Blood flow restriction to improve performance and injury recovery
Blood flow restriction or BFR has become popular in the last few years in the training and physical therapy field.
Their mission at Barça is to work outside the immediacy of everyday life. Not to look just at the next game or the next season, but by means of the scientific method to look miles beyond the present, within a decade. Gil Rodas, head of medical research at Barça Innovation Hub, laid down the foundations for a management model in the field of sports medicine R & D + i, which is regarded a pioneer in the world and that has established guidelines for the preservation of the health of athletes and optimisation of their performance. Dr. Rodas (together with his team) tries to solve questions about sports medicine that were asked two decades ago and helps to ask and think about the problems that will be solved by those who come in twenty years.
The great change took place in the 2003-2004 season. From that moment the first stone was set to create a multidisciplinary team both inside and outside the playing field and always supported with scientific evidence. As a FC Barcelona doctor, I had spent four years in the first football team and nine in the basketball team. But it was in 2016 when we had the opportunity to set up a project we had been talking about for a while. The idea was to put together the experience in the field with the research experts.
In the world of sports there are two phenomena or realities. When the professional is in the day to day, they cannot raise their head, and the experts do a lot of science, but they do not know the daily practice and what it demands. We wanted to take advantage of the people who had been on the bench, who knew first-hand the problems of the club, and together with the help of scientific experts, take their work to the scientific field.
Scientists are in a lab. To give answers they need good questions for them to get closer to reality. For that reason, it is important to move science closer to the professionals who have experienced the daily pressure of the bench. A field different from that of science but that can complement each other. From there, we create guides that we disseminate for it to reach other professionals. Now, after some time, we have seen how the NBA has not only come to hire players, but also to sign experts from the club (doctors, physical trainers, etc.) who have developed this scientific-practical mentality and who inculcate this mentality with new knowledge.
In our daily work we saw that there was an overwhelmingly frequent problem: muscle and tendon injuries. We went to see many muscle and tendon experts from all over the world. However, we realised they did not have more knowledge than us because there was not a great development of medicine applied to sports.
We saw that we were clients looking for experts all over the world and in we also realised that we were in fact the experts we were looking for all along, we had been dealing with and solving the problem for years already. Hence the idea of creating a knowledge Hub on muscle and tendon injuries in which Barça has embedded Barcelona, our local experts, and both FC Barcelona and Barcelona, are now a world reference in the treatment of these injuries. We have been celebrating Medicine in Sports Tomorrow for more than twelve years, where we bring together the best experts at the Camp Nou, to exchange opinions and new practices in this field. This year due to the pandemic we’ve done it online, allowing more professionals to listen to these experts and collaborators of the club in the matter.
We are trying to answer the questions that, for example, I asked myself when I was on the bench. In the same way, the work I am doing now may be of use to those who come to the club in ten years. For example, we are compiling a biobank with samples from our players. We believe that within a decade there will be enough technology and knowledge to be able to interpret this information we are storing.
One of the most important preventive strategies is follow-up. Control of the external load, the exercise performed, the internal load, and how it affects the human body. We monitor our athletes through tracking technology and what we call “Sportsomics”: genomics, epigenomics, transcriptomics, proteomics and metabolomics. A chain that studies from your genes to how environmental factors influence you, such as what you eat, how you train, how you sleep, etc… and how this generates changes in proteins and enzymes and how they act with your muscles, tendons or any other part of your body. Thus, depending on the relationship between external and internal load, we can provide the coach with tools to anticipate the fatigue of our players and prevent them from getting tired or injured.
In the past, the first thing we saw was the magnitude of the problem. The most frequent injuries were muscular and then tendon injuries. From here, we focused on looking for the aetiology of the injuries, their possible risk factors and the injury mechanisms. We do this through multidisciplinary teams that include not only clinicians but also epidemiologists, biostatisticians, or bioinformaticians. The more of this information you find out, the better you are going to cure and prevent. You will achieve a decrease in the magnitude of this kind of injuries.
However, we have been working on this for years, trying to establish the most advanced protocols, and have we prevented anything? Each year more injuries take place. The chain is good, but we are missing something.
Density and intensity. That is not in our control . There are more and more matches, more interests. Every time we train athletes better, they run more, with higher intensity, but they also get more injured, resulting in that we need to look out for a balance. No matter how much we develop a preventive strategy with analytical work, recommendations for good nutrition and sleep, a care in many aspects of life, if then the player has to play three matches a week, what preventive strategy holds that? The first thing we have to do for preventing is to reflect on the direction professional football is taking.
Football is such a classic sport that no one wants to change it, but sports like rugby or field hockey have changed the rules, allowing unlimited changes, for example. Nobody wants to loosen the regulations so much in football, it is a show that works as it is, but it makes the players get more and more injured.
It is in football where there are more injuries, both in men and in women. Why not instead of five changes we allow to make eight? We should demand that the pitches should always be perfect for playing. There are temperature constraints, you cannot play at 35ºC. No matter how much work we do, there are important causes that are increasing injuries.
In the NBA they wanted to do the six-month league in three months, and injuries increased exponentially. If that happens, the show lowers its quality. You have to be more careful. We also have a lot of injuries in the European basketball league.
At a scientific level we have few markers to be able to decide if a player is ready to return on a specific day. That precision is accomplished with time and experience. More science is necessary to be able to have 90% success, which will never be 100%. Then there are more constraints. If one is six weeks off and there is a very important game in the fifth week, what happens? Usually, everything done for that term has to be accelerated. Between those margins, the player will think he is fine and that he can play, the coach will say go ahead and we have to be cautious, but never conservative. If there is a greater benefit that justifies it, you take the risk, even if the relapse risk in the injury increases.
Everybody is already following this line, establishing multidisciplinary teams where management and decisions are agreed on to optimize performance. An analogy could be drawn with the tuning of a Formula 1 car. However, not all of the clubs can be compared. There are others that train half as much as Barça and the footballers can play in worse physical conditions because there is not so much pressure. We also have the obligation to be great stress managers, as it also produces injuries. A game with one hundred thousand spectators creates a high risk of injury. The players who have not had the experience of growing up and playing at Camp Nou, seem to get more injured the first year.
Women who play football have increased fivefold in recent years, but we do not know much about women. Little research has been carried out. We are going to face an important challenge, because there are biological differences between women and men. We are talking about joint mobility, the skeleton, metabolic expenditure, hormones and we must not lose sight of the cardiovascular differences between both sexes. All of these differences affect the type of injuries suffered.
Right now, we are still in the questioning phase. Women are cyclical, menstrual cycles generate hormonal changes, which generate physiological changes and metabolic changes that influence performance and injury. It has still not been studied in depth. We are already working at Barça to learn more about female athletes in team sports. Individual sports such as gymnasts, marathoners, etc. is another world and there is more research.
You do not know where the absolute genius will come from, he or she can appear from anywhere, but we are convinced that new talents will keep emerging from our club. They are the club’s asset, if they do not continue here, wherever they go, they will succeed as players and as individuals. It is already happening to us that colleagues from other teams that have received players trained in La Masia, tell us how well prepared they are in terms of eating habits, knowledge of their body, routines for a good rest, etc.
To all of us who love this club, this should make us proud, we have players who are leading the way in other teams, consolidating our point of view and way of doing things.