Red light therapy with Blood Flow Restriction
As we realize the importance of staying active for optimal health and longevity, recovery and rehabilitation have become key pillars of a well-rounded fitness routine. In the modern day, everyone from recreational gym enthusiasts to high-level performance athletes are seeking efficient ways to heal, recover, and optimize their performance. Among the vast landscape of innovative recovery methods, red light therapy (RLT) and blood flow restriction (BFR) are gaining the most traction as the scientific understanding develops.
Red light therapy has gained widespread attention as a non-invasive recovery method to stimulate natural cellular healing processes. BFR has been shown in the scientific literature as a way to stimulate important muscle-building and strength processes at low loads.
While both modalities offer unique benefits, combining them may provide synergistic effects. RLT increases mitochondrial function and cellular health, while BFR enhances localized metabolic stress to increase muscular adaptations. Put together, they may offer a multi-functional approach to health, recovery, and performance.
As interest in habit stacking grows, this intriguing combination warrants further research. In this article, we explore the mechanisms of both recovery methods and how they may work synergistically. We finish by dissecting some of the key scientific research before providing future recommendations.
What is Red Light Therapy?
RLT uses red and near-infrared light to stimulate natural cellular functions. The red and near-infrared light penetrates the skin, interacting with both surface and deeper tissues.
Light photons are absorbed by the mitochondria, enhancing the activity of the electron transport chain alongside ATP production. This boost in cellular energy increases the body's natural healing processes, enhancing tissue repair and reducing oxidative stress.
Furthermore, the light energy from RLT increases vasodilation and microcirculation. The enhanced blood flow increases the delivery of vital oxygen and nutrients to target tissues.
At the molecular level, RLT modulates key inflammatory mediators (IL-1β, IL-6, TNF-α) and reactive oxygen species, increasing antioxidant enzymes to change the overall inflammatory response.
Put together, these mechanisms are thought to help with muscle recovery, exercise-induced damage, and muscular fatigue. Studies looking at RLT have shown better exercise performance and lower oxidative damage.
On this point, here's what Dr. Ed Le Cara had to say on a recent Podcast when discussing the potential benefits of using our Move+ RLT device:
“Any time someone has an acute pain episode, I'm sending them home with the Move+. Probably 70% will want to purchase one to use at home. Not just for the condition that I'm treating them for, but for other conditions that they (and their family) often complain of. That tells me that they’re having a positive effect from it.”
What is Blood Flow Restriction?
Blood flow restriction uses a special cuff to partially restrict blood flow to a limb or limbs during activity and exercise. This creates a hypoxic, metabolite-rich environment by mimicking the effects of high-intensity exercise. This allows comparable hypertrophy and strength gains using a much lower exercise intensity (20–30% 1RM) versus the normal high intensity resistance (65-90% 1RM
The reduced oxygen availability increases key metabolic stress signals (ie, lactate and hydrogen ions) and hormones such as growth hormone and IGF. Alongside this, BFR recruits fast-twitch muscle fibres at a much lower exercise intensity compared to traditional weight training
Put together, these mechanisms activate key muscle-building pathways, improving muscle growth and strength gains at comparable levels to high-load training in about ⅓ the time as traditional strength training.
With this, studies have shown BFR to be an effective way of increasing muscle mass and strength in young adults and elderly populations, using much lighter weights. This may be particularly useful for populations recovering from injury who are unable to train at high intensities.
Combining red light therapy with Blood Flow Restriction
Combining red light therapy and blood flow restriction may complement each other's mechanisms. While BFR provides a potent growth stimulus and provides comparable mechanistic effects at a much lower training intensity, it also causes oxidative stress, ischemia, and induces early muscular fatigue.
RLT may be able to counteract some of these acute side effects by improving mitochondrial function and enhancing local blood flow. This may reduce the drop in oxygen saturation, delaying the onset of fatigue.
What this means is that, under occlusion, muscles can work at a higher output or for longer when treated with RLT. Furthermore, the potential reduction of inflammation and oxidative stress can help mitigate the soreness and muscle damage caused by BFR training.
As a potent therapeutic combination that can offer multiple functional, performance, and recovery benefits, these are the main proposed ones according to current scientific research.
Increased Low Load Strength Training Efficiency
Combining BFR with RLT offers promising results for increasing low-load strength training efficiency.
In a recent study, researchers applied RLT to working muscle prior to each BFR session. Participants were split into a BFR training group, RLT+ BFR training group, and a control involving conventional training.
Results showed that applying 660 nm light therapy prior to BFR led to superior strength outcomes compared with BFR or training alone. Researchers reported a ~21% increase in wrist extensor strength when BFR + RLT was used together for 4 weeks. Interestingly, a larger near-infrared wavelength (830 nm) was shown to be less effective.
Overall, this suggests that when the right wavelengths are used, combining BFR with RLT can improve low-load strength training efficiency. This may be useful for individuals unable to perform higher-load training or those who simply prefer this training method.
Enhanced Acute Performance and Post-Exercise Recovery
The reduced muscle oxygen supply when using BFR causes the onset of early fatigue. The potential of RLT to improve exercise tolerance may help reduce early fatigue when applied before BFR.
In another recent study, researchers found that low-level laser light preserved muscle oxygen levels and maintained a more stable force output when applied before BFR training. This gave participants an immediate functional training benefit, allowing them to perform more repetitions and hold longer contractions.
As mentioned above, BFR may cause high metabolic stress and muscle damage. RLT is well-known to reduce delayed onset muscle soreness and blood creatine kinase levels, a key marker of muscle damage. Although studies are yet to specifically measure these key markers, we can interpret that RLT shows good promise as a way to mitigate the muscle soreness commonly seen. This may be of particular use for athletes and sports that require quick recovery periods.
With this, combining RLT + BFR shows promise for enhancing acute performance measures and post-exercise recovery, even though specific mechanisms are still developing.
Better Injury Rehabilitation and Functional Recovery
The major goal of injury rehabilitation is to restore muscle function. We already know that BFR is a powerful tool that can prevent muscle atrophy and improve strength in injured and immobilized limbs using low training loads. RLT is also well-known to promote tissue healing, reducing swelling and discomfort to improve the repair and recovery of injured tissues.
Therefore, combining both treatments for rehabilitation may provide synergistic benefits. While BFR can enable better training with lower muscle stress, RLT can support the healing of the injured tissue and reduce the subsequent discomfort.
This is what Kineon CEO and co-founder, Forrest Smith, had to say regarding these points:
“BFR is great for reducing atrophy post injury and safer low-load training. When you combine this with the RLT’s decrease in pain, increase in wound healing, and outcomes it triggers from scar tissue development, it forms an amazing combination.”
While published studies regarding these points are limited, the scientific rationale is strong for both treatments. With this, injury rehabilitation programs using RLT + BFR may improve functional recovery.
Improved Post-Operative Care
Patients often suffer significant muscle atrophy, joint stiffness, and general discomfort following orthopedic surgeries such as ACL reconstruction and knee arthroplasty. Using BFR during the early post-operative care period helps counteract the atrophy and strength loss by allowing sufficient low-load training once you’re cleared to exercise again.
RLT accelerates tissue healing and reduces the acute discomfort following surgery. Studies looking at the application of low-laser light therapy following surgery show decreased swelling and pain scores. This leads to reduced pain medication usage and better range of motion in the early recovery phase.
Combining both therapies may provide multi-functional beneficial effects on post-operative care. The RLT improves the healing environment of the affected tissue while BFR allows you to safely strengthen the affected limb. Put together, this may lead to improved post-operative care.
A practical guide to using red light therapy with Blood Flow Restriction
Before we get into this section, Kineon CEO and co-founder Forest Smith had this to say about the excitement surrounding combining RTL and BFR in the recent podcast:
“What’s really exciting about BFR and RLT is the ability of people to use these synergistically in a number of different environments.”
With the scientific understanding behind combining both methods improving, the key to getting the most out of the combined treatments is knowing how to correctly time and order them together. Later on in the podcast, Dr Ed Le Cara had this to say following Forrest's initial comment:
“We can use RLT in combination, we can use it before, we can use it after. We can be a little creative in what mechanisms you’re trying to facilitate.”
Most of the current research focuses on using RLT immediately before BFR training sessions. The RLT is applied to the target area before the blood flow restriction cuffs are applied and inflated prior to the low-intensity exercise. The idea behind this is that pre-conditioning the target area using RLT boosts the muscle oxygenation and energy stores. This can then be used during BFR hypoxic exercise to delay the subsequent fatigue.
In practice, here's what a typical session may look like:
- Apply RLT for 1–2 minutes on different points of the target muscle. This should equal 10–20 minutes for each daily session.
- mmediately perform low-intensity resistance exercise using BFR.
- Remove the BFR cuffs following each exercise to restore blood flow.
- Apply RLT following the exercise if the goal is to reduce soreness and improve recovery.
When taking the current research into account alongside Dr Ed Le Cara’s thoughts. Using RLT immediately before and immediately after a low-intensity BFR session would seem to be the current best application method.
While this may change slightly as research develops, the versatility of RLT allows it to be integrated at multiple points during BFR training. A portable RLT device like the Move+ would be the best option because of its ability to be used on-the-go and integrated alongside other wellness practices.
Building on this point, here’s what Dr. Ed Le Cara said about using the Move+ in his clinic:
“Now we have a tool that people can go home with and do multiple sessions per day to decrease pain and improve healing. “
Studies showing the practical applications of red light therapy and Blood Flow Restriction
Study 1: Acute physiological responses to combined blood flow restriction and low-level laser
Read the full research: Chen et al, 2020
Key findings about Blood Flow Restriction and red light therapy:
- Muscle oxygenation was better preserved during exercise when using RLT before the BFR exercise protocol.
- Muscle activation was higher and force output was more stable when using RLT before BFR compared to the BFR and control conditions.
- Participants reported lower perceived exercise exertion scores using BFR + RLT, despite the higher muscle recruitment.
Study strengths:
- The protocol used a randomized, double-blind, placebo-controlled design, which strengthens the validity of the results.
- Using three conditions (RLT+BFR, BFR, and traditional exercise) allows for further comparisons and examination.
- Using EMG and NIRS as objective measurement tools further improves the scientific validity.
Study limitations and challenges:
- The focus on short-term adaptations means that longer-term conclusions are hard to draw.
- Only one muscle group was used (quadriceps), which limits application to the other muscle groups.
- The sample size of 24 young males makes it hard to generalize the results to other populations.
Our thoughts on Chen et al. 2020
The results of Chen et al. 2020 provide compelling evidence that using RLT before BFR may provide synergistic benefits when used as part of a low-load resistance training protocol. This study shows that the improved muscle oxygenation and activation may prime the muscle tissue prior to BFR by increasing blood circulation and enhancing mitochondrial activity. BFR provides the metabolic stress for the adaptations to take place while causing reduced joint strain and tissue stress.
The study's finding that participants had less perceived effort with greater performance and recovery has exciting implications. This may be particularly beneficial for patients in rehabilitation settings when high-load resistance training isn’t possible and for performance athletes looking to optimize their training.While these short-term findings are promising, the small sample size and homogeneous population used make it hard to generalize the findings. Furthermore, the use of a single muscle group makes it difficult to apply the results to other parts of body.
This study lays the foundation for future research looking at the combined effects of using RLT before BFR. Future studies should focus on optimal timing and dosing, longer-term applications, and other populations.
Study 2: Effects of Photobiomodulation Therapy and Restriction of Wrist Extensor Blood Flow on Grip: Randomized Clinical Trial
Read the full research: Florianovicz et al. 2020
Key findings about Blood Flow Restriction and red light therapy:
- The group that received 660 nm RLT + BFR had significantly greater wrist extensor strength gains compared to just BFR and the control group.
- Using 660 nm RLT wavelengths showed bigger improvements in handgrip strength compared to the higher 830 nm RLT group.
- Muscle activation, shown by EMG RMS, was highest in the 660 nm RLT group.
Study strengths:
- The study focused on handgrip strength, which is a vital marker of overall health and function.
- The use of EMG data offers a quantifiable way of measuring muscle activation.
- The randomized control study design improved the validity of the study results.
Study limitations and challenges:
- The study only looked at short-term applications, meaning longer-term benefits can’t be drawn.
- The application to specific populations, such as those in clinical settings remains uncertain.
- The smaller sample size makes it harder to generalize the findings to wider populations.
Our thoughts on Florianovicz et al. 2020
The results of Florianovicz et al. 2020 provide further evidence supporting the potential combined benefits of RLT + BFR for improving muscular performance. The significant increase in handgrip strength and muscle activation when combining both methods suggested that they may act synergistically to boost output.
The ability of RTL to enhance natural cellular processes and improve blood flow may reduce the hypoxic environment seen with BFR, promoting better muscle recruitment and improving force output. This increased performance during low-load activity may have important applications in rehabilitation settings, for post-injury recovery, and when high-load training can’t be performed.
Being an acute study, the short-term nature makes it hard to draw longer-term conclusions. Future research should focus on the long-term effects of combining RLT with BFR using different populations. Even with this caveat, this study shows promise for the future of RLT with BFR for performance.
Conclusion
Current research examining the combined effects of using RLT with BFR show promising complementary effects on muscle performance and recovery. BFR allows effective strength training under lower loads by increasing fast twitch fibre activation and metabolic accumulation. RLT activates natural healing processes at a cellular level and increases blood flow. Combining this with BFR seems to enhance its benefits and mitigate the potential drawbacks.
“Before, it was just ‘exercise helps pain and gets people moving’. Now we’re starting to see these little combinations like walking with BFR and adding a Move+ session afterwards.”
With this, combining RLT with BFR may improve functional outcomes, enhance rehabilitation, and reduce recovery time. While large-scale studies are warranted, the future of combining both treatments is promising. Structuring exercise programs to incorporate BFR’s mechanistic benefits with RLT’s bioenergetic and healing effects, clinicians may be able to achieve much better functional outcomes compared to using each treatment alone.
References
- https://kineon.io/blogs/news/red-light-therapy
- https://bmcsportsscimedrehabil.biomedcentral.com/articles/10.1186/s13102-020-00197-6#:~:text=The%20main%20mechanism%20of%20action,45%2C%2026
- https://www.mdpi.com/2075-1729/11/12/1339#:~:text=Photobiomodulation%20from%20red%20to%20near,resistance%2C%20and%20speed%20of%20recovery
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8811521/
- https://pubmed.ncbi.nlm.nih.gov/36556004/
- https://www.mdpi.com/2075-1729/11/12/1339#:~:text=Photobiomodulation%20from%20red%20to%20near,resistance%2C%20and%20speed%20of%20recovery
- https://www.mdpi.com/2227-9059/12/7/1524#:~:text=...%20www.mdpi.com%20%20...%20blood,on%20the%20expression%20of
- https://www.rehabilityjournal.com/articles/jnpr-aid1061.php
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7547166/#:~:text=Blood%20Flow%20Restriction%20and%20Its,loss%20associated%20with%20ACL
- https://www.liebertpub.com/doi/full/10.1089/photob.2019.4751#:~:text=Background%3A%20Total%20knee%20replacements%20,and%20swelling%20and%20aiding%20recovery
- https://pubmed.ncbi.nlm.nih.gov/32318813/#:~:text=Conclusions%3A%20%20LLLT%20pre,effective%20and%20complex%20manner
- https://pubmed.ncbi.nlm.nih.gov/32744919/#:~:text=obtained%20for%20handgrip%20strength%20for,with%20an%20increase%20in%20RMS
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10777545/
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