The field of physical therapy is ever evolving. With new modalities constantly being tested and the science supporting these modalities becoming more readily available, we see an onslaught of training techniques to improve training and recovery. Blood flow restriction (BFR) is the latest method being used to treat muscle weakness and improve athletic performance. In this article, we will cover what blood flow restriction is, why it is used, when it should be implemented, and associated studies with this modality.
Blood flow restriction (BFR) is a newer modality, using a tourniquet or cuff to reduce blood flow leaving the muscles through the veins.
Research indicates various benefits of BFR, including using less weight and reps to achieve the same gains, while protecting joints and tendons.
There are several ways to implement BFR into your training or recovery regimen.
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What is Blood Flow Restriction Training?
Blood flow restriction is a deliberate impingement of the veins using a type of tourniquet or cuff while doing low-resistance weight training1. Blood oxygenates the muscles by traveling through arteries but is restricted as the unoxygenated blood tries to leave the muscles through the veins. Note that the pressure applied is not supposed to cut off circulation entirely. Blood should be flowing to the muscles and having a harder time leaving through veins due to pressure.
Pressure applied during BFR is not supposed to cut off circulation entirely. Instead, blood should be flowing to the muscles and having a harder time leaving through veins due to pressure. This restriction combined with low-impact resistance training has shown that the body thinks it’s working harder than it is, leading to muscle growth. Essentially, the body is being put under mechanical stress, which in turn leads to muscle hypertrophy.
Benefits & Research Behind Blood Flow Restriction
Research has shown many benefits to using blood flow restriction as a supplement to normal training or recovery purposes. According to the Cleveland Clinic, benefits include increasing muscle size faster than regular training alone, the same lifting gains as compared to regular training using 20-30% less weight or reps, less impact on joints and tendons during lifting, and prevention of muscle loss in those who are immobile.2 Another study evaluated BFR use with older adults: the researchers examined 11 published studies and found that low intensity training with blood flow restriction was a safe method to help older adults gain muscle strength and growth.3 Experts have concluded that BFR utilizes anaerobic metabolism.
Ultimately, with blood flow restriction training, you can see the same gains while lifting less weight, thus protecting joints and tendons. This is a great modality to incorporate for those who are recovering from surgery, an injury, or have limited mobility.
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A great option for blood flow restriction is Suji, a portable, professional BFR training and recovery device. Easy to use, portable and cable free, Suji also has their own app to help guide you along. Suji’s app also has exercise programs to help take out the guesswork when training. The app connects with Suji BFR cuffs via Bluetooth and allows you to set up a patient profile in minutes to calibrate the device to each individual athlete.
An alternative for the clinic is the SmartCuffs, which works like a blood pressure cuff, tightening around the arm muscles with a built-in pressure sensor and on-board computer. The cuffs will calculate and set the optimal pressure for your athlete’s body.
B STRONG Powered by HawkGrips is a great option for those new to BFR training. These bands come in packs of four and are a great, lightweight training accessory that you can take anywhere. HawkGrip’s B STRONG band package comes with a guidance app, providing step by step video tutorials on how to safely use the bands for BFR training.
If pre-sized bands aren’t your thing, give RockFloss a try. Rockfloss is an elastic, latex, 7-foot band allowing you to cut the band to your preferred size.
If you prefer to cut down your bands to size, try out RockTape Kinesiology Tape, offering 180% elasticity and providing better range of motion and comfortability. Use it for BFR training or to support movement.
How to Implement Blood Flow Restriction Training
Blood flow restriction is a restorative modality for those dealing with weakness, injury recovery, post-surgery recovery, osteoporosis, arthritis, and more. Including some form of resistance training is imperative to recovery, and maintaining muscle is an important marker of health. It’s important to note that BFR should only be used around the arms or legs. Before starting with BFR training, it would be best to consult a professional. There is some room for error due to the restrictive nature of preventing blood from leaving the muscles, but expect the cuff or band to fit your patient looser than it would if you were getting your blood pressure read. BFRT is part of the professional scope of practice for physical therapists, but it's best to refer to tutorials online from reputable trainers and clinicians before beginning BFR training.
If using BFR for active recovery, make sure your patients do this in addition to your normal strength training regimen, not in lieu of regular training. Blood flow restriction is not advised if the patient has cancer, blood clotting issues, bone fracture, infection, pregnancy, obesity, diabetes, poor circulation, renal compromise, or severe hypertension.2
Blood flow restriction (BFR) is a modality utilizing a tourniquet or cuff to reduce blood flow leaving the muscles. According to the research, blood flow restriction has shown promising results to those looking to recover from an injury while continuing to weight train, add an active recovery day, or maintain muscle while immobile. BFR should only be used around arms and legs. We strongly advise seeking a professional’s advice before beginning BFR training on your own.
- Vopat, B. G., Vopat, L. M., Bechtold, M. M., & Hodge, K. A. (2020). Blood Flow Restriction Therapy: Where We Are and Where We Are Going. The Journal of the American Academy of Orthopaedic Surgeons, 28(12), e493–e500. https://bit.ly/45M1Vym
- Work Out Smarter, Not Harder, With Blood Flow Restriction Training. (2022). Cleveland Clinic. https://bit.ly/3p9JHpR
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