Blood Flow Restriction Training 101 $0.00

Blood Flow Restriction Training 101

By: Emily Nichols |
Blood Flow Restriction Training 101

Any of you who are involved in rehabilitation, athletic performance, or sports medicine have probably been hearing about blood flow restriction training much more recently. Although “blood flow restriction training” or “occlusion” training has been around for quite some time, it has recently started growing in popularity within a variety of populations. The constantly growing research is in support of the use of blood flow restriction in combination with low-load resistance training. [1] It is emerging into the fitness and rehabilitation worlds as a way to help patients get their strength and muscle mass back quicker than ever before.

With guidance from Dr. Phil Page, PhD, PT, ATC, CSCS, FACSM, we have put together an article covering all the basics of blood flow restriction training to help give you a general understanding of what this buzz is all about.

What is BFR and How Does it Work?

Blood flow restriction (BFR) training is a training and rehabilitation strategy involving the use of an inflatable tourniquet, such as an elastic band or cuff, around the top of the arm and/or leg to restrict blood flow during exercise. The goal of BFR training is to increase strength gains while lifting lighter loads which reduces the overall stress on the limb and avoids muscle breakdown.

Blood flow restriction training works by:

  • Blocking venous return without blocking arterial flow
  • Facilitating growth hormones
  • Creating cellular swelling
  • Fatigue recruiting more Type 2 fibers
  • Metabolites, especially Lactate, accumulating and stimulating muscle growth

Dr. Ed Le Cara, DC, PhD, MBA, ATC, CSCS explains, “Under normal conditions, the metabolites produced in your muscles during hard exercise serve as cellular signals that trigger adaptations in your body – bigger muscles after resistance training, for example. With blood flow restriction, your muscles are forced to stew for longer in these metabolites, triggering bigger adaptations.” [2]

Who Uses BFR?

In recent years, blood flow restriction training has been gaining popularity in both athletic populations [3] and rehabilitation populations [4]. As Dr. Zachary Long, PT, DPT, SCS, says, “This obviously has huge implications in the rehabilitation world as it can help us get patients stronger without loading injured muscles, tendons, ligaments, and joints to the point where we further damage the tissues. For the sports performance world, the ability to create muscle strength and hypertrophy at low loads, without the breakdown of muscle proteins, also makes it a possible addition to training programs.”[5]

Take a look at this sample list of types of people who could be good candidates for using BFR:

  • Pre-op ortho patients
  • Post-op ortho patients
  • Geriatric populations
  • Bedrest and/or immobilized patients
  • Amputees
  • Active recovery populations
  • Athletes
  • Body builders

Benefits of BFR

How will the above populations benefit from using BFR training opposed to traditional training or rehabilitation methods? The Smart Cuffs website [6] has provided a list of benefits that blood flow restriction training can have for the user:

  • Increased muscle size
  • Increased muscle strength
  • Increased cardiovascular capacity
  • Increased GH, IGF1 (maybe testosterone)
  • Decreased joint/tissue stress
  • Little to no muscle damage
  • Little to no recovery needed
  • Little to no soreness or delayed onset muscular soreness (DOMS)
  • Low intensity needed

Contraindications of BFR

Although blood flow restriction training is proven to be safe, and injury resulting from this type of training is rare, there are several contraindications of BFR training that must be made note of to perform this safely. Always be cautious and screen possible BFR users.

Below is just a small list of some of the many contraindications:

  • Circulatory issues or clot risk (DVT)
  • Heart disease/insufficiency
  • Severe, uncontrolled hypertension
  • Diabetes
  • Sick Cell Anemia
  • Varicose Veins
  • Pregnancy
  • Less than 12 years of age
  • Open would or incision
  • Infection
  • Cancer
  • Lymphedema

Possible Side Effects

I’m sure you’re aware by now, as with anything, side effects are always a possibility. When exercises are performed appropriately and when equipment is monitored by a professional, the risk for possible side effects can be lowered.

Be knowledgeable and prepared in the event that any of the below side effects do occur during or after the use of BFR training:

  • Pain (tourniquet too tight)
  • Numbness
  • Nerve damage
  • Bruising
  • Subcutaneous hemorrhage
  • Syncope
  • Rhabdomylosis


Blood flow restriction training has been growing in popularity and is increasingly being used, meaning more and more questions are popping up about BFR training. Dr. Phil Page, PhD, PT, ATC, CSCS, FACSM has taken the time to compile a list of some of the most frequently asked questions and provide you with simple, concise answers to help you feel at ease about this new training and rehabilitation strategy.

Is BFR safe?

Yes, very few side effects have been reported in the literature.

Is there research supporting BFR?

Yes, over 800 published research studies have evaluated BFR.

Can I use “floss bands” for BFR?

No, they are often too narrow and can’t quantify the compression.

Does BFR need FDA clearance?

While not required, FDA listing ensures the device follows safety parameters.

Is BFR within scope of practice?

Yes, the APTA has stated that BFR can be a physical therapy intervention.

Can patients use BFR at home?

Yes, patients can use BFR at home once parameters have been set.

Do I need to take a certification course?

You don’t need to be certified to use BFR, but training courses (live or online) are recommended.

Why do I need a Doppler?

The Doppler allows for accurate measurement of LOP, which is then used to prescribe the appropriate occlusion.

Why do I need multiple cuff sizes?

Limb circumference varies, and wider cuffs require less pressure.

Is BFR just for rehab?

While rehab patients may benefit the most, BFR can also be used for personal training and athletes.

Are You Ready to Implement BFR Into Your Practice?

If all the talk you’ve heard about BFR training has peaked your interest, and you’re anxious to learn more, consider taking the Smart Cuffs Level 1 Blood Flow Restriction Certification Course. [7] The one-day course could help to revolutionize your practice and training program.

For those of you who are still on the fence about this new training and rehabilitation strategy, take a deep dive into the many studies that have been completed on blood flow restriction training and research all that you can on this topic!

Once you feel ready to implement BFR training in your training room, physical therapy office, occupational therapy office, gym, or private practice, it’s time to choose one of the many cuffs that are available to you. Be sure to take the time to look over your options and figure out what will be the best fit for you and your patient population.

Smart Cuffs have a few benefits that make them stand out from the rest. These uniquely designed rehab aids will increase patient growth, muscle hypertrophy, muscle strength, and VO2 Max. These benefits are achieved when metabolic stress and cellular swelling is increased during training. Smart Cuffs are specifically designed for at-home or clinical use, and measure 4 inches wide for safe, lower pressure training.