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Blood Flow Restriction Training: The Basics

Have you heard about blood flow restriction training (BFR)? It is one of the more popular modalities in rehab at the moment. We use it all the time for our athletes and we will go over the basics of what blood flow restriction training is. Let’s jump straight into it.

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.

Why Should You Use Blood Flow Restriction Training?

BFR training is a MUST after any knee surgery, especially after ACL surgery. The reason is that it allows you to get muscular and cellular adaptation without putting excessive load on the joint. This is HUGE, especially early in rehab, when the knee joint is still irritated and vulnerable after surgery. If we put more load on the knee joint, this could lead to unnecessary excessive swelling. In other words, we are able to increase muscle size and strength without lifting as much weight.

Muscular Adaptations Include:

  • Increased muscular strength
  • Increased muscular cross sectional area AKA muscle size
  • Improved muscular endurance
  • Improved VO2Max

Is It Safe To Use?

The great thing about blood flow restriction training is that almost everyone can use it! Essentially, if a doctor clears you for surgery, then you can perform blood flow restriction training.

Contraindications, or reasons you should not perform blood flow restriction training, include: 

Furthermore, BFR training can be used for healthy individuals, not just for people following surgery. For example, we like to use it for basketball athletes during the season to decrease the stress on their joints and still get the desired muscular adaptations.

How Do You Use It?

In order to use BFR training, a tourniquet system is used and applied in the proximal part of the body that you are using. In other words, for your legs, you would apply the tourniquet as high as you can up the thigh. Moreover, for your arms, you would place it as high as you can up your arm. 

Furthermore, we have different parameters for each body part. For example, for the lower body, we will have a range of occlusion from 60-80% occlusion of the artery bringing blood flow to the leg. Meanwhile, for the upper body, the occlusion is 30-50% occlusion of arterial blood flow to the upper body.

Recommended Weight With Blood Flow Restriction:

As we mentioned above, one of the benefits of BFR training is that you do not need to use the same amount of weight when doing the exercises to get the same benefit. Studies have shown that you only need 20-30% of your 1 repetition max to get the same results you would get when lifting at around 70-80% of your 1 repetition max.


We just broke down the basics of BFR training and hopefully you have a better understanding. The big takeaways are that blood flow restriction is one of the most important things to perform after knee surgery, especially ACL surgery to decrease the loss of muscle following surgery. Also, it is not just limited to people that have gone through surgery to use this, but for athletes to use during the season for maintenance or healthy population.

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Telfer et al. Biomechanical effects of blood flow restriction training after ACL reconstruction 
Wengle et al. The effects of blood flow restriction in patients undergoing knee surgery
Alvarez et al. Comparison of blood flow restriction training versus non-occlusive training in patients with anterior cruciate ligament reconstruction or knee osteoarthritis: a Systematic review

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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