Episode Summary

This episode’s guest is Dr. Ryan Zumwalt, a Strength and Conditioning Specialist, and Doctor of Physical Therapy based in Washington State.

In this episode, Dr. Scott Jablonka, Carolina Movement Doc, sits with Dr. Zumwalt and they discuss Blood Flow Restriction, a revolutionary treatment modality with applications that are immensely valuable to both the fitness and rehab industries.

More More Podcast with Dr. Scott Jablonka | What are Blood Flow Restriction treatments?

Top Takeaways

  • “I’ve never had anyone quit a plan of care with Blood Flow Restriction.”
    – [Dr. Ryan Zumwalt]
  • “BFR can be applied to anybody, and anybody anywhere.”
    – [Dr. Scott Jablonka]
  • “In general, in practice, I haven’t seen anyone have any negative effects from using BFR.”
    – [Dr. Ryan Zumwalt]
  • “Stronger people are harder to kill and generally more useful.”
    – [Dr. Scott Jablonka]

Episode Highlights

  • [00:43] Intro
  • [03:00] About Today’s guest, Dr. Ryan Zumwalt.
  • [06:04] What is Blood Flow Restriction?
  • [10:47] Applications of Blood Flow Restriction.
  • [15:12] Are there certain concepts to determine the number of BFR reps to use?
  • [16:41] What kind of feedback do you get from patients who are skeptical about the treatment?
  • [12:22] Drawbacks of Blood Flow Restriction.
  • [20:11] Connect with Dr. Zumwalt

Episode Notes

Dr. Ryan Zumwalt

Dr. Ryan Zumwalt

Dr. Ryan Zumwalt is currently practicing in Spokane Valley, Washington. His interest is in Sports Performance which led him to his interest in Blood Flow Restriction. He is currently a Strength and Conditioning Specialist, as well as a Doctor of Physical Therapy.

Blood Flow Restriction

Blood Flow Restriction is a treatment modality based on the stress response from your body. It involves a complete occlusion of arterial blood flow to the limb by compression and noting this pressure where complete occlusion occurs. Next, one applies about 60-80% of Limb Occlusion Pressure, which is the therapeutic level for lower extremities.

Once this is completed, light exercises is done at that pressure. The idea behind it is that the pressure is removed after exercise, and there is a hyperemic response with a lot of metabolites flowing in and out.

What happens during Blood Flow Restriction?

Some metabolites are upregulated when using Blood Flow Restriction; one of them is the Vascular Endothelial Growth Factor which causes the formation of new blood vessels (Angiogenesis) thus increasing blood and nutrient flow to the muscles. There is also an increase in Growth Hormone which is good for bone mineral density and muscle tissue density. Testosterone is also increased, helping to improve muscle tissue and bulk.

On the other hand, Myostatin decreases with Blood Flow Restriction, which is good because Myostatin degrades muscle. This is particularly advantageous for a sedentary person either due to a fracture or sprain.

The technique is applicable to every individual across any spectrum despite the level of fitness.

When is Blood Flow Restriction useful?

Man with knee pain

Blood Flow Restriction is significantly useful as an actual treatment for different medical conditions. For instance, Patellofemoral Pain syndrome, which often comes with severe generalized pain around the knees. In many of these cases, the patients have weakness in muscles that should help in tracking the Patella, and BFR can be used to target muscle groups or tissues that can’t handle 100% load, to correct the imbalance.

People also going for surgery that involves occlusion of blood supply for hours, may experience a huge stress response with pain afterward, However, ischemic conditioning through BFR helps decrease the post-op pain and stress response.

In the same vein, patients with an ankle or knee sprain have to be immobile for weeks. Afterward, the other joints are unstable, especially with the loss of muscle tissue. This is another place where Blood Flow Restriction would be highly beneficial. Usually, within 3 to 4 visits for treatment, even people with chronic ankle instability start to show significant improvement.

What workouts are recommended with Blood Flow Restriction?

The evidence-based approach is to do 4 sets with the first set having 30 reps, and the other 3 sets with 15 reps each, making a total of 75 reps. Dr. Zumwalt often does 15-20% of 1 rep max, giving a 30-second rest break between the 30 reps and the first 15. By the end of the first 15reps, there should be some muscle fatigue or burning felt in the muscle. If it is absent then the load will be increased.

Even skeptical patients start to feel an improvement right after the first visit as the brain also secretes hormones that help the person feel better alongside other metabolites released during the treatment.

What are the drawbacks of Blood Flow Restriction?

One of the possible drawbacks that have been considered is Virchow’s triad where there is a hypercoagulable state, venous stasis, and blood pooling. All of which predispose to blood clot formation. However, a lot of studies have shown that BFR releases antithrombotic agents in the body that break down clots. Dr. Zumwalt has used the procedure safely on patients with a history of DVT, although not an active one.

Patients with multiple heart attacks or vascular diseases may be excluded from the treatment.


Find | Dr. Scott Jablonka (the Carolina Movement Doc)

Find | Dr. Ryan Zumwalt