The use of blood flow restriction (BFR) in rehab has become increasingly popular over the last few years. The treatment works by placing a tourniquet (typically in the form of a pressure cuff) around the proximal part of a limb to partially restrict blood flow while the patient is exercising. The goal is to create an environment that mimics one that would result from heavy resistance training or high intensity exercise. 

However, with BFR we are able to achieve a lot of these same physiological effects while using lower loads that are more friendly on the joint or tendon. This can be especially useful for individuals who have undergone a recent surgery or are experiencing joint or tendon pain that has prevented them from being able to effectively train the muscles surrounding the affected area. 

For instance, somebody who is dealing with knee pain and begins to compensate for how they load their knee will often develop atrophy of the quadriceps muscle, which will then weaken the muscle and the ability to actively support the joint due to the intolerance they have with loading their knee. However, with using BFR we can minimize atrophy to the quadriceps by creating an environment that mimics high intensity training, which can halt atrophy of the muscle and increase the patient’s ability to properly load their knee without unnecessary compensations. To summarize, BFR allows us to create a high intensity environment for the muscles while minimizing load placed on the affected joint(s) or tendon(s). 


How It Works

The cuff that is placed around the limb is set to a pressure that intermittently will restrict arterial and venous blood flow. With this restriction in blood flow, a hypoxic environment is created that creates an accumulation of metabolites that would likewise be seen with high intensity training. These metabolites promote growth hormone production and fast twitch fiber recruitment (require less oxygen), resulting in improvements in muscular hypertrophy and strength development. 


Who Should Use It

Blood flow restriction training can be useful for any individual who is unable to perform normal strength training, either due to injury or lack of equipment available. Specifically, BFR has been shown to be really helpful to promote strength and hypertrophy adaptations for post-surgical patients and those who have an irritable tendon or joint that does not allow for sufficient loading during training (>75% of 1 rep maximum).


For patients who are coming off of arthroscopic surgery (ie. ACL repair), BFR can be used as early as 1-3 days afterward as long as incisions and wounds are small without significant swelling. For surgeries that produce larger scars and increased time for wound healing (ie. total knee arthroplasty), it is recommended to start BFR at least 2 weeks after the procedure. For individuals with tendinopathy, preliminary evidence for BFR is very promising and has been shown to have a positive effect on collagen production for tendon remodeling. 


How To Use It

The cuff should be placed on the proximal part of the limb (toward the hip or shoulder) and a limb occlusion pressure should then be calculated. It is recommended to keep this no higher than 80% for the lower extremities and 50% for the upper extremities, and the pressure should be calculated while the individual is completely relaxed. 


Once the cuff is set up, you can use BFR with any exercise that you would typically do while strength training. The only things this would not be recommended for is running or plyometrics. 


A typical repetition scheme for BFR training is 30-15-15-15, totaling up to 75 repetitions. However, for compound movements where this rep scheme may seem too aggressive, we can decrease to 4 sets of 10-15 repetitions. In between sets, it is recommended to rest for approximately 30 seconds. 


The intensity for BFR training should be around 20-30% of your 1 RM. You can also use an RPE scale, which would similarly be between 2-3/10. Ideally, the goal is to reach volitional fatigue toward the back end of the last set. 


BFR can be a very helpful tool for somebody looking to maximize hypertrophy and strength gains following a surgery, while recovering from an injury, or if they are temporarily limited in equipment. Additionally, it can be a great form of training to supplement heavy lifting in order to provide increased rest for joints/tendons while still creating a similar stimulus as to high-intensity resistance training.

Are you dealing with an injury and know that you need to build strength to resolve it? Have you tried working on your strength but feel like you can’t make progress due to it always just aggravating your symptoms? Blood flow restriction may be a great option to help you finally get over the hump. Tap the button below to book a time to chat and get started.

Disclaimer: The information provided in this blog is for educational purposes only and should not be considered a substitute for professional medical advice or treatment. Always consult with a qualified healthcare professional before starting any exercise program, especially if you have a pre-existing medical condition or injury.