By Brianna Hurt, SPT


Blood flow restriction (BFR) is the use of a pneumatic cuff that is placed and inflated at the most proximal portion of the upper and/or lower limb, which causes arterial blood inflow to be reduced and largely occludes venous return. BFR in combination with low load resistance training has been demonstrated to increase muscle size and strength similar to that observed in traditional high load resistance training.

BFR training is effective across a variety of populations with the most common protocol of repetitions being one set of 30 reps followed by three sets of 15 reps, reaching a total of 75 repetitions. While there are some concerns related to BFR training including, increased risk of blood clots, muscle damage, and negative effects on the cardiovascular system, these concerns have been unsupported in research studies. When applying BFR safe practice should be used in order to minimize risks of these concerns by individualizing factors such as cuff width, cuff type and the pressure that is being applied.

Applications in Clinical Medicine

BFR can be used for several clinical conditions, including but not limited to postoperative care, joint replacements, patellofemoral pain, and muscle injuries. For postoperative patients, BFR in combination with neuromuscular electrostimulation or with low load resistance exercise, is shown to improve muscle atrophy and strength loss. Patellofemoral pain is a common condition among active individuals. The use of BFR training with this condition allows for low loading of the quadriceps in order to strengthen without aggravating symptoms.


BFR training is an effective alternative to traditional high load resistance training and can be beneficial during rehabilitation. When using BFR, safety is important so the appropriate width, material and pressure should be used based on the individual. The same absolute pressure should not be used for each individual in the clinic setting.

Kevin T. Mattocks; Matthew B. Jessee; J. Grant Mouser; Scott J. Dankel; Samuel L. Buckner; Zachary W. Bell; Johnny G. Owens; Takashi Abe; and Jeremy P. Loenneke, Phd