Blood Flow Restriction (BFR): A Powerful Tool for Physical Therapy

At Eastside Movement Company, we keep up with the latest, evidence-based physical therapy techniques and tools to help our clients get back to what they love faster and more efficiently. We’ve recently begun using Blood Flow Restriction (BFR) training with our clients, with great outcomes thus far. You can check out our post on Instagram about it here.

As there’s been more research done on BFR over the past decade that has shown BFR has substantial benefits for certain populations, BFR has gained popularity in the physical therapy world.

BFR, also known as occlusion training, involves the application of a specialized tourniquet or cuff to partially restrict blood flow to targeted muscles while exercising. This technique was initially discovered in Japan in the 1960s by Dr. Yoshiaki Sato. In this blog, we will explore the evidence-based benefits of using BFR during their recovery from pain.

How Blood Flow Restriction Works

The principle behind BFR is based on the body's natural response to hypoxia, which is the deprivation of oxygen in muscles during restricted blood flow. When applied correctly, BFR creates a localized hypoxic environment using a pneumatic cuff to top of the arms or legs to restrict arterial blood flow while allowing venous return. This simulates the physiological responses seen in high-intensity training with less mechanical load on the joints.

Benefits of BFR in Rehabilitation

A large number of research studies have been conducted to analyze the mechanisms behind BFR therapy, and the findings provide compelling evidence for its efficacy. Here are some of the key physiological responses and benefits:

Reduced Muscle Wastage

Following an injury or surgery, patients often experience muscle atrophy due to inactivity. BFR helps combat muscle wastage by encouraging muscle growth even with low-resistance exercises, minimizing strength loss during the recovery phase. In addition to surgical patients, this method can be applied to post long covid patients to reduce their muscle wasting rate and get them back to baseline. 

Accelerated Healing of Injured Tissues

BFR stimulates the production of collagen and other regenerative factors, which can expedite the healing process of injured tissues and ligaments. In addition, BFR therapy was shown to promote angiogenesis, the formation of new blood vessels, and increase localized growth factors in damaged tissues. This vascular and cellular response supports the healing process and aids in the repair of injured tissues.

Improved Muscle Strength

BFR training, when combined with low-intensity resistance exercises, produced comparable muscle hypertrophy to high-intensity resistance training without BFR. This leads to significant muscle strength gains, making it highly effective for patients who are unable to bear heavy loads due to their condition. The induced metabolic stress and muscle fatigue contributes to increased muscle protein synthesis and growth. This finding is particularly beneficial for patients with limited strength due to injury or post-surgery restrictions.

Improved Cardiovascular Endurance

BFR training can lead to improvements in cardiovascular endurance despite the use of low-intensity exercise protocols. This can be especially advantageous for patients who are unable to engage in high-impact or high-intensity exercises during their recovery phase. 

Joint Protection

BFR allows physical therapists to focus on targeted muscle groups without placing excessive stress on vulnerable joints, making it a safe and effective rehabilitation tool for people with joint-related issues. This is especially effective with clients with knee pain that are unable to squat heavy load; squats done with BFR strengthen the quadriceps without excessively loading the knee joint. 

What’s It Feel Like?

BFR makes body weight and light weight exercises feel much more difficult and increases muscle fatigue. We like to tell our clients that BFR makes your muscles feel like they’re starting on rep 7 or 8 of a set of 10. BFR training is only done for about 15 minutes at a time, so the workouts are short but intense.

Let's Wrap Up

Blood Flow Restriction (BFR) therapy is a scientifically grounded approach to enhance recovery during the rehabilitation journey. By utilizing controlled hypoxic conditions, BFR elicits numerous physiological responses that promote muscle hypertrophy, strength gains, cardiovascular endurance, and tissue repair. Moreover, it provides a safe and effective option for patients who are unable to engage in high-intensity exercises. As research in this field continues to grow, BFR is likely to become an increasingly vital tool in the physical therapist's arsenal, helping people achieve optimal outcomes and return to an active and healthy lifestyle.

References

Loenneke JP, Thiebaud RS, Abe T. Does Blood Flow Restriction Result in Skeletal Muscle Damage? A Critical Review of Available Evidence. Scandinavian journal of medicine & science in sports. 2014;24(6):e415-e422. doi:10.1111/sms.12246

Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(13):1003-1011. doi:10.1136/bjsports-2016-097071

Sundberg CJ. Exercise and Training during Space Flight. Sports Medicine. 2000;30(3):167-180. doi:10.2165/00007256-200030030-00001

Centner C, Wiegel P, Gollhofer A, König D. Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Medicine. 2020;50(12):2385-2404. doi:10.1007/s40279-020-01359-w

Cook SB, Murphy BG, Labarbera KE. Neuromuscular function after a bout of low-load blood flow-restricted exercise. Medicine & Science in Sports & Exercise. 2013;45(1):67-74. doi:10.1249/MSS.0b013e31826c60ea

Cook SB, Clark BC, Ploutz-Snyder LL. Effects of exercise load and blood-flow restriction on skeletal muscle function. Medicine & Science in Sports & Exercise. 2007;39(10):1708-1713. doi:10.1249/mss.0b013e31812383d6

Takarada Y, Nakamura Y, Aruga S, Onda T, Miyazaki S, Ishii N. Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. Journal of Applied Physiology. 2000;88(1):61-65. doi:10.1152/jappl.2000.88.1.61

Scott BR, Loenneke JP, Slattery KM, Dascombe BJ. Exercise with Blood Flow Restriction: An Updated Evidence-Based Approach for Enhanced Muscular Development. Sports Medicine. 2015;45(3):313-325. doi:10.1007/s40279-014-0288-1

Sousa JB, Fukuda TY, da Silva JJ, da Silva CG, Vieira TL, Costa PB. "Ischemic Resistance Exercise improves muscle strength and somatic pain in rotator cuff tendinopathy: a randomized controlled trial." Journal of Shoulder and Elbow Surgery. 2020 Oct;29(10):2084-2092.

Sundberg CJ. Exercise and Training during Space Flight. Sports Medicine. 2000;30(3):167-180. doi:10.2165/00007256-200030030-00001