Blood Flow Restriction Training

Posted March 16, 2024

Author: Dr. Aaron Bass, PT, CSCS

Strengthening is important, this is not breaking news. A variety of aches, pains, and injuries could be mitigated or alleviated with a good strengthening program. Is strengthening the answer to every problem we have? No, but it is something that is beneficial for virtually all populations. Here is the problem – there are populations of people who would benefit from strengthening, but for whom high- intensity strengthening is not recommended or is contraindicated altogether. Post-operative patients who have a strict protocol. Acute injuries with soft tissue that is still healing. Patients with certain cancers or other chronic diseases, like COPD, who cannot tolerate high-intensity or heavy resistance strength training. Osteoporotic patients who may be nervous about picking up a heavy weight. These are just a few examples of the types of patients we see in physical therapy who need to get stronger but are not ready for traditional resistance training regimens. What do we do when strengthening is necessary but doing so by traditional means is too problematic or harmful? This is where blood flow restriction (BFR) training enters the scene.

I know what you may be thinking…”I might not be a doctor, but I am fairly certain blood flow is a good thing… maybe let’s not restrict it.” Fair point. But when done safely, meaning only partially restricted (not fully) and under the guidance of a trained professional, it can be beneficial. When doing any type of strengthening with a heavier-than-normal resistance (e.g. weights, resistance bands, even body weight), there is an increase in anabolic (muscle growing) hormones and a hypoxic (low oxygen) environment is created in the body.¹ These factors are important to stimulate hypertrophy (muscle growth) and become stronger. The overall goal of BFR training is to mimic this environment in the body without the use of a heavier-than-normal resistance. In fact, one must use a much lighter resistance, a.k.a. low-intensity load, to appropriately accomplish the exercise. By restricting blood flow out of the limb and performing low-intensity exercise, low oxygen blood collects and the same hormonal response will occur that we see with high intensity exercise. In short, you are “tricking” your muscles, tendons, and cardiovascular system into thinking they are performing heavy resistance training. Therefore, you will get similar muscle hypertrophic and cardiovascular effects to lifting a heavy weight without the physical stress of lifting a heavy weight.^2,3,4 Pretty cool right? Research has shown this to be effective with both upper and lower extremity strengthening and can even have positive systemic effects on cardiovascular and musculoskeletal system outside of the areas treated with the BFR cuff.⁵

Your next thought may be, “Cool, next time I go to the gym, I’ll bring a tourniquet and get super strong.” No. Don’t do that. Please. Traditional resistance training is still superior overall for strength development and the health of your muscles, tendons, joints, and bones. BFR training is simply great tool and very beneficial alternative for those who need to get stronger but cannot perform traditional resistance training (yet) during exercise and rehabilitation. You always want to perform under the supervision of a qualified professional that is trained and follows specific parameters to assess appropriate cuff setup, pressures, and exercises. If you have any questions or think you may benefit from BFR training, reach out to us to start the conversation and we would be happy to guide you in the right direction.

de Freitas MC, Gerosa-Neto J, Zanchi NE, Lira FS, Rossi FE. Role of metabolic stress for enhancing muscle adaptations: Practical applications. World J Methodol. 2017 Jun 26;7(2):46-54. doi: 10.5662/wjm.v7.i2.46. PMID: 28706859; PMCID: PMC5489423.
Early KS, Rockhill M, Bryan A, Tyo B, Buuck D, McGinty J. EFFECT OF BLOOD FLOW RESTRICTION TRAINING ON MUSCULAR PERFORMANCE, PAIN AND VASCULAR FUNCTION. Int J Sports Phys Ther. 2020 Dec;15(6):892-900. doi: 10.26603/ijspt20200892. PMID: 33344005; PMCID: PMC7727422.
Takarada Y, Takazawa H, Sato Y, Takebayashi S, Tanaka Y, Ishii N. Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. J Appl Physiol (1985). 2000 Jun;88(6):2097-106. doi: 10.1152/jappl.2000.88.6.2097. PMID: 10846023.
Yasuda T, Fujita S, Ogasawara R, Sato Y, Abe T. Effects of low-intensity bench press training with restricted arm muscle blood flow on chest muscle hypertrophy: a pilot study. Clin Physiol Funct Imaging. 2010 Sep;30(5):338-343. doi: 10.1111/j.1475-097X.2010.00949.x. Epub 2010 Jul 4. PMID: 20618358.
Miller BC, Tirko AW, Shipe JM, Sumeriski OR, Moran K. The Systemic Effects of Blood Flow Restriction Training: A Systematic Review. Int J Sports Phys Ther. 2021 Aug 2;16(4):978-990. doi: 10.26603/001c.25791. PMID: 34386277; PMCID: PMC8329318.