Blood flow restriction (BFR) therapy/training is one of the newer and more exciting techniques being used in the sports medicine field. I received training with Owens Recovery Science and have been utilizing personalized blood flow restriction (PBFR) therapy in my clinic since November 2017 using the Delfi personalized tourniquet system (PTS).

What exactly is BFR?

It is the application of a specialized tourniquet system to the proximal arm or leg, which is inflated to a personalized and specific pressure to reduce blood flow to an exercising extremity. For the lower extremity, the occlusion pressure is 80%, whereas the upper extremity pressure is usually set at 50%.

The application is brief and intermittent, usually lasting about 6 minutes per exercise. For most clients, a total of 3-4 exercises are used leading to 24-30 minutes based on the specific exercises prescribed. Typically, to increase strength and hypertrophy a person would need to lift a significant amount of weight (greater than or equal to 60% of a 1 repetition maximum). With PBFR you can create significant strength and hypertrophy gains with loads as low as 20% 1RM.

We utilize the Delfi tourniquets as suggested with the Owens training course. You can see the PTS and tourniquets below:

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What is the science behind this training tool?

The landmark study by Takarada published in 2000 revealed that significant hypertrophy gains are seen with occlusion and the use of lighter training loads. There is an increase in muscle protein synthesis as well as growth hormone secretion. Below you find some links to abstracts from Takarada’s work:

https://www.ncbi.nlm.nih.gov/pubmed/10846023

https://www.ncbi.nlm.nih.gov/pubmed/10642363

https://www.ncbi.nlm.nih.gov/pubmed/11128848

In addition to hypertrophy, there also appears to be an application for preventing disuse atrophy simply using occlusion. This may prove very beneficial for clients who are non-weightbearing after an injury or surgery, yet not able to perform much resistance training.

Who are good candidates for this type of therapy?

It should noted that there are several type of BFR training aids on the market. Since I am in the clinical setting day to day, I wanted to use a system that accurately and consistently measures the amount of occlusion in my clients. This is why we partnered with Owens Recovey Science and use the PTS and wider tourniquets.

With respect to my therapy clients, I have used it for the following:

  • Post-op ACL reconstruction
  • Patellofemoral pain cases where the client cannot perform heavy training to strengthen the quadriceps
  • Osteoarthritis of the knee
  • Patella tendinitis
  • Rotator cuff strengthening

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You can see my client above (Division 1 college soccer player) doing a TRX double leg squat following her ACL reconstruction. I have also seen very good results in younger clients with patella tendinitis that have not responded to other methods for pain relief. Consider the following case study:

A 14 y/o soccer player w/BTB autograft ACLR performed on 6-13-17 develops patella tendinitis at 14 weeks post-op. I used a Cho-pat strap, ultrasound, iontophoresis, IASTM, stretching, eccentrics, activity modification and laser used from 9/11 - 12/4 to reduce pain w/o success (23 visits). Therefore, I shifted the treatment focus from 12/4/17 to 1/4/18 to strength only with BFR focused therapy with resolution of palpation tenderness and ability to run and jump pain free in in just 8 visits.

That result speaks volumes to me and the patient. I am currently in the process of testing and adapting exercise protocols with different diagnoses, but I am very encouraged with the early returns. I feel this adjunct to PT will be an excellent tool for accelerating strength recovery after surgery, reducing disuse atrophy and allowing people who could not previously load their joints with traditional strength training an opportunity to increase strength with lower loads thereby sparing their joints from higher loads.

Are there contraindications?

The following list includes some general contraindications, but ultimately your physician or healthcare provider can determine if you are a good candidate or not.

  • History of deep vein thrombosis
  • Open fractures of the leg
  • Post‑traumatic lengthy hand reconstruction
  • Severe crushing injuries
  • Severe hypertension
  • Elbow surgery (where there is concomitant excess swelling)
  • Skin grafts in which all bleeding points must be readily distinguished
  • Compromised vascular circulation, e.g., peripheral artery disease
  • Sickle cell disease or trait

BFR is currently being used by professional athletes, the military, NCAA, PT/OT programs, large healthcare systems and private clinics. While it may not be appropriate for everyone, it seems to offer some promising benefits for both the rehab and performance training worlds.