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Blood Flow Restriction Therapy: A Modality that Hacks Physiology to Produce Muscular Hypertrophy at a Lower Resistance

By: Caroline Hodges, PTA


What exactly is Blood Flow Restriction Therapy?

Blood Flow Restriction Therapy (BFR) is a therapeutic modality in which the provider uses a cuff to restrict arterial blood inflow and venous return to a specific extremity during exercise, most commonly resistance training. 


What is the Benefit of Blood Flow Restriction Therapy?

Our muscles require the nutrients and oxygen from our circulatory system (blood flow) in order to do work and either maintain or build muscle (hypertrophy). When we reduce the blood flow to this targeted area, we’re reducing the energy available to the muscle, causing it to work harder; this increased metabolic stress increases muscle hypertrophy at the cellular level. This may also be supported by satellite cell proliferation, which was previously thought to only occur with high intensity training, but has been shown in this setting with low intensity at the reduced blood flow. 



This is done in combination with lower resistance in order to reduce the load on the muscle and the stress on the joint space in order to build more muscle (hypertrophy) or to prevent muscle wasting (atrophy). Research also demonstrated great motor unit recruitment from areas both distal and proximal to the occlusion; the increase in muscle groups above the occlusion are speculated to be recruited, not due to decreased blood flow of course, but the rapid fatigue, which is also beneficial.


What Types of Exercise Can You Use with Blood Flow Restriction Therapy?

Currently, BFR therapy can be used with aerobic exercise, neuromuscular stimulation, resistance training or it can be used passively. At the Green Room, you can expect that we will most often combine BFR therapy with resistance training and neuromuscular stimulation at reduced loads.


Who would benefit from Blood Flow Restriction Therapy?

Patients who are:


  • Pre-operative

  • Post-operative

  • Athletes

  • Geriatric

  • Amputees

  • Bedrest/immobilized

  • In active recovery


could all benefit from BFR therapy.



Who would not benefit from this treatment?

Anyone who has the following conditions would be considered contraindicated for this modality, even if they fall within the demographics above:


  • Circulatory or clotting dysfunction

  • Heart disease/insufficiency

  • Uncontrolled hypertension

  • Diabetes

  • Sickle cell anemia

  • Varicose veins

  • Pregnancy

  • Open wound or incision

  • Infection

  • Cancer 

  • Lymphedemia

  • Under 12 years of age


Are there any risks associated with treatment?

Yes, there are risks with every treatment and modality, but our clinicians are trained to either completely avoid or limit the extent of them if they are present at all. The following are the the known possible risks:


  • Pain if the tourniquet is too tight 

  • This can be immediately adjusted and remedied.

  • Numbness

  • Expect sensation changes from the changes in blood flow but let your provider know if an extremity goes completely numb, so they can adjust it. 

  • Nerve damage

  • This may occur if the tourniquet is too tight and goes unresolved, so notify your provider if you experience pain or numbness. If you are being supervised during the session, this should not occur.

  • Bruising

  • This may occur if the tourniquet is too tight and goes unresolved, so notify your provider if you experience pain or numbness. This risk becomes higher with clotting disorders, like hemophilia, which is contraindicated, so communicate with your provider. 

  • Subcutaneous hemorrhage  

  • This risk becomes higher with clotting disorders, like hemophilia, which is contraindicated, so communicate with your provider. 

  • Syncope/Fainting

  • If you begin to feel faint or lightheaded, alert your provider so they can remove the cuff and sit down to recover.

  • Rhabdomyolysis

  • This is a rare but life threatening muscle injury due to muscle damage and can happen after either injury or excessive exercise without rest. If you notice subsequent intense muscle fatigue and soreness, changes in urine color/concentration, or low back/kidney pain, alert your provider and physician. 


Is Blood Flow Restriction Therapy Safe?

Yes, BFR is considered very safe and low risk; there are over 800 published research studies supporting this treatment. The most extreme risks, outlined above, are not expected symptoms but rather things that can go wrong if treatment is not properly monitored and dosed. If your therapist is supervising you and working with you one-on-one, these side-effects should not occur. You can expect mild to moderate changes in sensation during treatment and mild to moderate muscle soreness; however, research shows that delayed onset muscle soreness (DOMS) is actually lesser with MFR than other higher intensity exercise.


Ask your provider if Blood Flow Restriction Therapy would be a beneficial for you! 



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