standard approach to administering BFR training in clinical populations (Patterson, 2019). However, despite prior research showing LOP does not change much over the course of 4-8 weeks in healthy participants (Mattocks, 2019), other studies show LOP can change based on the time of day (Ingram, 2017), position (Hughes, 2018), cuff width (Loenneke, 2012) and even cuff bladder positioning (Spitz, 2020) on the limb. In clin...ical practice, patients may present to the clinic at different times of day. This may influence LOP assessment. Similarly, whether or not the LOP changes between limbs during these different visits has not been investigated before. This study investigated whether assessment of LOP was reliable between different times of day and between limbs using the Delfi personalized tourniquet device (cuff width, 12 cm). Forty-two males and females participated in this study. Each reported twice to the lab separated by 3-10 days and at different times of the day to get their LOP, BP values and thigh circumferences assessed. Results showed group values were not different between LOP taken at different times or between legs, but at the participant level, significant values were seen between legs and LOP and the 95% confidence interval was around 14 mm Hg. Interesting, this study did not support that SBP plays a role in LOP determination in the upper body, but pulse pressure and limb circumference does. The results of this study highlight the importance of looking at individualized data compared to group means which may paint a slightly different outlook on assessment of LOP. As clinicians, assessment of LOP takes 2 minutes maximum and the results of this study suggest that if you see clients/patients at different times of the day, LOP values may change. Whether or not this has significance on perceptual, cardiovascular and/or musculoskeletal outcomes - we’ll see (but likely not). Last, this study tried to create an algorithm for LOP, but was largely unsuccessful as the equation under- or over-predicted LOP by as much as 50 mm Hg. This highlights the fact that we should be measuring LOP!

AVOIDING COMPENSATIONS WITH SHOULDER EXTERNAL ROTATION This video goes over some of the more common compensations that occur when individuals perform shoulder external rotation, a VITAL movement that can keep you healthy and exercising. So don't be a dunce...check out the video and see how to avoid these mistakes. I think you'll notice a common trend here *COUGH* too heavy *COUGH*. WHAT other compensations do you see? I know I left out one or two ;).... KEY POINTS: Make sure to not do the compensations shown in the video if you want maximal benefit. HOW MANY: 12+ for multiple sets If you enjoyed this post, follow my page @thehpm for other exercise variations and write me a comment below! Or better yet, come see me in New York City!

Bet they can’t squat 315 either

HAIR LOSS & BFR TRAINING? No, but for real - looking for hair loss on the extremities (calves/feet & forearms/hands) can clue you into any underlying vascular compromise that may make an individual inappropriate for BFR training. Obviously, just a local loss of hair is not a red flag by itself, but if it is clustered with other signs and symptoms of peripheral vascular disease such as leg pain during activity that improves with rest, poorly healing wounds and/or poorly growin...g toenails. Hair needs blood to grow and if it doesn't get blood - well - the follicle will die and you have hair loss! Always try to cluster these symptoms together before excluding someone just on the basis of a localized loss of hair! Want to learn more about how to safely and effectively implement a systematic screening process to determine appropriate BFR training candidacy? We cover it from head to toe (okay - pun intended!) in our on-demand online BFR training course. Head to the link in bio or post below if you're interested and maybe we'll hook you up with a discount code ;) Anyone have any questions on this screening process?