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Grant H. Garcia, MD

Grant H. Garcia, MD Orthopedic Surgeon & Sports Medicine Specialist View Profile

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Grant H. Garcia, MD

Grant H. Garcia, MD Orthopedic Surgeon & Sports Medicine Specialist View Doctor Profile

Blood Flow Restriction Training Benefits | BFR Training Band written by Hi Def Physical Therapy

Blood Flow Restriction by Hi Def PT

What is blood flow restriction training?

Blood Flow Restriction Training (BFR) is a training technique designed to enhance muscle hypertrophy and strength by limiting arterial blood flow to an exercising muscle. During BFR, arterial inflow of oxygen-rich blood to the muscle is maintained while venous outflow of deoxygenated blood is restricted using a tightly-regulated cuff or wrap. The arterial-venous pressure gradient without exorbitant amounts of external load causes metabolic stress at the microscopic level in the exercised muscles, thus leading to hormonal changes that promote adaptation and remodeling. As such, BFR Training enables individuals to increase muscle size, strength and endurance with lighter loads than normally required for traditional resistance training programs. With its increasing popularity among athletes and recreational exercisers, Blood Flow Restriction Training techniques have become an essential part of any exercise regimen for those wanting to make lasting improvements to their physical performance as well as muscular development. Even with low load resistance exercise, you will often experience delayed onset muscle soreness 24-48 hours after exercise.

Blood Flow Restriction (BFR) physical therapy is a relatively new technique that has become increasingly popular in physical therapy settings. BFR involves constricting the flow of blood to a certain part of the body, such as the arm or leg, by wrapping the limb with a special tourniquet-like belt or sleeves. While this may sound uncomfortable, this physical therapy actually helps to improve physical performance and rehabilitation outcomes. By restricting the blood flow, physical therapists are able to reduce the load on an injured area while still stimulating muscular growth. This mechanism can help to put less strain on an injured body part while also promoting aerobic capacity and muscle growth.[1]As physical therapists incorporate BFR into their routines more often, we will likely see its potential not just for physical rehabilitation but for sport performance improvement as well. All in all, BFR physical therapy is proving itself to be a safe, effective way to promote recovery from injuries—both large and small.

Blood flow restriction in physical therapy

Blood Flow Restriction by Hi Def PT

The benefit of blood flow restriction therapy is that you can exercise with lower weight but get the same output as you would with heavier weight. If you have a tendon or muscle injury and are not able to tolerate load because of a tear or strain, this is a great option for you. Think about it this way, you can get the same benefit of lifting 100 lbs when you lift only 30 lbs.[2]

Low load resistance training with BFR stimulates the metabolic overload pathway of skeletal muscle hypertrophy. It does so by activation of the mTOR pathway, which is the master growth pathway of your body.[3] Release of hormones, hypoxia and cell swelling also occur when a muscle is under metabolic stress.[4]These factors are all part of the anabolic process of muscle tissue.

Physical therapists often utilize blood flow restriction therapy with patients who are recovering from long periods of inactivity that have caused muscle atrophy, surgery or other muscular injuries. Your physical therapist will likely start off with lower pressure on the cuffs and lighter exercises to get your body used to this style of training. As you progress through your physical therapy, you will be able to do more exercises with higher pressure in the cuffs. The goal is to increase the pressure to 80% of limb occlusion pressure in the lower extremities and 50% of limb occlusion pressure in the upper extremities.

Conditions for which BFR is indicated include:

  • Anterior cruciate ligament (ACL) reconstruction
  • Achilles tendon repair
  • Patellar tendinitis
  • Lateral epicondylitis
  • Rotator cuff repair

Blood Flow Restriction by Hi Def PT

Blood flow restriction training

Training with blood flow restriction devices can be an effective means of maximizing muscle development. These devices work by temporarily restricting part of the arterial supply to muscle tissue, allowing only oxygen-depleted venous blood to enter. This causes a buildup of metabolic bi-product, which has been shown to increase muscle growth and muscle mass. Furthermore, because this type of training can be done with lighter weights than a typical workout, it can also lead to greater muscle strength gains in less time. Because this method helps muscles adapt quicker and with less risk of injury or muscle damage compared to traditional resistance training techniques, it has become increasingly popular among athletes looking for safe ways to improve their performance. With all these benefits, it's no wonder why incorporating blood flow restriction devices into a routine is becoming more common in gyms and physical therapy clinics across the world.

Risks of using blood flow restriction

Blood Flow Restriction by Hi Def PT

Blood flow restriction (BFR) is a technique used in physical rehabilitation and sports conditioning to promote muscle growth. During BFR, a specialized cuff is secured around the limb to reduce blood flow from leaving the muscle cells. While it is an effective form of exercise, there are some potential adverse events that should be monitored for. The most serious is compartment syndrome, which occurs when the pressure in tissues exceeds the limit of small blood vessels. If left untreated, it can cause permanent damage or disability. Fortunately, these adverse events are rare if the cuff pressure is not set too high and training sessions are conducted with adequate rest periods between sets. Additionally, by limiting BFR sessions to 30 minutes or less and avoiding lower extremities at risk of skin breakdowns due to venous insufficiency, there can be significant benefits with minimal risk. Ultimately, understanding how to use BFR safely can help practitioners get maximum benefit while minimizing adverse effects.

With all this being said, BFR remains one of the safest forms of exercise when utilized properly by a trained professional in accordance with industry standards and guidelines set forth by governing bodies within the healthcare field. When done correctly it could be just what an individual needs to build muscle quickly and effectively.

  1. Formiga MF, Fay R, Hutchinson S, Locandro N, Ceballos A, Lesh A, Buscheck J, Meanor J, Owens JG, Cahalin LP. EFFECT OF AEROBIC EXERCISE TRAINING WITH AND WITHOUT BLOOD FLOW RESTRICTION ON AEROBIC CAPACITY IN HEALTHY YOUNG ADULTS: A SYSTEMATIC REVIEW WITH META-ANALYSIS. Int J Sports Phys Ther. 2020 Apr;15(2):175-187. Erratum in: Int J Sports Phys Ther. 2020 May;15(3):486. PMID: 32269850; PMCID: PMC7134358.
  2. May AK, Russell AP, Della Gatta PA, Warmington SA. Muscle Adaptations to Heavy-Load and Blood Flow Restriction Resistance Training Methods. Front Physiol. 2022 Feb 3;13:837697. doi: 10.3389/fphys.2022.837697. PMID: 35185627; PMCID: PMC8850930.
  3. Fry CS, Glynn EL, Drummond MJ, Timmerman KL, Fujita S, Abe T, Dhanani S, Volpi E, Rasmussen BB. Blood flow restriction exercise stimulates mTORC1 signaling and muscle protein synthesis in older men. J Appl Physiol (1985). 2010 May;108(5):1199-209. doi: 10.1152/japplphysiol.01266.2009. Epub 2010 Feb 11. PMID: 20150565; PMCID: PMC2867530.
  4. 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.