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Blood Flow Restriction Training: ACL Considerations

Blood flow restriction (BFR) training following ACL surgery is a game changer that will help you in your rehab and recovery in numerous ways! If you recently had ACL-Reconstruction or are interested in BFR, this article is for you!

What is Blood Flow Restriction Training?

Blood flow restriction is a method of training that utilizes a tourniquet system to decrease arterial blood flow and venous outflow. In other words, it limits the blood going into the muscle (arterial blood flow) and prevents blood getting back to the heart (venous outflow). Limiting this blood will ultimately limit oxygen supply to the muscle. The reason we deplete the muscle from oxygen is to be able to get muscular and cellular adaptations without putting excessive external load.

If you want to learn more about blood flow restriction training, check out our recent blog.

Why is Blood Flow Restriction Training Important Following ACL Surgery?

To understand why BFR is so important following ACL surgery we need to first understand the basic goals after ACL surgery.

After getting ACL surgery the 3 most important things you have to be working on is:

  1. Decrease Swelling
  2. Straightening Your Knee
  3. Activating Your Quadriceps

BFR training will help the most on goal three of activating the quadriceps muscles. As mentioned above, BFR allows you to work the muscle without putting excessive stress on the joint. That is the biggest battle as healthcare practitioners we face during ACL rehab, in which we want to strengthen the muscle; however, we do not want to overload the joint because that will contribute to increased swelling.

Furthermore, we have seen improved ability for the athlete to activate their quads after performing BFR training due to the tactile cue from cuff and muscle pump. Therefore, BFR training could almost serve as a warm up to make sure you are able to activate and feel your quads when performing exercises.

What Exercises Should Be Performed With Blood Flow Restriction Training?

When it comes to exercise selection with BFR after ACL reconstruction surgery, we have to find the right exercise to achieve the goal of activating the quads.

For instance, in early rehab, we use neuromuscular stimulation to help facilitate quad activation; therefore, we add in BFR with neuromuscular stimulation to further enhance quad activation. We start with simple exercises that allow you to feel your quads turn on. Examples of these exercises would be, quad sets or standing terminal knee extensions.

As you progression, you would move to more functional movements like a mini squat variations, sit-to-stands, lunges, etc. There isn’t a specific set of exercises, since every athlete is different and one exercise does not fit all. It all depends what stage you are in your rehab and create the exercise that meets your specific needs. 


Check out this video below on what a sample session of exercises would look like following ACL reconstruction surgery with blood flow restriction.

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Suji Flow Restriction Unit

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If you are struggling with your ACL rehab or have any questions feel free to send us an email at or schedule a free 10 minute discovery call with us at


Charles et al. A systematic review of the effects of blood flow restriction training on quadriceps muscles atrophy and circumference post ACL reconstruction
Wengle et al. The effects of blood flow restriction in patients undergoing knee surgery
Colapietro et al. Effects of blood flow restriction training on clinical outcomes for patients with ACL reconstruction: A systematic reivew

The Basketball Doctors - Gabriel Ignacio Physical Therapist

Dr. Gabriel Ignacio PT, DPT, OCS, TPI

The Basketball Doctors - Marco Lopez Physical Therapist

Dr. Marco Lopez PT, DPT, CSCS

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