By: Conor Schmidt, PT, DPT, CEO
Blood flow restriction training, termed "BFR" for short, is a fairly new technique being performed in the rehab world. Simply put, it involves placing a special, FDA approved, tourniquet around a proximal limb and exercising with the tourniquet inflated to a specific pressure. While this seems crazy to some (after all, why would we want to DECREASE blood supply when exercising?), it is actually a well studied, safe and advantageous technique designed to increase strength and muscle mass.
...it is actually a well studied, safe and advantageous procedure designed to increase strength and muscle mass.
First and foremost, most of our readers are going to want to know if BFR is safe. The short answer - yes. As long as the patient is screened appropriately and BFR is performed under the supervision of a trained healthcare professional it is considered a very safe technique. While the most common concern among those uneducated about BFR is blood clots. There have been numerous studies that suggest not only does BFR have no risk of increased clot formation, but it actually may have a fibrinolytic effect (breaking down clots) acutely after exercise (Madarame et al 2010; Clark et al 2011). Furthermore, various other studies have found the stress placed on the heart and peripheral vascular system using BFR to be well below that of conventional exercise (Takano 2005; Lida 2007). The takeaway - BFR is safe when performed properly and with a trained healthcare professional.
However, the question remains: what exactly does BFR do and why would we use it? An excellent question and one we at TierOne Physical Therapy get a lot. According to the American College of Sports Medicine if an individual wants to build strength and hypertrophy (a major part of rehabilitation) they must lift weights 2-3x per week at a minimum of 65% of their one rep max (Donnelly 2009). To put this into perspective, if my max bench press is 100 lbs, I need to bench a minimum of 65 lbs 2-3x per week to achieve meaningful strength gains. While healthy individuals may have no issue with this, patients undergoing physical therapy often cannot tolerate such loads due to pain and/or post-operative precautions. This begs the question - how do we rehab someone to make them stronger if they cannot tolerate the amount of weight required to build strength? Making it a catch-22 that rehab specialists have long struggled with.
Using BFR, we can lower the weight required to build strength to as low as 10% of an individual’s one rep max.
This is where BFR becomes most beneficial & effective. Using BFR, we can lower the weight required to build strength to as low as 10% of an individual's one rep max. 10 percent! That means all of a sudden the 65 lbs required for me to increase my bench press strength is now only 10 lbs. That's a significant reduction in the amount of stress through my joints and is much more tolerable for patients with pain and those who are post-operative. As one may deduce, this is a huge tool for rehab professionals to improve patient outcomes and satisfaction.
While strength and hypertrophy of musculature is the primary benefit of BFR, new and exciting research is emerging indicating it may have beneficial effects on multiple other physiologic processes. For instance, one study found that cycling at 40% of one's VO2 max (primary variable used to determine aerobic fitness) while using BFR increased one's relative and absolute VO2 max by 6.4% (Abe et al 2010). Another study examined walking under BFR conditions and found an 11.6% increase in VO2 max (Park et al 2010). These studies, along with numerous others, demonstrate how effective BFR can be at increasing aerobic capacity/fitness without the need for high intensity exercise that most rehab patients cannot tolerate. As with increasing strength and hypertrophy, this is a huge tool for rehab professionals.
Additionally, BFR has been found to significantly improve tendinitis. A study by Centner et al (2019) demonstrated BFR was found to have similar tendon changes to that of high load training. High load training is the main tool rehab specialists use in treating tendinitis, however the high loads/weight are often too painful for the patient to handle. Thus creating another catch-22 of knowing how to treat something but being unable to treat it. BFR has shown promise in creating a bridge that can treat tendinitis without the need to load patients with heavy weight.
Finally, in a first of its kind, very interesting study by Barbalho et al (2019), BFR combined with passive mobilization was found to reduce muscle wasting in coma patients. When patients are bed ridden or in comas the musculoskeletal system deteriorates rapidly, and patients often require extensive rehabilitation when they finally recover. BFR was shown to slow and potentially even halt this process; preserving muscle and therefore having potential to mitigate the amount of rehab a patient requires after recovery. While BFR is primarily used in rehab settings this study could have huge implications for its use in ICUs and hospitals.
In conclusion, BFR has been shown time and time again to be a powerful tool for rehab specialists.
In conclusion, BFR has been shown time and time again to be a powerful tool for rehab specialists. From increasing strength/muscle mass to improving aerobic fitness, as well as treating ailments such as tendinitis, BFR is safe and reliable. If you or someone you know is interested in trying Blood Flow Restriction Therapy, feel free to request an appointment via our website or call directly at 401-584-9098. We would be happy to answer all questions you may have regarding this incredible addition to therapy techniques. We accept all major insurances and can accommodate same day appointments with most patients. Give us a call today!
Madarame, Haruhiko, et al. "Effects of low‐intensity resistance exercise with blood flow restriction on coagulation system in healthy subjects." Clinical physiology and functional imaging 30.3 (2010): 210-213.
Clark, B. C., Manini, T. M., Hoffman, R. L., Williams, P. S., Guiler, M. K., Knutson, M. J., Kushnick, M. R. (2011). Relative safety of 4 weeks of blood flow-restricted resistance exercise in young, healthy adults. Scand J Med Sci Sports, 21(5), 653-662.
Takano, Haruhito, et al. "Hemodynamic and hormonal responses to a short-term low-intensity resistance exercise with the reduction of muscle blood flow."European journal of applied physiology 95.1 (2005): 65-73.
Iida, Haruko, et al. "Hemodynamic and neurohumoral responses to the restriction of femoral blood flow by KAATSU in healthy subjects." European journal of applied physiology 100.3 (2007): 275-285.
Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK; American College of Sports Medicine. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459-471.
Abe, T., Fujita, S., Nakajima, T., Sakamaki, M., Ozaki, H., Ogasawara, R., Ishii, N. (2010). Effects of Low-Intensity Cycle Training with Restricted Leg Blood Flow on Thigh Muscle Volume and VO2MAX in Young Men. J Sports Sci Med, 9(3), 452-458.
Park, S., Kim, J.K., Choi, H.M., Kim, H.G., Beekley, M.D. and Nho, H. (2010) Increase in maximal oxygen uptake following 2-week walk training with blood flow occlusion in athletes. European Journal of Applied Physiology 109, 591-600.
Centner C, Lauber B, Seynnes OR, Jerger S, Sohnius T, Gollhofer A, König D. Low-load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared with high-load resistance training. J Appl Physiol (1985). 2019 Dec 1;127(6):1660-1667. doi: 10.1152/japplphysiol.00602.2019. Epub 2019 Nov 14. PMID: 31725362.
Barbalho M, Rocha AC, Seus TL, Raiol R, Del Vecchio FB, Coswig VS. Addition of blood flow restriction to passive mobilization reduces the rate of muscle wasting in elderly patients in the intensive care unit: a within-patient randomized trial. Clin Rehabil. 2019 Feb;33(2):233-240. doi: 10.1177/0269215518801440. Epub 2018 Sep 24. PMID: 30246555.