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Dr. Nicholas Rolnick - Blood Flow Restriction Training Expert

@thehpm

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The Human Performance Mechanic DPT
🕺I help people with back pain keep training and feel amazing
📚80 peer reviewed articles
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Your shoulder has been treated for months. Nothing sticks. Have you considered the real source might be your neck?

Cervical-referred pain is one of the most commonly missed diagnoses in upper extremity presentations. I see it every day in Manhattan.

If your shoulder, elbow, or arm pain doesn’t make structural sense, that’s exactly the kind of case I work with.

📍 Manhattan, NYC

🔗 Link in bio to get in touch

#NeckPain #ShoulderPain #CervicalSpine #PhysicalTherapy #backpain taken in CompleteBody by @thehpm

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6 months ago

It’s #physicaltherapy. Not #massagetherapy.

Here’s a snapshot of a #hamstringrehab case.

We’re #training with a purpose. taken in PHIT Well by @thehpm

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a year ago

Sometimes it just be like that. taken in CompleteBody by @thehpm

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How precise does BFR really need to be? And does more precision always mean better results?

New episode of the BFR Better for Results Podcast is live. I sat down with Dr. Warren Bradley, PhD, co-founder of Hytro, to debate the trade-off between the “ideal” protocol and the one athletes will actually use consistently.

We get into:

How much pressure precision actually matters
What the evidence says about BFR for recovery
Intermittent BFR and neuromuscular recovery
BFR during aerobic work
Safety screening and why tolerance matters
Reperfusion and vascular response after cuff release
Practical BFR vs clinical cuffs
How pro teams use BFR for recovery, warm-ups, and travel
Hytro’s funded PhD research program and where the field is headed
Lab meets real world. Some agreement, some pushback, all useful.

Listen or watch now on Apple Podcasts, Spotify, and YouTube. Link in bio.

#BloodFlowRestriction #BFRTraining #SportsScience #AthleteRecovery #PhysicalTherapy taken in CompleteBody by @thehpm

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It really be like that sometimes. The most random people critiquing #bodybuilding or offering #fitnesstips with absolutely zero credentials or expertise.

Imagine some random coach critiquing #Cbum for his posing. 😂 by @thehpm

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Amazing how that happens.

Like a sniper, getting some #backextension can suddenly address lingering issues that has nothing to do with your #hipflexortightness and more about #backmobility taken in CompleteBody by @thehpm

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#lowbackpain #physicaltherapy is pretty much guaranteed to have some #backpain flare at some point. This is almost necessary as the goal is to help push physical capacities and reset the neurological system. Yes, we address impairments (like strength), but no, impairments don’t matter as much as people think. If they did, we’d have a cure for #lowerbackpain, but we don’t. There’s alot of different ways to approach rehab, and the most effective way is a mix of both approaches. And having a flare is a part of that approach. Normally, the inclination is “I’m doing more damage” when pain increases, but we know that is just not the case. It is a protective response. The key is embracing it as a temporary overshot of current capacities, and just have a strategy to gently continue pushing out boundaries. Keep addressing what needs to be addressed through physical examination, keep working on movement patterns etc., but know, the flare will pass and you will be stronger for it.

Do you avoid flares in your rehabs? Why or why not? What do you do when you flare? Let me know. taken in PHIT Well by @thehpm

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One of my go to beginning to advanced exercises - meaning it is appropriate for everyone all the time because of the stability it has as well as the overall ability to enhance its execution via manual cueing. For those with sensitivities in sitting from #neckpain or #lowbackpain, maybe we’d want to keep the spine in more extended positions. That’s fine, let’s load it. For those that need more tactile cueing to encourage proper form, book it! All in all, the fine-tuned ability of this machine to address everything we’d need in a #strengthtraining program targeting the lower #latissimusdorsi.

Remember: rule 1 of #bodybuilding is don’t get injured. Number 2 rule is optimize your movement patterns before trying to load them. Easier to hit the targeted muscles for better longevity and reduced compensations.

For this pattern, I showed my client’s difficulty in adducting the shoulder without excessively recruiting the middle scapular muscles. This is both a coordination issue as well as a load based issue. The machine allows us to add as much support as needed to normalize the pull. Then we load. taken in CompleteBody by @thehpm

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The most-cited exercise trials in our top journals often don’t tell you how hard patients worked...and I thought the #bloodflowrestriction literature was bad at reporting!

Researchers in this preprint took the 5 most-cited trials each year from 2015 to 2024 in Q1 #physiotherapy journals: 50 trials and 3,556 patients with #lowbackpain, knee OA, #patellofemoralpain, tendinopathy, and shoulder pain.

1 in 3 never reported intensity!!!!!!!
Of those that did, 42% used vague descriptors such as “the last 3 reps should be challenging.” That leaves fewer than 2 in 5 that objectively quantified intensity!!!

Intensity is the variable that most determines the adaptation. Without it, “3x10” means nothing, and patients left to choose their own load tend to go too light and overestimate their proximity to failure which is the key variable when #strengthtraining.

The rest of the reporting wasn’t much better:
60% didn’t report rest periods!!! WHAT. THE. Fing F.
72% were rated high risk of ineffectiveness based on the dose prescribed. Meaning, we probably don’t have a really good idea of how effective our interventions truly are because the studies have incomplete reporting!

When we say “exercise didn’t work,” we often can’t say what dose was tested. Especially when “strengthening” isn’t properly applied in 72% of the trials. Wow. Shook.

Source: Ingram LA, Bennett H. (2026). Beyond 3 Sets of 10: A Critical Evaluation of the Dosage Parameters Prescribed for Exercise Interventions in Highly Influential Musculoskeletal and Sports Physiotherapy Research taken in CompleteBody by @thehpm

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Like nails on a chalkboard. I smile, nod, and let them know I’m listening, but these things really challenge my composure. They’re so easy to blame, conceptually speaking, but not really the cause in most cases.

#Lowbackpain is multi factorial. #Neckpain isn’t always due to weakness. #Shoulderpain isn’t always due to #rotatorcuff issues.

But very rarely is there discussion on factors outside of the body that contribute to predisposing individuals to this pain. My job is not only to expose the body issues that may lead to pain, but everything else as well. It’s a program. taken in CompleteBody by @thehpm

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True story. If #metabolicstress was responsible for #hypertrophy we should see some massive gains with #bloodflowrestriction but we only tend to see between 6-10% muscle gains. Not supercharged. Not even if we trap them post-exercise. In fact that may attenuate growth in women (Dankel 2017). But when taken to failure metabolic stress (which is hilarious because we only typically measure lactate which is one metabolite, the only one) is largely the same in various loading ranges, but the growth is the same 😮‍💨. I love me my pumps, but that too isn’t hypertrophic. If you like your pump work that’s great but don’t be fooled with the swole. Gotta get that tension on the muscle fibers my peeps. Ps none of you even read this 💀 taken in Virginia by @thehpm

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