Blood Flow Restriction (BFR): How its used in the Physical Therapy Clinic & its Astounding Results
By Eric Faatz, ATC
Blood Flow Restriction is becoming a practice that is being utilized more frequently with astounding results. Also known as BFR, the method consists of placing a cuff around the most proximal portion of an upper or lower extremity while the cuff applies a controlled specific amount of pressure to the limb. The pressure cuff restricts the blood flow to the muscles that are associated with the limb but allows the blood flow returning from the extremity to stay at a normal rate. The restriction of blood flow to the extremity allows the muscles to become fatigued quickly which helps elicit a strength response much faster than with traditional exercise. Since muscle tissue becomes tired much faster during BFR training, the individual exercising does not have to use heavy weights to achieve an increase in strength and muscle growth. Using lighter weights during exercise allows them to be safer initially for post-operative patients, such as ACL reconstructions, biceps tendon reconstruction, Achilles tendon repair and many other operations.
After having a major orthopedic surgery, such as ACL repair, the tissues are highly sensitive and have restrictions and limitations placed upon the patient to ensure the safety of the repaired tissue. These restrictions typically include limitations on range of motion, non-weight bearing, use of a fixation brace, and others based on the specificity of the surgery. This is where the implementation of a blood flow restriction cuff and protocol become most useful. In a review by Hughes, Luke; Rosenblatt, Benjamin; Paton, Bruce; et al. at St. Mary’s University – London. proper integration of BFR training protocol, into ACL rehabilitation, resulted in reducing the amount of muscle atrophy post-surgery, an increase in muscle protein synthesis, and decreased loss of muscular motor patterns in post-op patients. These previously common hurdles in ACL rehabilitation are becoming easier to address early on postoperative without compromising the graft health with the use of BFR training. In another systematic review by Charles D et. Al* use of blood flow restriction protocols in post-ACL reconstruction therapy was correlated with increase in quadricep cross-sectional muscle increase through multiple studies. Maintaining muscle during recovery from any surgery can only be advantageous for the patient’s return to activity. Through cross analysis of these two and many other existent studies, integration of a blood flow restriction program along with physical therapy can help make an immense difference in the recovery from surgery and in the later stages of recovery/return-to-sport.
Blood flow restriction training does not only benefit post-surgical patients but can be an addition to an individual’s fitness/exercise program. In a study by the International Journal of Sports Physiology and Performance by Cook, Kilduff, and Beaven 2014* , a group of trained athletes integrated BFR protocols into their weightlifting sessions three times per week for three weeks. When compared to an equal number of athletes performing the same weightlifting program but without the BFR integration, the BFR group showed greater improvement in squat strength, maximum top speed and power output, and increased tolerance to stress from exercise. When applied appropriately by a licensed exercise professional, BFR can become an amazing tool to use during athlete performance training.
Integration of blood flow restriction is safe and effective along with physical therapy and exercise. While it can be a useful tool to utilize, a certified healthcare professional should always be the one to integrate the use of blood flow restriction into the individual’s program.
Eric Faatz, ATC is a Certified Athletic Trainer for ProClinix Sports Physical Therapy & Chiropractic in Armonk. For any questions about this article or our services, please call (914) 202-0700 or email Eric at efaatz@proclinix.com
*Charles D, White R, Reyes C, Palmer D. A SYSTEMATIC REVIEW OF THE EFFECTS OF BLOOD FLOW RESTRICTION TRAINING ON QUADRICEPS MUSCLE ATROPHY AND CIRCUMFERENCE POST ACL RECONSTRUCTION. Int J Sports Phys Ther. 2020;15(6):882-891.
Cook, Christian J., Liam P. Kilduff, and C. Martyn Beaven. “Improving strength and power in trained athletes with 3 weeks of occlusion training.” International journal of sports physiology and performance 9.1 (2014): 166-172.