Blood Flow Restriction Training

A New Take on Exercise and Recovery: Blood Flow Restriction Training

Blood Flow Restriction training (a.k.a. BFR) is a very new training concept. Although there is not a plethora of research available on the subject in terms of exactly how it works, or how it might affect people with specific diseases such as EDS, we do know that it builds muscle and strength. BFR is extremely effective, especially for populations who cannot lift heavy weight, such as patients recovering from surgery and elderly populations.

Imagine This:

You are referred from your doctor to receive physical therapy after you’ve had a total knee replacement. In terms of recovery, we know that upper-leg strength is paramount. When you arrive at physical therapy, would you want to lift heavy weights on a leg extension machine? Of course not! Nor would it be safe. The operated limb would be endangered. That’s where BFR comes in.

Let’s Stress!

When we build muscle and strength, it’s because we are stressing our muscles enough to get that adaptation. Traditionally, we lift very heavy weights multiple times, causing small but significant damage to our muscles. These heal and, over time, grow in size and strength. With BFR, the weight is much lighter, so how could we have a similar response?

It all comes down to stress. With traditional weight lifting, 100% of the stress comes from the weights (external load). With BFR, most of the stress is internal – working muscles’ blood supply is intentionally limited, providing them with less oxygen, inducing a stress response. This creates a great environment for muscles to adapt and grow.

If BFR is So Great, Then Why Perform Traditional Resistance Training at All?

Although BFR has its strategical uses and benefits, it is not an equal replacement for traditional resistance training. Research has shown that although increases in muscular size is similar for both training methods, neuromuscular adaptations (strength) is about half as effective for BFR versus traditional resistance training. That said, BFR is an excellent alternative training method for those who cannot perform traditional resistance exercises safely, and it is a great supplemental training method for populations who can. Using BFR in conjunction with – rather than as a replacement for – traditional training has exhibited additional benefits compared to traditional training alone.

Does BFR Hurt?

As mentioned earlier, all muscular adaptations require stress. Stress is uncomfortable. BFR should not hurt nor injure the participant. However, it may be too intense for some individuals, especially for those who are not familiar with resistance training. That is why BFR intensity is variable, and can be tailored to the individual.


The standard protocol for BFR is 40-80% occlusion of arterial flow at rest, using 20-40% of one’s 1-rep-max, performing 75 repetitions over four sets. Wow, that’s a lot to unpack:

  • 40-80% occlusion of arterial flow at rest: Under professional supervision, the cuff is applied to the appropriate limb while rested, and is pumped until there is no pulse. Then, the pressure is adjusted to 40-80% of that value.
  • 20-40% of one’s 1-rep-max: The weight used during a given exercise should be 20-40% of the maximum weight one can perform only one repetition with, with good form.
  • 75 reps over four sets: The standard scheme is to perform four sets of a given exercise, at 30-15-15-15 repetitions, respectfully.

The important take away from this is that BFR prescription and intensity is variable. If someone is new to exercise, be conservative, utilizing 40% occlusion pressure and 20% of their 1-rep max. If they are more advanced, a more intense prescription may be more appropriate. Everyone is different!

I Can’t Lift Weights at All. Is BFR Still for Me?

Absolutely. BFR has been shown the be effective in increasing muscle size when applied to individuals performing low intensity cardio, such as walking or cycling. If you are immobile, BFR application to the affected limb alone can help prevent muscle loss. Ask your doctor what’s right for you.

A New Frontier

Blood Flow Restriction Training is a new frontier. Research as been done, but there is a long way to go. Regardless, I hope this blog was informational, helps you to understand BFR’s principles, and helps to prepare you for your next journey to recovery through exercise.

Interested in trying BFR in the clinic? Fill out our contact form here to learn more!

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