Article By: Travis Jewett
Call it whatever you like. Flossing, voodoo wrapping, compressing, blood flow restriction; you name it. There are a lot of terms floating around that describe a similar activity. We have gotten to a point where you can find compression bands just about anywhere. There is a reason it’s becoming more popular, it works. What most people don’t realize is there are a lot of different ways to use deep compression and a lot of different reasons someone may do it in certain situations.
1. Improving Lymphatic Drainage & Reducing Swelling
The idea of deep compression has been around for a very long time. The first time I heard about using this kind of compression was from Dick Hartzell and a book titled, Don’t Ice that Ankle Sprain. In the book, Dick goes into detail about leaving that ice bag in the trash and applying super compression to the ankle to stabilize and flush swelling. The super compression also can be analgesic (acting to relieve pain), allowing the clinician or athlete to apply traction and motion to the joint so you can begin to move the joint within tolerance and realign any of the bones of the ankle. He was one of the first people to say icing is not that important when it comes to working with a joint injury (which has since been confirmed through scientific studies; icing doesn’t do any damage if you do it but it also doesn’t supply any appreciable benefit) and that the important things are the compression and motion. Your body does not drain lymphatics passively. Getting rid of swelling is an active process.
2. Joint Distraction
Another point I want to emphasize about the concepts Dick presents is the idea of super levels of stability and joint distraction with motion. I do not have scientific studies to back up the next statements. I do have thousands of hours of patient interactions at my clinic and many hundreds more athlete interactions teaching seminars around the world. Many times, your central nervous system does not allow you to access full ranges of motion in a joint due to a perceived instability. Your brain is not a big fan of allowing your joints to move into ranges and produce force where it does not feel stable. It seems you can apply tremendous amounts of compression and override the guarding mechanisms by creating super stability. While I would not recommend training under such high levels of compression around a joint, from a practitioner stand point, many times this compression allows me to improve movement in a joint at a very deep capsular level that I cannot get otherwise. With this kind of compression, I am going to wrap very tight but only keep the wrap on the joint for a minute or two. This is just enough time to create a change in the joint and move on to some kind of motor control drill to help the nervous system pattern in any change we have made.
I am going to bundle the next two reasons to use deep compression. What is commonly being referred to as flossing and passive compression. This may seem odd as one is an active process and one is a passive process, but I see them as two sides of the same coin.
Flossing is wrapping a joint or soft tissue at a particular place and then actively moving through your available range of motion to improve how all the layers from your skin down through your muscles are sliding over each other and interacting. This can be done as part of a lymphatic flush for a swollen area (I do advise consulting with a professional if you are experiencing unexplained swelling) or a possible way to improve lymphatic and blood flow after an intense training stimulus to enhance recovery (this statement is more anecdotal than anything and an extrapolation of the interpretation of research, not something that has been heavily researched itself).
4. Passive Compression
Passive compression is exactly what it sounds like. If you have some swelling or pain in an area, deep compression can act not only to help flush the swelling, it can also be an analgesic. Not only does the compression help with the pain in the area, the deep compression can slightly change the angle of pull of a muscle and give relief at an origin or insertion if there is pain there from a tendon pathology. This is how the compression bands for jumper’s knee and tennis elbow work. If you watch the old VHS tape from Westside Barbell, they would use this technique to train around muscle strains and overuse injuries using duct tape. They could apply tremendous compression around a muscle that was painful and change the line of pull slightly to allow them to continue to get in the work. You are likely getting some mild blood flow restriction effects as well. We will discuss that next.
To find specific techniques related to passive compression and flossing check the video library on kabukistrength.com here.
5. Blood Flow Restriction OR Occlusion Training
The final reason for super compression, which is becoming more popular with the literature coming out, is blood flow restriction (BFR) or occlusion training. This concept has been around for a very long time. You can probably find old pictures of bodybuilders with bands around their biceps doing curls. Somewhere along the line, people realized you could restrict blood flow and improve hypertrophy. This concept was later formalized by Dr. Yoshiaki Sato as the KAATSU method. It has become further popularized (and heavily researched) not only in the world of muscle hypertrophy, but also the world of rehabilitation, by Johnny Owens. You can check out their websites (www.kaatsu-global.com and www.owensrecoveryscience.com) for more detailed information, but I will give you a quick overview.
To put it simply, you are using the restriction of venous blood flow to cause a pooling of blood in the limb you wrap. You keep the wrap proximal (as close to the trunk as possible) and do not wrap it nearly as tight as if you were doing the joint distraction work I mentioned previously. This allows you to leave the wrap on a little longer as there is a specific protocol for BFR training that has been used heavily in the research. When you restrict venous return, you can expand and improve circulation and vascular elasticity. Your body will start to release vascular endothelial growth factor. This can result in neovascularization by increasing the density of your capillary beds. Over time, this leads to improvements in oxygen exchange (studies have shown up to an 11% increase in VO2 max while walking on a treadmill with bilateral leg occlusion) and the ability of the muscles to exchange other metabolites. You will also see an increase in pH in the muscles and your body will start to secrete more growth hormone in response. It can also help stimulate many more hormones and pathways in your system to improve muscular hypertrophy and improved cardiorespiratory efficiency. BFR can also help your body heal tendinopathies, even if they are downstream from where you have the wrap. As an example, even if you are dealing with an elbow tendinopathy, you would still use the BFR protocol with the wrap at the shoulder. I will not go into great detail as you can easily find articles discussing BFR.
What do you need to know as someone who is training? You can get very fancy if you like. KAATSU units and Delphi units are available for purchase but can come at a steep price. The advantages are they allow you to closely monitor blood flow and make adjustments on the fly as you train. The downside is of course the price tag. This will make them difficult for the average gym goer to take advantage of. The other option is to use the more widely available compression bands that are on the market. I would suggest getting the four-inch versions for your legs and the two-inch versions for your arms. You can grab them here. You are not going to get the specificity of the fancy units, but you can still get a stimulus and response.
There are going to be some things to consider before using any type of BFR in your training. Just to be safe, if you or the person you are working with has high or uncontrolled blood pressure, history of severe cardiovascular disease, or is pregnant, just don’t mess around with it. The risk to reward ratio is not worth it. If you are going to do BFR sessions using the readily available compression wraps, you would wrap the upper extremities with a three out of ten on the tightness scale (ten is wrapping as tight as the wraps are capable of wrapping, like if you and a friend were out on a hike and you needed to apply a tourniquet for a rattlesnake bite). You would wrap the lower extremities at a six or seven on the tightness scale. BFR can be a great way to finish a workout every now and then with your accessory work. Just like anything else, cycle it in and out of your training. This is not a programming article so we won’t get too deep into it. Just understand the load necessary to get a stimulus is very low, less than 30% of one rep max. You can get a hell of a response with air squats, so don’t get too carried away. Less is more.
To break it down into one example, let’s look at a bench session. After all your working sets of bench and maybe some dumbbell work, you could finish up with an easy BFR session of banded triceps extensions and biceps curls. The most studied protocol is 30 reps, 30 seconds of rest, 15 reps, 30 seconds of rest, 15 reps, 30 seconds of rest, 15 reps, then rest for one minute (keeping the BFR on mind you) and then repeat that same reps and rest protocol. Two exercises are plenty but, in the literature, they will go up to four different exercises before taking off the cuffs. Here is a video of me explaining a session and going through it:
Now you understand the many purposes of using deep compression. It has many applications in treating injury and the training of an athlete. For further discussion, feel free to email me, firstname.lastname@example.org.