Three years ago when we started researching blood flow restriction, there were two schools of thought.
The first school consisted of vendors and some practitioners. This school taught that BFRT was not only dangerous but also difficult to master. Practicing BFRT was limited by one vendor to "credentialed" professionals.
The second school was mainly bodybuilders and extreme athletes. They believed and taught that "BFRT has to hurt like hell" to be effective. They induced occlusion with anything readily at hand. Wraps, straps, cords were all employed to get that "pump".
In reality, back then, both these schools were probably right. Effective equipment was difficult to master, it required electronic monitoring, professional judgments, and if misused, it was indeed dangerous.
On the other hand, the second school did not look at science instead of relying on word of mouth.
That is when RockCuff began questioning the choices based on studies.
Studies, like equipment, require careful analysis. Some studies are good, others ok, and the balance? The fact is, not so good. Riddled by conflicts of interest, studies designed to produce a single outcome, you know the drill.
Each school had its proponents, usually arguing without any real backup.
I first ran into one of these "researchers" (at least that is how he described himself) at the Combined Sections Meeting for the APTA. This "expert researcher" listened to our design issues and then promptly went online (he looked at the camera over his shoulder while working on his computer) and pronounced our cuff as "elastic nylon" (which it is not, nor has it ever been). He warned his followers that there was a charlatan in the house. At that time if I remember right, he was hawking a $4,500 pneumatic cuff.
Later, in a video he posted, he recorded determining the limb occlusion pressure, LOP, or an interested party. Using a $120 acoustic doppler, he pronounced that her LOP was "140" and then continued "research shows that we should set occlusion at 50% of at 70 mmHg".
When I told my daughter Elizabeth, a great artist, and PhD in Psychology, she came up with the artwork below.
So many things wrong with this that it just hurt. Where did he get 50%? I read maybe 1,300 articles and case studies and the only one I had run across was a study where they used 50% of VO2 Max, not occlusion.
How did he factor the "effective pressure area" of the cuff he was using? No research could verify the cuff, the effective width, or anything else. His surety of "50%" seemed genuine but as the user exercised, we know that her LOP would, in fact, no longer be 140 mmHg and was in all likelihood 180 or 190 mmHg.
I tell you this story, because in his, and many others, the pursuit of credibility, he had relied too heavily on information from the vendor.
So as we unpacked this information, good and bad, we relied on good information, evidence, and equipment agnostic studies. We looked for a "hidden" relationship between vendors and their so-called experts.
One company had gone so far as to tell potential clients that their equipment was "FDA Approved", it was not, not would any BFR equipment obtain this. Maybe it was registered or listed, but not approved.
Likewise they "stretched" an FDA guidance to refer to a requirement for "instructions" as a requirement for "training". They told professionals that if they did not use their equipment, they could potentially lose their business to a lawsuit.