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What is blood flow restriction training?

Blood flow restriction (BFR) training, also known as occlusion training, involves the use of cuffs or straps to partially restrict blood flow to the muscles being exercised. This restriction creates a metabolic stress response that leads to muscle growth and strength gains, even with lighter loads. BFR training typically utilizes low-intensity resistance exercise combined with moderate levels of blood flow restriction.


BFR training has been shown to be effective in treating various issues, including:


1. Muscle Atrophy: BFR training can prevent or reverse muscle atrophy, making it valuable for individuals recovering from injuries, surgeries, or immobilization where muscle loss occurs.


2. Rehabilitation: It's beneficial in rehabilitation settings to helping maintain and regain muscle mass and function during the recovery process. I like to include BFR in the plan of care for issues such as:

  • post-operative recovery for ACL reconstructions, knee replacements, and other knee surgeries

  • non post-operative knee injuries such as meniscal pathologies, patellofemoral syndrome issues, patellar tendinopathy, etc.

  • Ankle/foot issues such as achilles tendinopathy, posterior tibialis tendinopathy, plantar fasciitis, etc.

  • Elbow issues such as golfer's or tennis elbow


3. Joint Issues: BFR training enables muscle hypertrophy and strength gains with lighter loads, reducing stress on joints. This makes it suitable for individuals with joint issues like osteoarthritis.


4. Endurance: BFR training improves endurance by enhancing cardiovascular function and increasing muscle fiber recruitment. It's beneficial for athletes aiming to enhance endurance performance and overall cardiovascular health.


A performance physical therapist works with a young high school athlete by using blood flow restriction training on her leg to help improve her leg strength.

Recommended guidelines for BFR training typically include:


1. Cuff Placement: Cuffs are usually placed around either the thigh or upper arm as close to the torso as possible. The type of cuff depending on the size and thickness determines its comfort and in part its effectiveness.


2. Pressure: The pressure applied during BFR training is typically expressed as a percentage of the individual's limb occlusion pressure (LOP). LOP is the pressure required to completely block arterial blood flow. This ideal pressure for performing BFR is usually around 50-80% of LOP. Some units such as the brand I have (Smart Tools) allow you to calculate an individual's LOP so there is no guessing.


3. Exercise Selection: BFR training is commonly performed using low-intensity resistance exercises such as leg extensions, leg curls, or arm curls. Compound movements may also be used but with caution due to the increased risk of technique breakdown with fatigue. I typically choose 1-3 exercises to perform as supersets that target the area we are focusing on.


4. Sets and Reps: A typical protocol for BFR training might involve 3-5 sets of each exercise, with around 15-30 repetitions per set. Rest periods between sets are often kept short, around 30-60 seconds, to maintain the metabolic stress response. The main goal is to get close to fatigue or even to failure as able to get the most out of BFR training.


5. Frequency: BFR training can be performed 2-3 times per week but it's essential to allow adequate recovery between sessions. It can also be used less frequently as a supplement to training or to get a break from heavier loads.

A photo of Smar t Tools smart cuffs pro device and cuff used during performance physical therapy for rehab and strength improvements at Outshine Physical Therapy and Fitness in Asheville, NC.

I recommend you consult with a qualified professional before starting BFR training, especially if you have any underlying health conditions or concerns. Performance physical therapists are a great fit to guide you through this process and may even have this tool to incorporate into your plan of care. They can help determine the appropriate pressure, exercises, and frequency based on your individual needs and goals. Additionally, proper cuff placement and monitoring during exercise are essential for safety and effectiveness.

If you have any other questions, feel free to contact me!

Let's talk soon,

Dr. Sieara Hinshaw


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