Blood Flow Restriction training 

If you have not heard about this unique training and rehabilitation tool then get ready to read up on how this technique could benefit your recovery from injury or surgery, improve your strength and build muscle mass as well as the capability to improve your endurance. Blood flow restriction (BFR) training is a tool that has actually been around for a long time but is just now, within the last few years making its way into the physical therapy and performance training scene. BFR training was introduced primarily in the realm of the Army as there was a desperate need to find ways to help our wounded soldiers build up strength and muscle mass following traumatic injuries that lead to large losses of muscle and amputations. It has since then found its way into the training rooms of many professional sports teams including NFL, NBA, MLB, NCAA and Olympic training facilities. This is not a training tool just for professional athletes though. BFR research shows positive effects on people of all ages when it comes to improving strength, building muscle mass and increasing endurance.

What exactly is BFR?

Blood flow restriction utilizes a personalized tourniquet system to partially occlude blood flow to either the upper arm or upper thigh. The pressure provided by the tourniquet system is enough to stop blood from passing back towards the heart but partially allows new blood coming from the heart to the working muscle. Since BFR has become more popular in the training realm there has been an increase in products that claim to be safe for BFR training. However, if you are considering partially occluding blood flow to any part of your body you want to make sure that it is being done safely. The only system on the market that meets FDA standards for application of a tourniquet is the Delphi personalized tourniquet system. By using any other system you are putting yourself at risk!

How does BFR work?

Let’s take the leg for an example, by placing the tourniquet at the uppermost part of the thigh it will partially restrict the new oxygen rich blood from entering the working muscle and will prevent the oxygen depleted blood to pool around the working muscle. This is advantageous for many reasons, all of which revolve around the chemical byproducts that occur during exercise of muscles. One of the biggest effects is the creation of something called lactate. This is the byproduct of working muscle that is commonly known as “the burn” that you feeling during and after your work out. Usually it requires a high intensity exercise to increase the release of lactate and along with high intensity exercise comes small amounts of actual muscle damage. The other cool and important thing about lactate is that it is needed to set off certain pathways in our body that promote the release of growth factors that are needed to help facilitate recovery following exercise. Furthermore, the release of growth hormone signals the release of another important protein in our body, insulin like growth factor, which promotes muscle growth.

The cool thing about BFR is that you are able to create a similar environment around the muscle with low intensity exercise and see similar improvements in strength and muscle gains without the muscle damage associated with high intensity workouts. For example, the American College of Sports Medicine (ACSM) states that its guidelines for strength training is 2-3 times per week at or above 70% of your one repetition maximum. The literature supports that there is an absolute need for this level of work load to see maximal gains in muscle strength and size and in no way is BFR training a replacement for high intensity exercise. However, for individuals who do not tolerate that level of intense training, for example, people rehabbing from an injury, athletes who are in season and trying to keep decrease the extra load on their joints and body or the general aging population. The literature for BFR training shows that you can get very similar training responses with a load of 20-30% of your one repetition maximum, pretty cool, huh?

Five reasons why BFR training could be right for you!

  1. Recovery from an injury Immediately following any injury, for example an ankle sprain, there is damage to the ligaments and possibly muscle tissue as well. By using BFR following this injury it can assist in activating the necessary pathways that help collagen formation, an integral part in the repair and recovery process. Not to mention preventing possible loss of strength during the time period where your tissues will not tolerate high intensity exercise.
  2. Prevent muscle loss following a surgery Literature has shown that following a surgery, for example following an ACL reconstruction, that the thigh muscle loses muscle mass and size, up to 20% loss within the first two weeks following surgery. This occurs for several reasons including disuse of the leg muscle and the inability to work the muscle at a high enough intensity to maintain muscle strength and size (due to post operative restrictions). BFR has been shown to help minimize this loss and help facilitate recovery and strength gains due to the chemical pathways that are triggered by working the muscle in low oxygen state.
  3. Promote strength and muscle mass gains By restricting the outflow of blood from working muscle, as done during BFR, it allows a build up of physiological components necessary to facilitate strength gains and increase in muscle size. Not only can you see similar gains when compared to high load (heavy) weight training, you can do it without the muscle damage that occurs during heavy resistance training. Although BFR can help facilitate the protein synthesis process necessary for muscle growth, it does need proper nutrition to help reap the benefits!
  4. Decrease joint and body stresses during exercise Are you looking for a way to help decrease the stress and strain your body endures through your in-season or off season program? Have muscle and joint aches and pains that prevent you from training and seeing strength gains? BFR training’s unique approach allows individuals to work at much lower loads (lighter weights) which ultimately leads to less stress on your spine, hips, knees and ankles with similar strength and mass gains seen with heavy load strength training.
  5. Improve your endurance tolerance Whether you are a high level competitive athlete or just looking for a way to stay healthy and active BFR training could be right for you. As we age it has been shown that we start loosing muscle mass and strength. As we get older it is harder for our bodies to process protein (the main source of nutrition to help build muscle). On top of all that, it gets harder for some us to to tolerate the increased intensity of training necessary to see strength and endurance gains. Luckily, BFR has been showing to improve both strength and endurance with as little as 15 minutes of walking on the treadmill over a six week span!


Dr. Kyle Schwebke DPT, OCS

Board Certified Specialist in Orthopedic Physical Therapy