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Blood Flow Restriction (BFR) Training in Rehabilitation:
A Useful Adjunct or Lucy’s Latest Trick?

Blood Flow Restriction (BFR) training has gained recent popularity in the rehabilitation, fitness, and performance industries over the past decade. Its origins date back to the 1960s, when scientists first noticed improved walking tolerance in people with intermittent claudication after a physical training program. This discovery sparked a wave of research into the mechanism and clinical use of BFR, some of it useful and some of it haphazardly dangerous.

However, skepticism is warranted whenever an intervention promises that low-intensity exercise with a blood pressure cuff can improve strength, performance, recovery, and even reduce pain. That said, we still need to weigh the breadth and quality of the research before drawing conclusions about its real-world application and benefit.

Strong Support: Improved Muscle Hypertrophy 
  • Low loads (15-30% 1-RM) performed to volitional failure
  • Comparable results to high-load resistance training
  • Best suited for patients when heavy resistance training isn’t clinically appropriate
Moderate Support: Occlusion Pressure
  • Wider cuffs reduce local discomfort and lower the chance of bruising
  • Individualize blood pressure for each patient
    • Measure pressure every session, in the position you’ll use for exercise
  • Target 40-80% LOP for the lower extremity (LE) and 30-60% LOP for the upper extremity (UE)
Weak Support: Performance, Recovery, and Pain Reduction
  • Some evidence points to improved post-exercise recovery
  • Patients may notice reduced pain during and after BFR exercise, through the evidence here is still limited

Key Points

  • Specifically, for patients who can’t tolerate high loads, low-load BFR training (15-30% 1-RM) can produce hypertrophy gains similar to conventional high-load training. 
  • Overall, training pressures should fall between 40-80% LOP for the LE and 30-60% LOP for the UE. Because wider cuffs need lower pressures, they also tend to be more comfortable for patients.
  • Before applying BFR, screen every patient for vascular compromise, clotting disorders, embolism risk, renal compromise, and hypertension. Then, tailor the pressure to the individual patient, the exercise, and the position they’ll use. 

References:

Whiteley, R. (2019). Blood flow restriction training in rehabilitation: A useful adjunct or Lucy’s latest trick? Journal of Orthopaedic & Sports Physical Therapy, 49(5), 294–298.