Blood Flow Restriction (BFR) Training: The Truth About Its Clinical Impact | Kyle Kimbrell, PT, MPT

Show Notes

In this episode of The Dr. JJ Thomas Show, we dive deep into the transformative world of Blood Flow Restriction (BFR) training with my dear friend and BFR expert, Kyle Kimbrell. We explore the science behind BFR and its remarkable benefits for rehabilitation and strength training and share personal insights on its application in clinical practice. As a passionate advocate for evidence-based treatments, I'm thrilled to bring you cutting-edge discussions that not only enlighten but empower our journey toward optimal health. Join us as we unravel the potential of BFR to reshape rehabilitation and fitness, making powerful healing more accessible to everyone.

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What is The Dr. JJ Thomas Podcast?

Welcome to The Dr. JJ Thomas Podcast! Here I'll be talking all things physical therapy, raw and unplugged, giving you the unfiltered insights you've been searching for in your cash-based physical therapy business. If you're caught in the grind of the traditional model, swamped with paperwork, or feeling like you're not reaching your full potential as a physical therapist, this podcast was created just for you.

Dr. JJ Thomas: 00:00

He was like, I don't understand why you're actually so expensive. And and I said, well, I believe we're worth it. And he said, what do you do that's so, you know, that makes you so worth it? And I said, well, Chelsea's about to show you. And after that visit, if you don't believe that, you could your fee goes somewhere else.

Dr. JJ Thomas: 00:12

Like, literally, that was the conversation. 100%.

Kyle Kimbrell: 00:17

Welcome

Dr. JJ Thomas: 00:23

Hey, everybody. Welcome to the doctor JJ Thomas podcast. I'm JJ Thomas. I am here today with one of my friends and rock star clinician slash educators, Kyle Kimbrell.

Kyle Kimbrell: 00:33

Hi. Welcome, Kyle. Hi.

Dr. JJ Thomas: 00:37

I will do a brief introduction into Kyle, and then, I wanna get into a lot of the nitty gritty of of why he's on and and some of the cool stuff he does. So, Kyle, gosh, I met him through my first BFR, blood flow restriction training, exposure years before COVID. And It was a time before BFR. Oh my gosh. It was a time before COVID, yes.

Dr. JJ Thomas: 01:02

And, I was impressed with BFR right away, but, it grew and grew since then. So, and Kyle's always been a great resource. So it's been great, you know, having you as a resource, Kyle.

Kyle Kimbrell: 01:14

Thank you. You're welcome.

Dr. JJ Thomas: 01:16

Kyle was one of the first, like, took the first courses with Johnny Owens and Yeah. Before when Owens Recovery Science was in its infancy. Yes.

Kyle Kimbrell: 01:23

Yeah. And Johnny was just a one man show. Yeah. Crazy enough.

Dr. JJ Thomas: 01:27

So one man and then Yeah. And then he so, yeah, tell us about that story. Tell me how that tell me how that came to be.

Kyle Kimbrell: 01:34

That's Well, it's kinda funny. So I I kinda Twitter stalked Johnny, honestly.

Dr. JJ Thomas: 01:42

You did?

Kyle Kimbrell: 01:43

I did. A little bit. A little bit. I didn't I didn't know who he was, so I had no real reason to Twitter stalk him. But I I saw that he was, going to be on this ESPN special that that Stefania Bell and Hannah Storm were doing, down, Center For the Intrepid on, Veterans Day.

Kyle Kimbrell: 02:04

This was probably must have been 2014. Yeah. Had to have been. So, I followed him on Twitter because they had tagged him, and and I just randomly I think it was one of his first 10 followers, and I said to him a message. And, and he responded back, and, and I had just some questions, and and he had I can't remember if he had mentioned on the the show with Stefania and and Hannah that they were gonna be teaching classes, but somehow the topic of of there actually being, like, classes to learn BFR had come about.

Kyle Kimbrell: 02:44

And I I knew what BFR was, just from picking up an article about 10 years prior, funny enough. And it and it had it was in the journal of strength and conditioning, and it they called it occlusion training, and it it didn't tell you anything about how they did BFR at all. No mention whatsoever of the device or the crusher that they used, any of that stuff, it was literally just, you know, use the lightweight 20 to 30% load, and when I read that I thought, wow, you know, if that's a thing, that actually really reshapes rehab as we know it. Because as you know, like, getting people to lift heavy is hard for a lot of different reasons for rehab. You know?

Kyle Kimbrell: 03:28

Yeah. And so I thought, man, I really wanna learn that if it's a thing. And, you know, it just so happened that that's what he was doing on that show. And, from there, I kept asking him, like, when is this thing happening? You know?

Kyle Kimbrell: 03:43

And in my mind, I'm like, dude, let's go. Just, like, get off the pot. You know?

Dr. JJ Thomas: 03:49

Yeah. Let's just me. Let's just show how I got my pen and paper. I'm ready to go.

Kyle Kimbrell: 03:53

You know? And and meanwhile, you know, he's, like, trying to build content and figuring out, do I leave this, like, amazing job in the DOD where, you know, making fantastic money, incredible job security, lots of influence. Do I just leave that and, sell my house to fund this business? And and, you know, that's what he's going through. And and and me, I'm like Right.

Dr. JJ Thomas: 04:20

And there's you.

Kyle Kimbrell: 04:21

Like, what's the date? You know?

Dr. JJ Thomas: 04:25

So finally How many CU's am I gonna get?

Kyle Kimbrell: 04:27

Exactly. Right? Yeah. I was like, god.

Dr. JJ Thomas: 04:29

Exactly. Right?

Kyle Kimbrell: 04:31

So, anyway, you know, like, he finally kinda gets everything sort of organized and started to think about having the classes, and he's like, dude, you just wanna host? And I went, oh, I never even thought about that. And so then I I had to

Dr. JJ Thomas: 04:45

convince my

Kyle Kimbrell: 04:45

boss to bring this guy in to strap tourniquets on our arms and legs and exercise. And my boss trusted me a lot, but that conversation did not go well initially.

Dr. JJ Thomas: 04:59

I can only imagine.

Kyle Kimbrell: 05:01

There were some choice words, and and some very absolute terms used, and I said I understand, but just listen to this podcast, and it just so happened to be a podcast that I had posed some questions to Johnny for and the he knew me from Twitter and the host knew me from Twitter, so they started making fun of my mustache because I had, like, this big must Lorax looking mustache with the beard at the time. And,

Dr. JJ Thomas: 05:32

That's great.

Kyle Kimbrell: 05:33

And so they make fun of me on the podcast, and, like, that was the thing that got the my boss to decide, oh, this guy was pretty alright. He's looking for the cow. Let's bring him in to do some product. You know?

Dr. JJ Thomas: 05:47

Oh my god. Look.

Kyle Kimbrell: 05:48

I'm just gonna though, I'm kidding. Making any of this.

Dr. JJ Thomas: 05:50

But I totally I respect that because you know what it showed? It showed that he's a straight shooter. Like, it showed that they were like, this is the this is the god's honest truth. Your mustache is a little funny. Yeah.

Dr. JJ Thomas: 06:01

That's awesome.

Kyle Kimbrell: 06:02

I just had to wear it all. You know?

Dr. JJ Thomas: 06:05

So You did. You wear listen. You you can wear it all. That's that is the god's honest truth too. That's cool.

Kyle Kimbrell: 06:11

Yeah. But that's that's really

Dr. JJ Thomas: 06:12

Oh my god. That's kinda

Kyle Kimbrell: 06:13

how it happened. And so then, you know, from there, Johnny came out. He told us what to do, and I just got super interested in the technique, You know? Yeah. Just trying to learn more about it, and and then he just was incrementally needing help because it was just snowballing big time.

Dr. JJ Thomas: 06:30

Blowing up. Yeah. Yeah.

Kyle Kimbrell: 06:31

So so I I just

Dr. JJ Thomas: 06:32

started doing all the West Coast stuff.

Kyle Kimbrell: 06:33

What's that?

Dr. JJ Thomas: 06:34

The first podcast you mentioned, was it, like, was it It was Johnny? Or was it No.

Kyle Kimbrell: 06:39

That was

Dr. JJ Thomas: 06:40

With somebody else?

Kyle Kimbrell: 06:41

With Ursun religioso and Gene Sharakobrod, and I think they had another guy. It was the therapy Cool. Therapy Insiders podcast. This was

Dr. JJ Thomas: 06:53

Oh, cool.

Kyle Kimbrell: 06:53

Was, like, 2015. Probably, like, early 2015, somewhere there. Yeah. So

Dr. JJ Thomas: 07:02

So for the people that don't because I know a lot of these stories, like, just from over the years, and I love them all. They they'll never get old for me. But but I think the one that is really important for people to hear is how the Center For the Intrepid kind of came upon the progression of BFR.

Kyle Kimbrell: 07:22

Sure.

Dr. JJ Thomas: 07:22

And, yeah. Do you mind sharing that?

Kyle Kimbrell: 07:24

Not at all. And and I would say that sometimes I get kinda lumped into being a part of this. I had no part in this part of the story whatsoever. It's just I've

Dr. JJ Thomas: 07:33

Yeah. But I've I've except that it wouldn't have grown if you weren't stalking me on Twitter. That's that's

Kyle Kimbrell: 07:38

my piece, you know.

Dr. JJ Thomas: 07:39

You're welcome,

Kyle Kimbrell: 07:40

Johnny. Exactly. On second thought, it's all me.

Dr. JJ Thomas: 07:46

It's all you.

Kyle Kimbrell: 07:47

Oh. Everybody needs a wingman. You gotta gotta have a wingman or a wing woman. It doesn't matter. You know?

Dr. JJ Thomas: 07:54

Or a wing woman. I can be a wingman. I'll be whatever.

Kyle Kimbrell: 07:58

Yeah. So Johnny Owens, our our founder and and kind of the the straw that has stirred the drink in some ways in the rehab world with BFR, he was working at, Brook Army Medical Center down in San Antonio, and he had gotten hired on to really take, like, a sports performance type job. But at the same time, we were in these wars, Iraq and Afghanistan. And so shortly after hiring on, they were like, yeah. So about that.

Kyle Kimbrell: 08:30

You know? We kinda got a lot of stuff we're dealing with here in terms of trauma from war. And and so he very quickly transitioned into, what he has just described as, like, a limb salvage role. Yeah. So the the chief ortho trauma surgeon, doctor Joe Hsu, who, he was featured on the Alex Smith stuff some, I think, and some other kind of high profile cases recently.

Kyle Kimbrell: 09:04

He he had come in and he and he approached Johnny and he said, look. You know, our people that have amputations, our people that have had them salvage procedures, they they really need kind of this sports loading approach to rehab as well because those tissues also respond to load bone, tendon, etcetera. And Yeah. The stuff on the table is great to a degree, but, I really want you to help me kind of need to look at better ways to to rehab these folks. So so that was kind of the start of it.

Kyle Kimbrell: 09:40

And then and then from there, the problem that they started having was guys and girls that got their lower legs blown up were going on to, like, later stage amputations after having all these procedures to save the limb, you know, and and going through all that. And and so the first thing that they did was they devised a an orthosis that helped those service members load that limb and ultimately be able to run. Like, that was really the main purpose of this orthosis was not only, you know, to help them walk, but in order to go back to service you have to pass these running tests and you could do that if you had a prosthetic and your leg had been amputated, but if you had a limb salvage procedure and you had had a difficult time developing some loading tolerance and ability to run, that was an issue. So, the device was very successful in that regard what they developed it was totally unique, totally custom made through by their prosthetist and orthotists there in Brooke Army Medical, and at this point they've had, this big facility built called Center For the Intrepid where, you know, all of them have offices it's just this incredible space where collaboration happens and a lot of innovation happens and that sort of thing.

Kyle Kimbrell: 11:02

So kind of following the the limb salvage and the development of the IDEO brace, they also started noticing a problem that about 25% of those people that had gotten the brace could never really get strong enough in their quad to to be able to use the brace and to run with it. And and that was that's problematic because that device is very stiff, and it has to be very stiff. But the stiffness of it allows it to kind of store and release energy much like a tendon does when you walk or when you run. I think one of the things that we we forget about sometimes is, like, even when we ambulate, like, it's very efficient because of just the stiffness and the elasticity of our tendons. Like, it there's not actually a whole lot of metabolic cost to walking because of that.

Kyle Kimbrell: 11:51

And so, you know, and and a similar thing is is is true for running, of course, there's a lot more energy expenditure with running, but you're still storing and releasing energy and these tenants have to do that and so the device had to be very rigid to do that. In so doing, your quad had to be strong because it has to kick in a bit there not necessarily more than just a normal limb that's uninjured, but it had to be sufficient and if the quad wasn't insufficient you could really harm someone's knee and have you know a not good kind of event just trying to run with that device. So, they're searching for ways to use lightweights to get bigger and stronger because they were having a really difficult time loading those limbs due to pain. You know the limbs are painful That's why they needed a device. In some cases, they could lift the quad, others they couldn't.

Kyle Kimbrell: 12:50

And so they started searching for, you know, solutions and kinda happened upon BFR. In so doing, you know, they they have a lot of exercise physiologists there near Center For the Intrepid at the Institute For Surgical Research, and so you know they get those guys in a room, they Johnny and the ortho people in a room, they have tourniquet experts down there, they got a lot of really smart people down there to start looking at this BFR thing and trying to figure out is this really a thing? You know? Like, none of us have heard of it. Why?

Kyle Kimbrell: 13:23

That kinda deal. And so

Dr. JJ Thomas: 13:25

That must have been cool to be in that room, like, part of that. Yeah. So cool.

Kyle Kimbrell: 13:30

And and I also think of that in the context of how people make a decision to use BFR now versus

Dr. JJ Thomas: 13:36

Oh, I know.

Kyle Kimbrell: 13:37

You know. You know. Like Exactly.

Dr. JJ Thomas: 13:39

Exactly. That's why I that and and and we'll talk about this later, but, like, not just to use BFR, but, like, to use occlusion as you're talking about. Like, in general, like, people are just, like, slapping crap on. Yeah. I'm like, oh god.

Kyle Kimbrell: 13:50

I know. We're asking for trouble sometimes, I think.

Dr. JJ Thomas: 13:54

Yeah.

Kyle Kimbrell: 13:54

So anyway, they, you know, they have this big round table and, you know, a lot of a lot of smart people, and finally decide to trial it. And they met with BFR researchers from around the US. The main one that they they really got to know is Jeremy Linneke, who's at University of Mississippi, and is probably one of the most prolific BFR researchers in the world. I want to say he's got over a 100 BFR publications, but that that might be a little bit of an exaggeration, but not much. Anywho, they start messing around with this PFR thing, and it was really it really was working well for those service members that that needed to get stronger.

Kyle Kimbrell: 14:31

And so they had a small cohort of people that they trialed it on. They all did extremely well in terms of regaining their ability to produce force out of their quad, and thus being able to use that IDEO device. So so from there, they kinda rolled it out into using it more and more at rehab, and it just kinda snowballed from there to the point where a device was developed, off of the stuff that they were using at Center for the Intrepid, a whole a whole new device was developed out of that. So then here we are.

Dr. JJ Thomas: 15:03

That's so cool. And here we are. And that's, like I said, I think I first trained in it in, I'm gonna say, I think it was like 2017, 2018 maybe. And then, I didn't actually buy my first unit though. I think then, it's funny, I didn't buy the unit right away and I didn't but we were talking about this a little bit, Brent.

Dr. JJ Thomas: 15:25

I didn't actually use BFR at that point yet because I was insistent that when I started using it, I was gonna use the unit that that they developed, because I just felt like it's a reflection of it's a reflection of things being done right. It's a reflection of, you know, I'm I'm a firm believer that, like, you need to be able to, stand by your product and, I just felt like the other the other options out there, I wasn't able to rely on in terms of knowing that I was giving them what I thought I was giving them. So so I finally, like, circled back and fulfilled my wish list a few years later. And I actually think I did buy it in COVID and then went from there. So, anyway, but what I wanted is what I wanted to actually mention was the like, the evolution.

Dr. JJ Thomas: 16:12

So through that time, I always followed BFR and the progression of the applications now

Kyle Kimbrell: 16:18

Right.

Dr. JJ Thomas: 16:19

And the evidence behind different applications is actually incredible to me.

Kyle Kimbrell: 16:24

Yeah.

Dr. JJ Thomas: 16:25

So I would love to talk a little bit about that. Like, from from my perspective, when I was first starting to explain EFR to patients, it was it was primarily for the, for the hypertrophy benefits, for the tapping into type 2 muscle fibers when you can't load a tissue enough. And then through, honestly, through COVID, I started listening to a lot of your podcasts, and, they're one of the only podcasts I'll listen to that's longer than 30 minutes, quite honestly. But I was saying because they're so good, like, there's so much content in there that is, research based and applicable that I just could, you know, it's worth it to me, the time investment. But, and then I started so opening my eyes to like I listened to the, the long COVID application, the PACER project, the, like, 10 like, application for tendons and bones and ACLR and I mean, the list goes on and on.

Dr. JJ Thomas: 17:21

So what's your perspective on that? What's your perspective on the growth of the applications? And, honestly, it's a free whatever you wanna say there.

Kyle Kimbrell: 17:29

I I, no, I appreciate that. And, and I and I echo that. I think that, I was just a a guest on another podcast last week, and the guy asked me what what really what I'm excited for with BFR. And I said, well, I'm really excited to see it moving more and more clinical. Like, seeing it being used in neurologic populations.

Kyle Kimbrell: 17:57

Like, I just reviewed a paper the other day on, BFR use in multiple sclerosis, people with pretty advanced multiple sclerosis. So we're we're seeing trials, you know, getting put together, for people. So we're we're seeing this exercise solution that, really is for hypertrophy and strength, and we're seeing it getting looked at by other groups that are saying, look. We've got exercise problems too. You know?

Kyle Kimbrell: 18:27

And Yes. Could this could this be a solution for us, and and how do we how do we navigate that? I I I've I've, you know, the the one of the fun things about doing what I do now, and being and also kind of being active on social media, honestly, as I've just met people from all different arenas of PT and rehab and physiology. And so I get to have a lot of fun, interesting conversations. And, you know, I've I I got a buddy that works a lot with, chronic fatigue or I I can never say it, but it's myalgic encephalopathy or something like that.

Dr. JJ Thomas: 19:06

You said it.

Kyle Kimbrell: 19:06

I know

Dr. JJ Thomas: 19:07

how you said it. I never

Kyle Kimbrell: 19:08

I think I got it right. It it always gets immediate in the CFS. And and now we're seeing that also be, like, long COVID ish, and people kind of going into that. And so, you know, you know, we've had these conversations to where it's just like, you know, exercise doesn't work for these people a lot of times. Mhmm.

Kyle Kimbrell: 19:28

You can't exercise them. Like, the littlest thing can really get their heart rate up, but it still seems like they need some sort of I mean, everything needs a stimulus to change. Right? This is a matter of what it is, whether it's our intelligence or our physique or whatever you there has to be the right stimulus. And so, you know, I can't help but wonder if well, can we just manipulate their blood flow a little bit That kind of mimics exercise.

Kyle Kimbrell: 19:50

Yeah. You know? Can we is it just a matter of finding the right load, if you will, you know, and figuring out how to how to dose it. So, you know, we've had conversations about that, and he's played around with it a little bit. So that stuff really gets me energized and and excited and wanting to learn more and work more with people.

Kyle Kimbrell: 20:11

But I also, I get concerned when people just I I I don't want people to forget about the hypertrophy and the strength because I I, like like

Dr. JJ Thomas: 20:23

Oh, yeah.

Kyle Kimbrell: 20:23

The skeletal muscles, so important for our health in general. You know, in the the there's we have a we have a paper that we use in the in the class now, which I don't I don't know if it's new since you've taken it or not, but, you know, I think it was year 2,002, the US spent something like $200,000,000,000 managing just the the limited amount of muscle mass that people have because of the complications that it has to do with surgery and and and and mortality and all of that. And so I just think that, as PTs or or just anybody in the in the rehab world that works with people, the more we the better we understand skeletal muscle, the better we understand just like what our patients are going through and what's happening because of just their reduction in activity and those sorts of things, I think we're just getting that much better at prescribing exercise if we if we better understand that, you know? So we it means we were earlier. You know?

Kyle Kimbrell: 21:31

But, it means we also have recognized that.

Dr. JJ Thomas: 21:34

Yeah. A couple things follow-up to the things you said. 1, yes, on the front end, like, we actually had a patient recently. I find myself utilizing it for more and more things

Kyle Kimbrell: 21:46

Mhmm.

Dr. JJ Thomas: 21:46

Because of the podcast and because of the research that you guys, put out there. And, like, I'm not concussion vestibular specialized, but one of my therapists is. And she had a long COVID. 1 of my actually, a family friend, is an athlete. Long COVID symptoms, concussion type sim like, I say concussion, but vestibular

Kyle Kimbrell: 22:05

Yeah.

Dr. JJ Thomas: 22:05

Yep. Fatigability, those kinds of, brain fatigue, brain fog. And she just started using BFR with her, and and she's seeing good results. So it's really cool. Like, that's the cool side of of the new applications and seeing it actually, you know, seeing it work clinically.

Dr. JJ Thomas: 22:22

And then but on the flip side, first of all, I can't imagine if anybody uses it and uses it well and correctly that they could forget about the musculoskeletal piece because it's, you know, it's, BFR was the one tool outside of needling that I felt like I could show my patients immediately that we could help them.

Kyle Kimbrell: 22:40

Yeah.

Dr. JJ Thomas: 22:41

Like, for me, most people feel a difference right away and you just can't deny that. So as a therapist, when your patients are seeing that and they're, a lot of them are skeptics because they've been through other things and, yeah, and they're like just like you said explaining it to your boss, like, you're strapping this cuff on and they're like, what? Yeah. Yeah. But

Kyle Kimbrell: 23:01

Yeah.

Dr. JJ Thomas: 23:02

But, but they the minute they feel they you know, you take that cuff off and then they walk down the stairs and they're feeling better, they're like, woah. Alright. When are we what day What do you have tomorrow? Right. You know?

Kyle Kimbrell: 23:13

Right.

Dr. JJ Thomas: 23:14

So, so that's cool. But another question that brings me to is, like, I've had some same social media conversations with, colleagues, other PTs who who are using BFR but haven't necessarily taken Owen's recovery science courses. And, of course, I am a big proponent of the way you guys do things and, I think it's important. But what so what advice can you give, therapists that are looking to learn BFR in terms of what, you know, what they need to what they need to know in order to be trained well?

Kyle Kimbrell: 23:47

Yeah. I mean, personally, I think you you you need to take an in person course and that that exposes you to using BFR. You can do that in an Owens recovery science course for sure. There are other courses also. I just don't think that you can I I can't I can't imagine personally doing this, like, taking an online class and then deciding to try this on a patient, like, not having done it myself, I just personally would not do that?

Kyle Kimbrell: 24:21

I'm not saying you can't, but I I just think that it it it makes it that much more difficult, to have the conversations that you have to have when you're working with

Dr. JJ Thomas: 24:31

Yeah.

Kyle Kimbrell: 24:32

A patient. You know? And it and it I guess it just kinda makes me wonder how good you are at having those a little bit if that's if that's all you've done

Dr. JJ Thomas: 24:41

is, like,

Kyle Kimbrell: 24:42

done an online thing. You know?

Dr. JJ Thomas: 24:44

And I'm putting myself in this in the shoes that you're talking about. Like, I know, like, giving having the I actually took so I took your course twice

Kyle Kimbrell: 24:54

Yep.

Dr. JJ Thomas: 24:54

Because I took the one, then I didn't buy the unit because I I Oh, I bought the

Kyle Kimbrell: 24:57

thing too.

Dr. JJ Thomas: 24:58

Yeah. I was having a hard time swag. So then I took it again because I was like, shit. Do I remember what to do? I better just I so I took it again, so that was actually really cool.

Dr. JJ Thomas: 25:07

I might have taken it 3 times, honestly. I'm hilarious. But, anyway, but the point was that just having that confidence of being able to navigate, as you said, you do one set of exercises with a patient when your goal is hypertrophy and then depending on how they tolerate it or how they respond, that decision making tree of, like, do I do a second set now? Do I you know, because actually what prompted this was I was I was messaging with a, you know, a colleague and, who's, like, in a different state, and we were talking about BFR and he was like I told him how I, you know, we usually do 3, 4, like, we work up to 3, 4 sets of, like, for rotator cuff, say, and he's like, woah, you do? We do, like, 1.

Dr. JJ Thomas: 25:53

No. I was like, well, dude, you probably need to be doing more, but, you know, you have to make sure that you're able to navigate, as you said, the patient's comfort and their response and all those things. Right,

Kyle Kimbrell: 26:05

for sure.

Dr. JJ Thomas: 26:06

Yeah. It's funny. But I was surprised to hear that is what that's what prompted the question exactly because I thought, I guess that's true. I guess if you haven't trained with people who are saying, like, these these are protocols we use and, this is what seems to work for us, then it's a little bit of a toss-up.

Kyle Kimbrell: 26:20

That's one of the things I really like about exercise. You know? Like, I I think our our profession everybody thinks their profession is tough. You know? Like, that's just the way it goes.

Kyle Kimbrell: 26:31

But, like, ours I mean, everybody, like, it counts. It doesn't matter what you do. Like, you think your profession is Yeah. And I'm not saying it's not Being you're right. But just also get over yourself.

Kyle Kimbrell: 26:42

Come on. Yeah.

Dr. JJ Thomas: 26:44

It's true.

Kyle Kimbrell: 26:44

But the difficulties that we have in our our profession is that it's really hard to say, well, how many visits are you gonna need? And what's the response gonna be to this intervention or that intervention? Kinda like you mentioned with tri needling or or BFR.

Dr. JJ Thomas: 27:02

Yeah.

Kyle Kimbrell: 27:03

You know, like, how many times like, for example, and I I tell this to students every like, so one of the fun things that I get to do is I get to talk to a lot of PT schools now that I love talking to students because they're, like, bright eyed and bushy tailed, and I like to kinda just smash that down a little bit. Not not really. But I do like to kinda just ask questions and challenge a little. Right? And so I'll never forget, like, being a PT student, I still think about this.

Kyle Kimbrell: 27:30

And every clinic I went into, I wondered, is is anybody ever gonna tell me, like, how long do you have to range of motion in knee before it before it gets to rage? Like, I mean, the most basic freaking thing we do JJ. Like every clinic like somebody's in the clinic doing this right now while we're talking.

Dr. JJ Thomas: 27:56

That's so funny.

Kyle Kimbrell: 27:57

And they haven't even thought about the fact, like, how long do you have to do this? How many visits a week do you have? You know, like and so I Yeah. The one thing I like about all that I'm leading up to, a point. I promise.

Dr. JJ Thomas: 28:09

I don't care.

Kyle Kimbrell: 28:10

I'm having fun. With exercise, we actually kinda have some answers. You know? Like

Dr. JJ Thomas: 28:16

Yeah.

Kyle Kimbrell: 28:16

I mean, in in in in credit to Zach who couldn't get on today because he was I don't know. His Google was messed up or something. But one one of the things he has has made a point of of bringing up a number of times, and we've just kinda integrated into our teaching is this this idea of if you want to add muscle you really need about 10 sets per week of activity exercise in that muscle, to get that muscle to grow. And and, you know, and we kind of infer strength with that. It's not necessarily accurate, but we can kind of infer a little bit of increase in strength when you when you get hypertrophy.

Kyle Kimbrell: 28:56

And so if you think about, like, BFR, for example, we have these 4 sets 30, 15, 15, 15. So we just kind of call those 4 sets. It's not, you know, some might kinda shrink it and say, oh, it's just one set because it's just one inflation. We think about the the, excuse me, the inflation as the set, but it's actually probably more like 30, 15, 15, 15, but 4 sets. And 2 of those sets, if you really have, like, the pressure good and the load good, 2 of those sets are terrible.

Kyle Kimbrell: 29:28

Like, they're hard. You know? It's They're fine. So you get 2 sets that are in a whole bunch of fatigue, which, you know, fatigue is key for getting muscle to change. So if you pull back from that and you go, alright, let me just look at this chart.

Kyle Kimbrell: 29:43

Like, I know I get the load right. I know I get the pressure right. I need this person's quad to get bigger and stronger. It you can just do math on it. You can go, okay.

Kyle Kimbrell: 29:52

Well, the only quad exercise they did was this one BFR of long arc quad. So if I take that 10 sets and I go, well, I got 4 of this person's coming in Monday Thursday. I only got 4 sits on Monday, and I only got 4 sits on Thursday. You get it on the camera. Now now now I know just from the math that this person might not have done enough to gain muscle.

Kyle Kimbrell: 30:18

Right? And so I can just use that as a way to kinda go check that box When that person leaves, now I at least know, hey. We were gonna have to add another exercise next time they come in. Right? Or they did enough.

Kyle Kimbrell: 30:34

And that feels good as a therapist to just kinda check that box and go, we earned some muscle today. We did some real good for that person. They gotta repeat it. That's right. You know?

Kyle Kimbrell: 30:43

But they at least because it's so hard to really have that sense of satisfaction. I'm like, that's why I love mowing the grass. Because when it's done, it's like, looks great. Right?

Dr. JJ Thomas: 30:53

See it.

Kyle Kimbrell: 30:53

It looks amazing. Like, I want a lawn business just because of that, you know, to, like, counterbalance the the uncertainty in my life.

Dr. JJ Thomas: 31:02

That's so funny. Yep. But then you'll be then you'll just like you said, every profession thinks their job

Kyle Kimbrell: 31:08

starts, so

Dr. JJ Thomas: 31:08

then you'll be in the lawn business. You'll be like, man, I really wish I could go into PT and teach people some BFR.

Kyle Kimbrell: 31:14

Tell it, dude. But

Dr. JJ Thomas: 31:16

yeah. It's funny. The so talking about the load stuff, you, what was I gonna say? The, gosh. I just lost my train of thought.

Dr. JJ Thomas: 31:32

I'm sorry. Thinking about the, thinking about the lawn.

Kyle Kimbrell: 31:35

I just distracted what you're gonna say. You're thinking about nice, clean-cut grass.

Dr. JJ Thomas: 31:41

I was. I was. But when you talked about I mean, for those listening who haven't tried BFR Yeah. I will say it's tough when you do it right. But, also, so I I tore my ACL, I remember, a little over a year ago.

Dr. JJ Thomas: 31:55

Right. And, I will say, like, BFR post op was a whole another mental game for me. Then, oh, man. I went to a dark place. I would go in the corner of the clinic.

Dr. JJ Thomas: 32:07

I was like, JJ is not home. You people don't talk to me. Don't look in my direction. In fact, don't even walk where I can hear you because I really need to dig here. Sam was not pretty.

Kyle Kimbrell: 32:20

Stop breathing. Do not come near me empty.

Dr. JJ Thomas: 32:22

I am not kidding. I would literally face the corner because if I saw people, I would get, like, annoyed at them that they walked in my field of view.

Kyle Kimbrell: 32:29

So funny. That's really funny.

Dr. JJ Thomas: 32:32

I know, but it worked. I mean, it's worth it. It's like, you know, it's worth it.

Kyle Kimbrell: 32:36

Yeah.

Dr. JJ Thomas: 32:37

So, yeah, it's been it's been a huge game changer. Thank you for continuing to train everybody in it. And I do you have any idea of how many how many therapists have trained through Owens Recovery Science? That's a that's a random question to ask you, like, on the fire.

Kyle Kimbrell: 32:52

Certified, around I wanna say around 15,000 people now. It's not That's rare. Not all PTs. You know, it's athletic trainers, PTs, PTAs, OTs, chiros, strength strength Yeah. Strength and conditioning, are all up in there, I think.

Kyle Kimbrell: 33:10

But, yeah, we've trained a lot of people.

Dr. JJ Thomas: 33:12

Yeah. I know a lot of the teams, like, have them in bulk. I mean, have many units for, like, recovery, and it's awesome.

Kyle Kimbrell: 33:19

Yeah. The, well, the Eagles, who

Dr. JJ Thomas: 33:24

Yeah. They do.

Kyle Kimbrell: 33:25

Didn't have such a good weekend.

Dr. JJ Thomas: 33:27

No. It's not the year to

Kyle Kimbrell: 33:30

My mentioning will caution me now. But last year, they they put out on social media their their offensive line or defensive line or somebody. It was, like, doing a little BFR exercise after after it gave Yeah. Doing a a BFR recovery exercise, if you will.

Dr. JJ Thomas: 33:45

Well, and I think they had a bunch of them on the bike. Bunch of

Kyle Kimbrell: 33:47

them on bikes. Yeah.

Dr. JJ Thomas: 33:49

They at least yeah. Yeah. Well, I don't think the BFR was the problem this year for them. Yeah.

Kyle Kimbrell: 33:56

They started all so good. Like, they look like

Dr. JJ Thomas: 33:59

I thought so.

Kyle Kimbrell: 34:00

I mean

Dr. JJ Thomas: 34:01

I just refuse to be a I refuse to be a hater. I'm supporting my boys. Yeah.

Kyle Kimbrell: 34:05

We got it.

Dr. JJ Thomas: 34:05

I'll be there for you when you're down. It's alright. We're human. You're human. Everybody's human.

Kyle Kimbrell: 34:10

Well, I I don't think We got another year. I don't think there's any other town that has the energy for fandom like Philly, you know.

Dr. JJ Thomas: 34:19

Oh, that's

Kyle Kimbrell: 34:20

I I

Dr. JJ Thomas: 34:21

don't know if I should take that as a compliment.

Kyle Kimbrell: 34:22

You should. I love it. I I you are enemies. Good. It is vulgar at times.

Kyle Kimbrell: 34:28

It is unreasonable. And I'm here for all of it. I find it so entertaining. Well, you know. Yeah.

Kyle Kimbrell: 34:36

I

Dr. JJ Thomas: 34:36

I mean, I will say I'm not I am a I'm a fan. Yeah. I can be vulgar, but not at my boys. I'm very loyal to my boys. So,

Kyle Kimbrell: 34:45

Yeah. I I I I love I love that energy. I think it's fun.

Dr. JJ Thomas: 34:49

I mean, that's about most of my questions. I'm trying to think if there is anything. Is there anything else? Oh, I know. We were just talking about the cuff and the one last thing I did wanna get out of you, if you don't mind, and I know it's probably a delicate thing, but the quest the question I get a lot or not even question, but therapists will tell me, oh, we don't have the Cadillac unit like you have.

Dr. JJ Thomas: 35:11

You know? Like like and so the differences in the units and the cuff and, just your take on that. To me, it's important. I already said that early on in the in the in the show that, to me, the the quality that you get with the Delphi units, and the intention behind the size of the cuffs and the real time Doppler measurements and every all the safety features to me are really important, but I'd love to hear your perspective on on it.

Kyle Kimbrell: 35:39

Yeah. It's it's layered for sure. I I think, you know, as we were talking kinda off air, the big barrier for people buying the Delphi unit that that we sell is cost because it's an expensive device. It's, you know, $5,000 for the basic unit. And, honestly, like, that shuts the conversation down right there immediately a lot of times.

Kyle Kimbrell: 36:08

Mhmm. And I I I understand that, I I think, to a degree. I do. I I I especially understand it in the the PT marketplace and where it is now in terms of payment and and all of that because it's, at least, you know, if you're straight up insurance based, it just kinda keeps getting worse and worse and worse. So I I

Dr. JJ Thomas: 36:29

I

Kyle Kimbrell: 36:29

get it. At the same time, I think that just looking at and this is what I said to you. I said, I think if you're just looking at upfront cost, that's not really a full cost analysis. You you have to kind of consider, is there any risk to you as a business owner, as a clinician, if you're using a device that does not meet standards that we have for tourniquets and and devices that are that are already out there that have been well established, and go back decades. So I think that's potentially problematic.

Kyle Kimbrell: 37:12

And one of the things that I actually have wanted to do for Owens, and I've just never done it, is to, like, hire a malpractice attorney and just, like, actually get them to to work something up. Like That's awesome. Do you think there's risk? Do you know what do you think in terms of, like, how would you approach this if there was harm done? You know?

Kyle Kimbrell: 37:29

Like, what would

Dr. JJ Thomas: 37:30

I'm gonna ask I I I might able to help you with that. I I happen to know the guys that did the, the dry needling Uh-huh. Research for, potential injury risk, when dry needling was first coming out and there were some. So maybe I can reach out to them and see if because the insurance company actually offered to do it. Interesting.

Dr. JJ Thomas: 37:52

So they had people on staff that yeah. Interesting. So I'll check into that. I think that's brilliant. Yeah.

Dr. JJ Thomas: 37:57

But, gosh. I hadn't thought of that when I asked you off air, but I think that's that's right. Like, in retrospect, I think that's why I didn't buy any unit. Like, when I when I originally didn't feel like I had the funds that I could put into it right away, I looked at the other units and I was like, I'm not gonna do that. I don't know if it's safe.

Dr. JJ Thomas: 38:15

I don't even know if I'm gonna get the results I want. Like, to me, it was all about the results. And I'm like, if I don't get the right unit, then I'm not I don't even know if I'm gonna give them the results. So, but I didn't even think of the risk factor. So that's huge.

Kyle Kimbrell: 38:27

You know, and and the the counterargument to to all that is people will say, well, people have used knee wraps and lots of other devices that that don't do the things like Delphi does in in research and have gotten results and that sort of thing. And that is true. It's accurate. However, the vast majority of those are not being applied in the clinical scenario, number 1, which is

Dr. JJ Thomas: 38:54

Yeah.

Kyle Kimbrell: 38:55

Brings up a big Retirement. Kind of important piece there, because you can do BFR in a lot of ways. There's there's no denying that. We can't we can't argue against that. I would never argue against that.

Kyle Kimbrell: 39:07

But, you know, what I do to myself is a little bit different than what I do to a patient. Right? So we have, you know, added layers of just rigor in terms of our thought and, our execution of things. So so I think you have to kinda take that into consideration and just kinda just think it's the same. I don't I don't I don't really follow that line of thinking.

Kyle Kimbrell: 39:36

So I think you gotta you gotta kinda go a different direction. There are things that we know about restricting blood flow. Like, for example, we know that we need kind of like a wider cuff to fully occlude blood flow and there are a number of devices on the market that do not meet that. They're not wide enough which ultimately means in the leg they can't create full occlusion. That's been shown in a in a few different research papers.

Kyle Kimbrell: 40:08

In fact, one, the title was, you know, looking for a more affordable kind of solution, essentially, kind of saying, like, well, the Hokanson device, which you see used a lot in BFR research, is not really attainable. And then, of course, Delphi is is is is expensive, and and we restrict who can buy it, you know, for for reasons. Yeah. Yeah. And so, you know, the just knowing that the device actually has the capacity to do what you need it to do is another piece, you know, that I see getting missed a ton Exactly.

Kyle Kimbrell: 40:41

Not considered. A ton. And and and we're actually seeing, even in the literature, studies coming out where people have misapplied things like an algorithm that Jeremy Linneke came up with to help determine limb occlusion pressure. You know, Jeremy, you know, showed that it was pretty accurate with the devices that he was using But then what people have done is they've taken it and they've applied it, like, with, for example, and not to bash any any company, but, there's been a number of studies that have used that algorithm with the BStrong device. And the BStrong device, if you're unfamiliar, it's it's not as wide as the Delphi.

Kyle Kimbrell: 41:24

It it it I think they do have a couple different widths. I'm not exactly sure about that. But the main thing, their main selling point if you will, is that they're a multi chambered device which means they can never occlude. No matter how high you pump it up, they can never occlude. Well, if you can't occlude then that means you don't have a way to determine limb occlusion pressure.

Kyle Kimbrell: 41:47

And so what some researchers have done is they've just taken the width of that multichamber device, and they've applied Jeremy's, algorithm to it, but they've ignored the fact that the manufacturer actually says you can never occlude with this device, and they have videos on their website demonstrating that. You know? So Oh my gosh. You know, I just think it's important that whatever device you use, you have an understanding of what that device can and cannot do and you're able to support it. You know?

Dr. JJ Thomas: 42:17

Yeah.

Kyle Kimbrell: 42:17

And that's where things fall down a little bit for some of the other devices is they just haven't really been developed in ways that comprehensively kind of evaluate their capabilities. You know, I think the the one device that was in that affordable study was getting sold, you know, and telling people that they're getting this pressure and they weren't getting that pressure. And we figured it out just from an Instagram video because strangely enough, there's this prominent PT that's using the device and he's got, like, a cross country let rudder leaning against the table, and it said his limb occlusion pressure was 270. And I went, they no way that dude's limit collision pressure is 270 on a Delphi. I know that for sure.

Kyle Kimbrell: 43:08

Well, come to find out that device maxes out at 270. So what it would do is if it maxed out it just gives you that number instead of telling you you can't determine a pressure. Well, that's

Dr. JJ Thomas: 43:22

that's not a that's not that's kinda dishonest. That's different information. Yeah. Exactly.

Kyle Kimbrell: 43:26

I mean, it just shows me that you haven't done

Dr. JJ Thomas: 43:28

your due diligence.

Kyle Kimbrell: 43:29

You know? Not the clinician. I'm just saying the device company. You know? You didn't do your due diligence.

Kyle Kimbrell: 43:33

So

Dr. JJ Thomas: 43:34

Yeah. But, honestly, I said this to you off air. I I know. That's I was telling Kyle I'm just gonna share with the listeners. I was saying how, like, I actually I use the Delphi and the Owens Recovery Science training sometimes as a measure of a therapist's standards when because I get patients all the time who want recommendations for PTs anywhere around the country.

Dr. JJ Thomas: 43:59

And if I don't know someone in that specific area, what I'll do is I'll search Owens Recovery Science, I'll look for somebody that has been trained for them, and then I know that they have high standards because they don't mind essentially paying for the best I have committed resources. And that's Literally yeah. I mean, to me, it says a lot. I'm not saying that if you don't have a Delphi, you're a bad therapist, but I'm saying if you do have a Delphi, I know that you have a good therapist.

Kyle Kimbrell: 44:27

Yep. That's Right?

Dr. JJ Thomas: 44:28

There you go, PTs.

Kyle Kimbrell: 44:29

There you go. Sweet shit. I mean, I You think I

Dr. JJ Thomas: 44:31

was you think I

Kyle Kimbrell: 44:32

It's it's it's fair.

Dr. JJ Thomas: 44:33

I think it's fair. You

Kyle Kimbrell: 44:35

know? Like Yeah.

Dr. JJ Thomas: 44:36

You think I swear I'm not getting a kickback, people. Like, this is just the way my brain works. Like

Kyle Kimbrell: 44:40

the big I'm always fascinated. And since we're kinda talking money a little bit here, and I know your podcast kinda talks about everything.

Dr. JJ Thomas: 44:48

So, like, I'm I'm like,

Kyle Kimbrell: 44:49

I do not ask for discounts. You know? I'm like Yeah. If your service costs whatever, I'm happy to pay for your service because it means I can't do it myself. Like, my barber, I'd literally, like, double that dude up.

Kyle Kimbrell: 45:07

You know?

Dr. JJ Thomas: 45:07

I know.

Kyle Kimbrell: 45:08

Like

Dr. JJ Thomas: 45:09

It's insurance. Right?

Kyle Kimbrell: 45:11

Like, I

Dr. JJ Thomas: 45:11

want him to be happy.

Kyle Kimbrell: 45:14

I'll let him know, and I appreciate his service. And he's only got half of a face to deal with too.

Dr. JJ Thomas: 45:21

I know. Can you double imagine that? But that also at the top. It's

Kyle Kimbrell: 45:26

You know?

Dr. JJ Thomas: 45:27

It's also because you want if you need him, you want him available. It's like it's like insurance. Right? I I think. I mean, I don't know about you, but I I do that with with hairstylists and babysitters.

Dr. JJ Thomas: 45:39

Yeah. They get paid very well because I want them to wanna take upset. That's so funny.

Kyle Kimbrell: 45:45

And and I don't wanna I don't wanna feel like I should be discounting my service. Like 100%. I'm forgetting every damn thing I can give you when you come take a course Yeah. With me.

Dr. JJ Thomas: 45:57

That's right.

Kyle Kimbrell: 45:57

And you're getting all of it. I'm crushed after these courses. You know? I'm just, like, exhausted. And and and by the way, you're

Dr. JJ Thomas: 46:04

getting it

Kyle Kimbrell: 46:04

all week every week because you got my phone number now. You got my email. You can reach out to me anytime.

Dr. JJ Thomas: 46:10

You can stalk them

Kyle Kimbrell: 46:10

on Twitter online. Twitter. You know? Like, it is open access. You know?

Dr. JJ Thomas: 46:16

That's right.

Kyle Kimbrell: 46:17

And, you've paid for that in my mind, and I I and you deserve that from me, and you have it if you want it. But that's kind of the approach I'm with you, so I expect I know. Do unto others is is is really kinda what it comes down to at some point. The golden rule, do unto others. This is how I wanna be treated, so this is how I'm gonna treat people.

Kyle Kimbrell: 46:36

You know?

Dr. JJ Thomas: 46:36

I'm with you, and I don't wanna treat people that don't like right. If somebody's asking for a discount oh, on the reverse side, like, I I had a guy recently. He was working with one of my PTs and I overheard him, like, giving haggling her about how expensive he said we were. And I was like and I I was like, can I help you out? And, later, she was like, thanks for taking that.

Dr. JJ Thomas: 46:58

But I was he was like, I don't understand why your show is so expensive, and and I said, well, I believe we're worth it. And he said, what do you do that's so you know, that makes you so worth it? And I said, well, Chelsea's about to show you, and after that visit, if you don't believe that, you could your fee to go somewhere else. Like, literally, that was a conversation.

Kyle Kimbrell: 47:14

100%. Right. We'll we'll deliver. We'll deliver. Yeah.

Kyle Kimbrell: 47:18

And if you don't Yeah. If you don't,

Dr. JJ Thomas: 47:19

well So Okay.

Kyle Kimbrell: 47:20

Don't spend the money again.

Dr. JJ Thomas: 47:21

Kyle, this has been awesome. I am sorry did Zach couldn't make it. I, I will Zac, we will have you back

Kyle Kimbrell: 47:27

because we're plenty of content though to come back at us.

Dr. JJ Thomas: 47:30

I know. I know. You can actually you can come back and talk about Kyle's beard and and whatever else. But, yeah, Zach is a a brain and listening to him, I actually would take the course with Zach over and over again because there's so much research content he gives that I learn more every time. So we will have you back, Zach.

Dr. JJ Thomas: 47:52

And, for everyone else, check out No One's Recovery Science. If you're not already following them on their podcast, on their website, look for Con Ed courses. They're just awesome humans to follow and listen to and and be friendly with anyway. Kyle, is there anything else that they should check out, regarding Owens Recovery Science?

Kyle Kimbrell: 48:10

Or I mean, our website is Owens recovery science.com, and the podcast is Owens Recovery Science. Just Google that, and you'll you'll find it all. And then just, you know, follow along as we continue to navigate this BFR thing. You never know where it's gonna go. So I love it.

Kyle Kimbrell: 48:26

In the outer space now, so you never know.

Dr. JJ Thomas: 48:28

You're right.

Kyle Kimbrell: 48:29

NASA and all that now. So

Dr. JJ Thomas: 48:31

Are you oh my gosh.

Kyle Kimbrell: 48:33

The coolest one of the coolest, conferences I've been to, JJ, was one, that that that the folks, they are they're called ACERS, which is basically, like, an acronym for an acronym. Is that right? That's probably right. Yeah. Acronym.

Dr. JJ Thomas: 48:48

I think so.

Kyle Kimbrell: 48:49

For, just people that help recondition the astronauts after they come back from the International Space Station. So,

Dr. JJ Thomas: 48:57

we're working with

Kyle Kimbrell: 48:57

them on some stuff. And,

Dr. JJ Thomas: 49:00

they have a

Kyle Kimbrell: 49:01

little, like, rehab conference that they're doing. So yeah.

Dr. JJ Thomas: 49:04

Yeah. This is what I'm saying. I mean, this is like, you guys are the the people I have on the podcast, in case the listeners haven't figured out, are people that I wanna surround myself because they're always looking to be better. Like, that's why people like you guys are on here because I wanna be around you because the the the bar is always moving.

Kyle Kimbrell: 49:21

We wanna be around you too, JJ. We enjoy you as well. So this is a mutual. It's mutual.

Dr. JJ Thomas: 49:27

I appreciate that. Alright. Well, you go have a great night, Kyle. Thank you to all the listeners, and, and we'll we'll we'll catch you guys next time. Bye.