Blood Flow Restriction Therapy (BFR)

Although blood flow restriction training (BFR) has been around since the 1970's, it has made a recent surge in popularity due to positive research studies and patient testimonials which have made this system popular in physical therapy settings. Originally BFR training started in Japan with Dr. Yoshiaki Sato and was known as "kaatsu training" which means training with added pressure.1 Last year, FYZICAL - Naperville added it to our growing list of cutting-edge techniques and the results have been promising.

What is Blood Flow Restriction Training?

Blood flow restriction (BFR) training is an exercise technique that places a restrictive cuff on the upper portion of the arm or legs in order to reduce the flow of blood in and out of an extremity.1 Once the cuffs are placed on the desired extremities and inflated, strength or cardiovascular exercises can be performed following specific guidelines to help improve muscular strength, performance, and endurance. BFR training utilizes low load/high repetition exercise parameters to achieve results, which have been shown to be as effective as traditional strength training.2,3,4 While exercising, the reduced blood flow out of the extremity causes an increased accumulation of muscle metabolites and decreased oxygen levels which results in muscle fatigue.1,2 During fatigue there is recruitment of additional muscle fibers in order to perform the exercise which can result in muscle hypertrophy.2 Strength gains and muscle hypertrophy can be achieved at low loads when exercising with restrictive cuffs similar to traditional strength training when using heavy loads.3 Exercising at lower loads decreases the risk of injury, so using BFR cuffs may provide a safer alternative while still achieving similar results as traditional strength training.3 This can be very helpful for people that cannot tolerate heavy loads in order to build strength.

Benefits of using BFR

BFR training may provide benefits such as strength gains, improved blood vessel health/circulation, and bone health. The American Sports of College Medicine recommends training at resistance of 60% or more of 1 rep. max in order to obtain strength gains. Working out with heavy loads such as 60% of 1 rep. max can increase risk of injury especially for certain populations such as post-surgical, following an injury, and for the elderly. BFR training can reduce the risk of injury while still obtaining strength gains because of the use of low loads (10-30% of 1 rep. max).3,4 The key for gaining strength with BFR or traditional strength training is achieving fatigue during the workout. Research has shown similar outcomes in strength gains with BFR training with low loads compared to heavy load training.2,3,4 Strength improvements were tracked based on 1 rep. max strength and has shown BFR training and traditional strength training is improved significantly to a similar magnitude.2 To keep it simple, instead of having to pick up a 30 pound dumbbell and workout your arms to improve your strength, you can use 3-10 pound dumbbells and get a similar result with less risk of injury.

BFR training may also provide benefits to blood vessel health and circulation by improving flow mediated dilation and increasing markers that help maintain and improve blood vessel health/integrity.3 Further research needs to be done to fully understand potential benefits of BFR training on blood vessels.

Lastly, BFR training causes an increased expression of bone formation markers and decreases bone resorption markers showing potential for improving bone health.2 BFR training could be a helpful exercise program for someone with osteoporosis and is safe as they will not have to use heavy loads in order to obtain results.1

Who can Benefit?2

  1. General population
  2. Adolescents, adults, and older adults
  3. After a surgical operation
  4. People suffering from pain, arthritis, decreased muscular strength/endurance, muscle injuries
  5. Athletes

Is it Safe?

Many may be concerned about the possible effects of disturbing haemodynamics while exercising, but if implemented and used correctly BFR training has not been shown to present any greater risk than traditional exercise modes.2 When used properly, blood flow is reduced and never occluded which permits safe exercise. Communicating with a medical professional that is knowledgeable and trained with the BFR exercise technique is important.

How to use BFR for Training

There are different brands of BFR belts that can be used, we are most familiar with B-Strong BFR belts which are easy to use and safe if recommendations are followed.

  1. First determine the belt size needed for your arms and/or legs by measuring the circumference of the upper portion of your extremities.
  2. Measure between the bicep and deltoid for the arms and just below the groin for the legs. Place the belts in the same place as you measured and tighten them.
  3. Use the pump and pressure gauge to accurately set the recommended pressure which is provided to you if using the B-Strong BFR belts.

Exercise Guidelines

  1. Always consult with your physician or a medical professional prior to starting BFR training.
  2. Hydrate before, during, and after using BFR.
  3. Workout for twenty minutes and release pressure, never workout longer than twenty minutes for safety.
  4. Perform 3 sets of 30 repetitions (or till fatigue), with 30 seconds of rest in between each set, attempt 3-6 exercises within 20 minutes and take a minute rest in between each exercise. First time, limit yourself to 3 exercises and progress as you gain experience.
  5. Use low load (15-20% of 1 rep. max), high repetition with BFR to get to fatigue, never use heavy weights.
  6. B-strong BFR has a guidance app to help with types of exercises. Target different muscle groups during a workout. Include exercises that work muscles above and below the belt.

Personal Experience

I was trained, along with two other physical therapists at our clinic last year using the B-strong BFR bands. I have used them with some of my physical therapy patients and for myself. I have my own set at home that has helped add more options to my exercise routines and has helped improve my strength. Many of the home exercises I perform utilize my own body weight in order to increase my strength such as pushups, dips, pullups, planks, etc. I have been able to challenge myself even harder with adding the BFR bands to my routine. I can get a great workout in only 20 minutes when using the bands. I try to change my exercise routines often to keep my body guessing and using the BFR bands helps me do this. I did not have to buy a lot of weights, which can be very expensive as well, because the bands are very suitable for improving strength. When using the bands, I quickly can feel the burn and benefit from the exercises and feel accomplished. I do not always use the bands to workout. I still use some of my traditional strength training routines, but the bands help add a unique option to my training.

I have also used them with a variety of physical therapy patients, which include patients following orthopedic surgeries, some with neurological weaknesses from nerve compression in the spine, athletes, and general deconditioned patients. All of the patients tolerated the BFR training and continued to safely use them throughout therapy to help improve their therapy progress.


BFR training is an alternative strength training technique that can be used with a variety of people, including physical therapy patients as well as the general public. When following specific guidelines BFR training can be safely implemented to help gain strength similar to traditional strength training. BFR training is continuing to be researched as the effects from training have not been fully studied or understood yet, but most research has shown promising benefits. BFR training has helped both my physical therapy patients and me, so in my professional opinion, it may be an option that can help many people.

If you would like to know more about this technique, please call us at 630-369-1015 or visit our website at


  1. Patterson SD, Hughes L, Warmington S, et al. Blood Flow Restriction Exercise Position Stand: Considerations of Methodology, Application, and Safety. Frontiers in Physiology.May 2019:N.PAG. Accessed January 27, 2021.
  2. THOMAS K. The Benefits of Blood Flow Restriction Training for Rehabilitation. Co-Kinetic Journal. 2019;(79):24. Accessed January 26, 2021.
  3. Early KS, Rockhill M, Bryan A, Tyo B, Buuck D, McGinty J. Effect of Blood Flow Restriction Training on Muscular Performance, Pain and Vascular Function. International Journal of Sports Physical Therapy. 2020;15(6):892-900. Accessed January 25, 2021.
  4. THOMAS K. The Benefits of Blood Flow Restriction Training for Rehabilitation. Co-Kinetic Journal. 2019;(79):24. Accessed January 26, 2021.