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  • Writer's pictureSteven Schwab

Blood Flow Restriction Training

Updated: Feb 17, 2022


Blood Flow Restriction Training (BFRT) is the brief and intermittent occlusion of both arterial and venous blood flow using a tourniquet while performing low intensity exercises. This is achieved by placing a strap or cuff around the exercising limb of which reduces, not completely occludes, blood flow. BFRT has been shown to produce similar results to that of high intensity strength and endurance training. BFRT has been around for over 20 years, however has been gaining popularity due to exciting and ongoing research of it's efficacy. It is recommended to train at 20-35% of 1 rep max for BFRT for total repetition count of 40-60.


Let's briefly discuss how muscles "get bigger". While this concept can be very complex, basically muscle strength improves through mechanical, neural, and metabolic mechanisms; all of which depend on load and volume causing muscle fatigue.

The higher the load & volume= greater muscle fatigue.

BFRT causes a hypoxic environment (hypoxic=lack of oxygen) due to limiting arterial blood flow thereby causing a greater increase in metabolic mechanism production. This in turn creates greater muscle fatigue, activation, and neural pathway production.

Benefits from BFRT include: increased muscle size & strength, increased cardiovascular capacity, decreased joint/tissue stress, minimal muscle damage, minimal soreness.


So why use BFRT over traditional training or rehabilitation methods? Although further research is needed, there has been studies published showing that BFRT improves muscle strength GREATER than high intensity training. Also, research has shown one can obtain faster results for both aerobic and resistance training compared to normal training! Wait, so you're saying I can do low intensity exercises such as body weight squats with BFRT and get the same result as squatting 75% 1 rep max? YES!


From a physical therapy standpoint, BFRT is extremely beneficial to properly build muscle strength without causing further damage to a joint. For example, those who have knee pain when squatting, we are able to strengthen the quads with lower intensity as to not further damage the knee joint (post-op ACL). BFRT is also a great tool for personal trainers. Those who are working with older populations can see tremendous gains while avoiding joint & muscle damage, and also improve cardiovascular endurance. Olympic athletes have been known to use BFRT to supplement their intense regimes.

Therefore, due to the ability to increase muscle production with low intensity exercises is extremely advantageous for anyone who suffers from joint pain, deconditioning, pre-op & post-op patients, obesity, and even athletes. So, basically anyone! With that being said, I highly recommend educating yourself prior to use and/or training with a professional.

Contraindications for people NOT to use BFRT include: circulatory issues or clot risk (DVT), heart disease/insufficiency, severe uncontrolled hypertension, Sick Cell Anemia, varicose veins, pregnancy, open wound or incision, infection, lymphedema.


There are different devices, techniques used to achieve BFRT. Some include basically wrapping the limb with a tight band/tourniquett which can be purchased relatively cheap. I would not recommend this method for this can be uncomfortable and difficult to measure exact pressure. A more efficient, popular technique is with an inflatable cuff. Although this can be more costly, it is much more comfortable, efficient, and one can obtain objective data to progress accordingly with the training regime.


A BFRT device that I highly recommend is SmartCuff. I use them personally and professionally for my patients. These cuffs come with an automated pump. The device automatically inflates, measures the occlusion pressure, then can inflate to a pre-determined percentage of limb occlusion pressure. The cuff is very comfortable too. They give you the option of ordering a pair for the arms, the legs, or both. The company offers a well educated, step by step manual which is very beneficial.

For 10% off, be sure to use coupon code sschwab10R





Another great BFRT device are Airbands. These are unique in they have an automatic pump attached to the band therefore no external devices/wires. Another unique feature is they sync with an app on your phone where you can inflate, measure pressure through the app. Now that's cool! Although these are a bit more expensive, I believe it's worth the money with all the neat features.

For 5% off, use coupon code absteven



Both of these devices are great products. Please do not hesitate to email me with any questions geauxphysicaltherapy@gmail.com.



Steven Schwab PT, DPT

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