Blood Flow Restriction (BFR) Therapy is a limited occlusion of arterial and venous blood flow by applying a tourniquet to the upper or lower extremity (arm or leg). In other words, it decreases blood flow to working muscles in order to promote growth of muscle cells and prevent muscle atrophy or wasting. It creates the same kind of pressure on a muscle that occurs with strenuous exercises, but without all of that strain. BFR is typically used with low-load resistance or endurance training. However, studies have shown that using it at rest with the compression alone is also effective. 

The compression device works similarly to a blood pressure cuff. The compression device applies a pressure high enough to decrease blood flow by 30-50% in the upper extremity and 50-80% in the lower extremity. The cuff is typically placed as high up as possible on the arm and leg. 

1. The compression from the cuff restricts blood flow through the arteries 

2. The occlusion leads to a local hypoxic event, meaning the muscles are deprived of oxygen. Because of this, your brain will start to think you are under a lot more pressure and load than you are actually bearing. 

3. This will then release hormonal and protein production responses that normally occur with high-intensity interval training. 

4. As a result, this increases the production of lactate and other metabolites in the muscles. Lactate is a chemical released by the body that fuels the cells during times of stress (think of it as gas for a car). With the occlusion, there will be an accumulation and pooling of lactate and other metabolites, which will promote faster muscle cell growth and healing.

Blood Flow Restriction Therapy is commonly used when a patient needs to preserve or improve strength but is unable to tolerate the heavy loads required for traditional strength training. BFRT is used for most post-operative conditions, including: 

• ACL/PCL reconstruction 
• Joint replacements 
• Achilles repair 
• Fracture ORIF 
• Meniscectomy, meniscus repair, meniscus transplant, root repair 
• Patella/quadriceps tendon repair 
• Brostrom procedure 
• Bunionectomy 
• Osteotomies 
• Plantar fasciotomy 
• Morton’s neuroma excision’ 
• Rotator cuff repair 
• Labrum repairs 
• Tendon transfers 
• Arthroscopic debridements 
• Ulnar collateral ligament repair 
• MACI procedure 
• Many non-operative conditions that limit load-bearing tolerance 
• Sprains 
• Osteoarthritis 
• Pre-surgical strengthening 
• Patellofemoral pain 
• Polymyositis / dermatomyositis 
• Atrophy/weakness 

BFRT can also be used in the elderly population who may be experiencing deconditioning and want to begin strengthening again.

Many people wonder how safe BFR is when they hear the words “occlude” and “restrict” blood flow. Hundreds of studies and countless clinical applications of BFR over decades have established a strong safety record. The potential for development of a deep venous thrombosis (DVT) with BFR has been thoroughly researched and risks are minimal.

BFR should only be performed in a controlled environment by trained professionals. Of course, it is not for everyone and there are precautions & contraindications. You’re likely not a good candidate for BFR therapy if you have any of the following conditions:

• Acidosis 
• Cancer 
• Extremities with a dialysis port 
• Excessive post-surgical swelling 
• Lymphedema 
• Infection in extremities 
• Increased intracranial pressure 
• Open fracture / open wound 
• Impaired circulation 
• Pregnancy 
• Previous revascularization of limb 
• Sickle cell anemia 
• Severe hypertension (> 180/100 mmHg) 
• Severe crush injury 
• Vascular graft 
• Presence of DVT 
• History of mastectomy and or axillary node dissection (affected arm) 
• Hemodialysis with arteriovenous fistula (affected limb)

If you are interested in Blood Flow Restriction Therapy, please reach out or make an appointment with your local Therapydia clinic. Our physical therapists will determine if BFR therapy is right for you and help implement it into your routine so you can get stronger and achieve your goals.