For who? young people and competitive athletes with broken bones
For what? recovery, functional movement, functional movement and strength
In the video above, 2010 Olympic silver medalist Todd Lodwick broke his left arm and torn his ligaments only 28 days before the 2014 Winter Olympics. He did Single-limb KAATSU on his non-injured limbs (both legs and right arm) and was able to compete admirably well in both the ski jumping and the Nordic combined events after only five weeks of KAATSU in 2014.
During his rehabilitation, the staff at the U.S. Ski & Snowboard Association noted that Lodwick was getting too muscular after a few weeks of KAATSU – despite his broken bone and torn ligaments. They noticed his muscle hypertrophy despite doing no weights or traditional strength training exercises. In response, his KAATSU pressure levels were reduced and he stretched more and did low-pressure, post-workout KAATSU Cycle sets so his muscle hypertrophy was not accelerated (see above).
Dr. Jim Stray-Gundersen, the attending US Ski & Snowboard Association physician who managed Lodwick’s rehabilitation with KAATSU equipment and bands, said, “His recovery was unheard of with the incorporation of KAATSU.”
People often ask how KAATSU the Original BFR can be safely used as part of their rehabilitation of a broken limb, especially when the injured arm or leg must be keep immobilized as it heals.
Similar to Lodwick who came back in an unprecedented time from a broken humerus and torn ligaments in his arm within four weeks prior to the 2014 Olympics, KAATSU users can perform KAATSU two or three per day if they primarily use the KAATSU Cycle mode. They can also incorporate KAATSU Aqua and KAATSU Cycle near bedtime.
- Be well hydrated with water before, during and after each KAATSU session.
- Be comfortable while doing KAATSU; stop immediately if you feel pain.
- Always start with Progressive KAATSU Cycle sets on your arms (i.e., either do Single-Limb KAATSU Cycle sets on only one arm or Standard KAATSU Cycle sets on both arms). Do 3-6 KAATSU Cycle sets that will take between 15 and 35 minutes.
- Then do Progressive KAATSU Cycles on your legs (i.e., either Single-Limb KAATSU Cycle sets on only one leg or Standard KAATSU Cycle sets on both legs). Do 3-6 KAATSU Cycle sets that will take between 15 and 35 minutes.
- If two KAATSU sessions are performed, do the first session at your convenience and the last session preferably at night closer to bedtime.
- If three KAATSU sessions can be performed, do the first session in the morning, the second session in the afternoon, and the last session at night, ideally an hour within bedtime.
- In the case that a KAATSU Aqua session can be performed, this in-water option presents additional benefits and can substitute for the first or session dryland session.
Progressive KAATSU Cycles:
The Progressive KAATSU Cycles is where the compression (i.e., pressure within the KAATSU Air Bands) begins gently and incrementally increasing (over 30-second intervals), followed by brief decompression intervals of 5 seconds. Your limb will gradually become more and more engorged with blood, as your skin color becomes pinker and more red over time.
With Progressive KAATSU Cycles, start with very conservative pressure (i.e., low SKU pressure) while you get comfortable in position. The more comfortable you are, the more benefit you will feel.
Your vascular tissue needs to be very, very, very gradually worked on. Starting with very low SKU pressures and then slowly increasing incrementally is the most effective and efficient way to increase the elasticity of your vascular tissue. For example, on the KAATSU C3, users can start on the LOW pressure several times and then gradually move to the MEDIUM pressure. Some users even go lower than the LOW SKU settings and use the CUSTOM mode.
- Movements with either the KAATSU arm bands or leg bands on can include standard physical therapy exercises or similar movements used in your sport.
- No movement or exercise should hurt or cause pain or discomfort.
- Your limbs (especially your hands or feet) should have a fast CRT (Capillary Refill Time) of under 3 seconds, and preferably under 1 seconds.
- In addition or alternatively, standard KAATSU 3-Point Exercises in the KAATSU Cycle mode can be used:
– Hand Clenches + Biceps Curls + Triceps Extensions on your arms.
– Heel Raises + Leg Curls + Non-lock Partial Quarter Squats on your legs.
- KAATSU Walking is another effective alternative if the injury is in your arms.
- KAATSU Aqua or KAATSU Aqua Walking is an additional effective alternative if the injury is in your arms. In the water, the KAATSU device is detached from the KAATSU Air Bands and the KAATSU Constant mode is used.
Various movements – or no movement at all – are up to your discretion. It could be as simple of Standard KAATSU 3-Point Exercises (e.g., Hand Clenches, Biceps Curls, Triceps Extensions, Toe Curls) or other movements (e.g., Head or Foot Rotations, Balancing on One Foot, Stretching, Walking, Standing Up and Sitting Down, Handwriting). But it is very important avoid any painful movements or any sudden movements. KAATSU is best done with slow, easy, gentle movements. You can think of KAATSU as slow stretching of the muscular and connective tissue.
Muscle Hypertrophy or Atrophy Avoidance:
The overall effects of KAATSU are best for muscle hypertrophy or avoidance of muscle atrophy if the movement of your limbs is slow, steady and gentle. Keep your muscles contracted while they are moved in both the positive and negative directions (eccentric and concentric).
Stamina Maintenance or Improvement:
The overall effects of KAATSU are best for maintenance or improvement of stamina is best if you do something aerobic like steady walking outside or an a treadmile, slow jogs, kicking in the water, rowing, and cycling if possible. There is no need to go all-out or intensely; steady is best.
Sometimes due to wearing a cast or brace or being in a wheelchair or using crutches, it is not possible to place KAATSU Air Bands around one or more limbs. In this case, you can do Single-limb KAATSU where you only place the band on one limb.
KAATSU has systemic effects all over the body, including in the injured limb – even if KAATSU is not done on that particular limb.
Systemic Effects of KAATSU:
At the Indiana University School of Health and Rehabilitation Sciences Center for Translational Musculoskeletal Research and the University of Indianapolis Department of Kinesiology, Dr. Alan Mikesky and his research team researched the crossover effects of KAATSU [see Modified KAATSU Training: Adaptations and Subject Perceptions here]. In his research, Professor Mikesky was looking to confirm the systemic effects of KAATSU.
The researchers applied KAATSU Air Bands on only one arm of subjects and tested the strength, girth, tomography scans along with RPE (Rated Perceived Exertion scale) of both arms of the subjects.
The research team correctly did KAATSU and measured both the Base SKU (which they called “Cuff Tightness Pressure in mm Hg”and Optimal SKU (which they called “Cuff Inflation Pressure in mm Hg”) levels.
It should be noted that the SKU levels were conservative for relatively young subjects. The subjects started at 10 Base SKU in Week 1 and increased to 30 Base SKU by Week 8; they started at 90 Base SKU in Week 1 and increased to 180 Base SKU by Week 8. Both the KAATSU arm and the non-KAATSU arm girth increased (measured in cm between Week 0 and Week 8):
Non-KAATSU Arm (cm) girth:
Week 0: 22.7 cm
Week 2: 24.3 cm
Week 4: 24.9 cm
Week 6: 25.7 cm
Week 8: 26.1 cm
KAATSU Arm (cm) girth:
Week 0: 23.0 cm
Week 2: 23.2 cm
Week 4: 24.5 cm
Week 6: 25.4 cm
Week 8: 26.1 cm
The research showed how doing KAATSU on one limb can have crossover (systemic) effects on the other limb – a very important goal for individuals with one injured limb who is trying to recover. Another previous study conducted in Japan is entitled Cross-Transfer Effects of Resistance Training with Blood Flow Restriction (see here).
In summary, doing KAATSU on healthy limbs can have direct crossover benefits to the recovery, strength and girth of an injured limb or core.
KAATSU SKU Pressure:
Always start conservatively with KAATSU (see here). You may not be able to do 3-6 KAATSU Cycle sets on your arms and legs in the beginning. Perhaps you can start with 1-2 KAATSU Cycle sets on your upper body and lower body – and then gradually increase the number of KAATSU Cycle sets over the course of several weeks. This is perfectly acceptable.
After several weeks of KAATSU Cycles performed daily on your arms and legs, you most likely will see a number of changes and benefits as you learn the best pressure and duration that fits your recovery and lifestyle.
You can also use other modalities and therapy in conjunction with or before or after KAATSU including acupressure, electric muscle stim therapy, aqua therapy, KAATSU Aqua, etc.
Ideally an hour before going to bed, do a few sets of KAATSU Cycles on your arms. Simply, sit or do very casual shoulder rotations. Do nothing vigorous and avoid all intense exercises. Your goal is to activate your parasympathic nervous system in order to get a good night of restful sleep.
KAATSU Aqua is ideally done in waist-deep water where the buoyance of the water assists in supporting your weight and, thereby, decreases the amount of weight bearing which reduces the force of stress placed on your joints. KAATSU Aqua can help improve flexibility, balance and coordination while building muscle strength and endurance.
A dryland alternative to KAATSU Aqua would be combining KAATSU Air Bands while working out in an AlterG machine.
KAATSU with People with Paralysis:
Q1. Why does a patient with paralysis become more relaxed and sleep better after doing KAATSU?
A1. The sympathetic nervous system has been activated for a long time. When KAATSU is performed, the sympathetic nervous system relaxes as the parasympathetic nervous system is stimulated and patients with paralysis are able to sleep well [after KAATSU]. Also, mechanical stress – which is a good stress – occurs and they can sleep comfortably.
Q2. What is the mechanism that enables an increased passive range of motion in her elbows, hands, and ankles?
A2. After the accident, joints became harden and spastic [for a long time, decades]. The tendons and ligaments become harden. Relaxed by KAATSU, because the sympathetic and parasympathetic nervous system are well activated, the joints and muscles become loosened. This increases its range of motion. There are tendons within the muscles, but they will not become soft soon. Over time, however, the tendons gradually softens over the course of many months.
Q3. The muscle and ligament contractures in their elbows, wrists, fingers and ankle plantar flexors are rigid. Can you predict how much a patient with paralysis can improve her range of motion?
A3. Patients with paralysis have been tense for a long time and their bodies became stiff as a result. It is very important to make concentrated efforts just like climbing stairs, step by step. They should not be impatient. Movement towards their goals might go in a good direction if they keep making steady effort.
Q4. Why do quadriplegic patients feel less pain?
A4. The pain is relieved because of the secretion of beta-endorphins, which is called intra-cerebral anesthesia in the brain. Also, the nerves of the muscle fibers that were in a sleeping state around the damaged muscle fibers are awakened by the application of KAATSU. Thus, the pain is relieved.
Q5. There are some red spots that showed up on a quadriplegic’s right thigh after the initial session. Was the Base SKU too high initially?
A5. You can judge that the patient’s blood vessels are weak due to the appearance of red spots on the skin. Perhaps next time, when KAATSU is applied with the same SKU, these tiny red specks might disappear. Some people might say that KAATSU is dangerous because the red spots appeared or KAATSU might cause blood clots. The red spots indicates that stimulation was sufficiently given to blood vessels. It is important to start with KAATSU Cycle 1 (i.e., 100 SKU) for people who are trying KAATSU for the first time and gradually move on to KAATSU Cycle 2 (e.g., 120 SKU), Cycle 3 and on.
Q6. Should we worry about blood clots in immobile patients? Does the potential for existing clots change KAATSU protocols?
A6. The potential for kicking off blood clots will not change as long as you do the KAATSU Cycle. Start with pressurization for 30 seconds and depressurization for 5 seconds (i.e., KAATSU Cycle on and then off). Since the blood vessels gradually increase resistance against pressure and patient’s blood vessels get used to SKU and can tolerate it. Do not worry about thrombosis.
Q7. If patients eat poorly, what should we worry about with KAATSU?
A7. Improving one’s diet in parallel with doing KAATSU is one kind of treatment. The three goals – exercise, good diet and sufficient sleep are important to become healthier. It is necessary to balance these three factors.
Q8. Do you recommend 2 full cycles, 2 times a day? What do you recommend for daily KAATSU usage?
A8. The daily usage of KAATSU varies according to patient’s abilities and their level of physical fitness. In the case of patients where spasticity tends to easily occur, even if their body loosens after one KAATSU session, it is possible that they will return to their original state after a few minutes. Rather than deciding whether to do one or two KAATSU Cycles, the amount of KAATSU should be decided by the patient. Generally, the more serious the patient, the more times they should do the KAATSU Cycle. Conversely, for less serious patients, the less time should be spent doing KAATSU. That is, the number of times doing KAATSU Cycles should be decided on a case-by-case basis.
Q9. Why do patients with spinal cord injuries feel warm during KAATSU – especially when they have no sensation in the same limb?
A9. The fact that their body feels warm after KAATSU is evidence that new blood vessels were created. Normally, there is no medical treatment to create new blood vessels instantly, but KAATSU instantly creates new capillaries. Blood flows to those points in the body and their body warms up. Conversely, when the body is exposed to below the freezing temperatures, capillaries are pulled away and the body becomes cold.
Q10. Why does KAATSU appear to help with neuropathic pain in spinal cord injury patients?
A10. For not only the patients with spinal injuries, but also the patients with various diseases, when they do KAATSU, cells and muscle fibers that have not been used until now start to work. Consider the case if there are 100 soldiers, but only 10 of them have been working. When those 10 soldiers are injured, the 90 other soldiers will start working on behalf of those 10 people.
Q11. The Masimo device measures Perfusion Index (an indication of the pulse strength at the sensor site). The Perfusion Index values range from 0.02% for very weak pulse to 20% for extremely strong pulse. Normally, the Perfusion Index decreases during KAATSU, but why does the Perfusion Index often increase during KAATSU for a client with a spinal cord injury?
A11. KAATSU immediately creates new blood vessels and the blood fills the place where no blood was flowing until then. Naturally, the perfusion index will increase in this case.
Q12. For spinal cord injury patients, Capillary Refill Time is often very slow with no KAATSU pressure, and speeds up during KAATSU. Why?
A12. Since the blood flow reaches every corner [in the limb], Capillary Refill Time is accelerated. New blood vessels are increased. When you do KAATSU, VEGF (Vascular endothelial growth factor) new blood vessel growth factor hormone increases. KAATSU effects have continued to surprise me.
Q13. If neural pathways are NOT intact (for example, with a completely severed spinal cord) for an individual with a spinal cord injury, why does the client still feel pain? Why does KAATSU appear to decrease that pain?
A13. Blood vessels are not connected, but new blood vessels are born. It is the same as bypassing a road. Rather than repairing broken roads, roads are made new. When new blood vessels are formed, nerve cells comes after, and nerves are completed. As new blood vessels are formed, neural cells are formed. In a previous KAATSU trial, we put a patient’s head in a Functional MRI machine as we applied KAATSU to both arms while doing Hand Clenches with a grip band. New blood vessels increased in the portion of the brain that was black. Naturally, neurons are formed after. Since KAATSU works, I would like doctors and researchers at the VA to conduct further clinical trials.
Q14. Many military therapists use electrical muscle stimulation on spinal cord injury patients. Can this Electrical Muscle Stimulation device be combined with KAATSU to achieve better results during the isometric contractions?
A14. There are various devices such as electric stimulation units and EMS available now. When electric stimulation is given, the muscles shake. There are several research results that cause muscle hypertrophy to some extent. We get requests from researchers who specialize in electrical stimulation to simultaneously use KAATSU and electrical stimulation. We performed clinical trials on patients with spinal injury who could not move their legs. It showed positive results with KAATSU.