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Blood Flow Restriction Training

By February 10, 2019September 8th, 2023Physiotherapy, Sports Physiotherapy

One of the newest trends that has been circulating the Physiotherapy, rehabilitation and performance worlds is Blood Flow Restriction (BFR) Training.  This novel resistance training method allows the participant to achieve muscle size and strength improvements equivalent to using heavy/high load resistance training (65-80% 1RM) while using low/light load (20% 1RM) + blood flow restriction. (1RM means it is the maximum amount of weight that a person can possibly lift for only one repetition).

Blood flow restriction training utilises the application of an inflatable pneumatic cuff (blood pressure cuff) or wraps, around a limb to limit the amount of blood flow available to the exercising muscle. The goal is to fully occlude venous return of the exercising limb and restrict a certain percentage of arterial blood flow into the exercising limb.

The theory is that through restricting the returning venous blood flow, you will create an environment of metabolic stress which may provide an improved capacity for muscular development, and improved functional strength.

For many years high-load resistance (65%-80% 1RM) has been recommended for rehabilitation and performance to produce strength and muscular development/muscle mass increase.  The issue in rehabilitation is when patients/clients/athletes are unable to perform these training loads to facilitate the necessary muscular development, these patients are at risk of developing chronic imbalances, weakness and pain due to being unable to make necessary change.

Recently there has been very promising research to suggest that low load resistance exercise plus blood flow restriction may be the bridge to allow these patient to progress to high load resistance exercise.

Tennent et al. (2017) studied the impact of BFR + Low Load exercise vs Low Load exercise on post operative knee arthroscopy patients, the results showed a significant increase in quadriceps development in the BFR + Low Load exercise group compared to the Low Load exercise control group.

Giles et al. (2017) Compared low load with BFR vs with standard quadriceps strengthening.  Low Load + BFR produced greater reduction in pain with daily living at 8 weeks post intervention in people with patellofemoral knee Pain. The subgroup with painful resisted knee extension had larger improvements in quadriceps strength from BFR training.

There are several other articles and research papers that support the use of blood flow restriction training in musculoskeletal rehabilitation, one of the most comprehensive articles is a systematic review of 20 articles published in 2017.  The conclusion of the systematic review is that “Compared with low-load training, low-load BFR training is more effective, tolerable and therefore a potential clinical rehabilitation tool.”

This may be the future of rehabilitation, or it may be a fad that comes and goes, I guess we will have to wait and see.  In a future post I will discuss the proposed theories on how Blood Flow Restriction Training is supposed to work.



  1. Tennent, D.J., Hylden, C.M., Johnson, A.E., Burns, T.C., Wilken, J.M., & Owens, J.G. (2017). Blood Flow Restriction Training After Knee Arthroscopy: A Randomized Controlled Pilot Study. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine, 27 3, 245-252 .
  2. Giles, Lachlan & Webster, Kate & Mcclelland, Jodie & L Cook, Jill. (2017). Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: A double-blind randomised trial. British Journal of Sports Medicine. 51. bjsports-2016. 10.1136/bjsports-2016-096329.
  3. Hughes, L., Paton, B., Rosenblatt, B., Gissane, C., & Patterson, S.D. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. British journal of sports medicine, 51 13, 1003-1011 .
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