Person with BFR cuffs on both legs

Blood Flow Restriction (BFR) – What You Need to Know

Elite Bodyworks has recently begun offering blood flow restriction (BFR) services to patients. Many people have expressed curiosity about this new and strange-sounding treatment technique. Hopefully, this post will explain what you need to know and how it can be incorporated into your therapy program.

What is blood flow restriction?

Blood flow restriction is a technique in which exercises are performed with reduced blood flow to the limb we are exercising. A specialized cuff applied to the upper portion of the limb accomplishes the reduction in blood flow. By using a Bluetooth connection, we are able to calibrate and inflate the cuff to a predetermined pressure which partially, but not fully, occludes the blood flow to the limb. The cuffs maintain the pressure throughout an exercise session of usually one to three exercises focusing on a particular muscle group. Essentially, we are drastically reducing the blood flow and oxygen delivery to the muscle that we are exercising. It’s almost like altitude training for your muscles.

For example, if we are exercising the thigh muscles, we would place the cuff as high on the thigh as possible. After calibration, you would perform a predetermined set of leg extensions, step-downs, and/or squats. Rest periods are built into the scheme, but the cuff usually remains inflated for the duration of the activity.

Sega BFR cuffs for use in Physical Therapy

How do muscles get stronger?

Muscles need both load and volume to get stronger. Load is the amount of weight or force you’re lifting, pushing, pulling, etc. Volume is how many sets and repetitions you perform.

Normally, you need to lift in the neighborhood of 60% of your one-rep maximum 8-12 times to increase strength. When you lift at a high enough load and volume, your body produces hormones, proteins, and by-products (think lactic acid, testosterone, growth factors, and others), which stimulate the muscle to repair and grow. Again, this won’t happen if the load or volume is not enough.

What happens when we exercise with BFR?

When we exercise with BFR, we increase the stress on the muscle by reducing the blood flow. There is an increase in hormones and exercise by-products produced, even at lower loads. In effect, the muscle produces the same substances as it does when lifting a heavy load but at lighter levels of resistance.

Blood flow restriction is also believed to have an analgesic effect on the body. Therefore, you will experience less discomfort while performing a normally painful exercise.

These concepts are especially important in the rehab setting.

Following injury, pain, and inflammation often interfere with being able to exercise with a high enough load to stimulate muscle growth and repair. Similarly, following most surgical procedures, exercise loads are restricted to allow for the tissue to heal. Unfortunately, significant weakness and muscle atrophy can result in both cases, further delaying the return to normal activities.

Strength training with blood flow restriction on the thigh

Why is BFR effective?

The benefit of using BFR is that we can train a muscle group with less intensity but still get the benefits of higher-intensity training. We can train the muscle at roughly 20-30% of the one-rep max. The body produces the same growth hormones to stimulate muscle repair and strength increases. However, the potential damage to the muscle tissue is greatly reduced. There is a reduction in stress on the joints. Because of the above-mentioned analgesic effect, there is also less pain, allowing better exercise tolerance.

Is BFR safe?

This is a common question. Fortunately, considerable research has been performed to determine both the safety and effectiveness of BFR.

BFR increases a person’s heart rate and blood pressure in a similar manner to exercise. It has not been shown to increase the risk of blood clots. However, as a precaution, we normally wait at least two weeks after surgery before initiating the treatment.

Using equipment that allows calibration of your individual occlusion pressure ensures that you are not exceeding recommended pressures which could lead to muscle, nerve, and overall tissue damage. Damage can occur with commercially available bands with no calibration or method to determine the proper training pressure.

General contraindications to BFR include pregnancy, active infections, clotting disorders, hypertension, cardiac disease, uncontrolled diabetes, and a history of stroke. If you are concerned about the safety of the treatment in your individual case, a discussion with your primary care MD is always a good idea.

Is blood flow restriction right for me?

If pain or injury is interfering with your ability to gain strength, BFR may be indicated. This is especially true if you have had surgery recently. We can incorporate BFR directly into your therapy session as part of your rehab program.

Blood flow restriction can also be used by healthy individuals looking to increase the effectiveness of their workouts. The technique is popping up more frequently in gyms and training rooms, especially with athletic individuals. Most current recommendations focus on using BFR as a supplement to your training. It is not a replacement for heavy lifting. Remember, when we lift heavy, we also recruit core and stabilizing muscles. There is also coordination, balance, and recruitment of multiple muscle groups occurring with heavy lifting. Lifting lighter loads with BFR won’t stimulate all of the same systems as heavy lifting does in a healthy individual.

Person squatting with BFR cuffs

Bottom line

Blood flow restriction can effectively promote strength gains when injury, pain, or recent surgery makes strength training difficult. It is safely performed with equipment that allows pressure to be calibrated and monitored. BFR can be a supplement but not a replacement for heavy lifting in healthy individuals.

If you are wondering if BFR is right for you, contact Elite Bodyworks for a consultation.

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Picture of Carol Grgic, PT, OCS, CSCS

Carol Grgic, PT, OCS, CSCS

Carol Grgic is the owner and treating therapist at Elite Bodyworks in the Historic Third Ward, in Milwaukee, Wisconsin. She has extensive experience treating athletes and active people of all levels. She has a particular interest in headache treatment. She also enjoys blogging about health and wellness topics.

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