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You may have heard of blood flow restriction training (BFR) since it’s becoming more popular in physical therapy clinics across the country. This is because, under the right circumstances, BFR promotes muscle growth and enables you to gain strength without lifting heavy loads; a feat that isn’t easily accomplished. What’s more, it’s safe to use in almost everyone, even those who are recovering from injury. 

Fortunately, Peak Physiotherapy & Performance is one of the few physical therapy clinics to offer blood flow restriction training in Columbus, Ohio. Follow along as we answer all of your questions about blood flow restriction therapy and how it can help you reach your strength and recovery goals. 

What is Blood Flow Restriction (BFR) Training?

As one of the most effective muscle-building techniques in a physical therapist’s repertoire, BFR can improve strength without heavy lifting, which can be extremely beneficial while allowing the body to recover from an injury. It does this by altering the flow of blood to and from your working muscles, thus creating an optimal environment for muscle growth. 

Other benefits to BFR training include:

  • Shorter recovery time
  • Less risk of muscle loss
  • Lower stress on injured area

Although this method of training may sound new, BFR dates back to the 1960s with Dr. Yoshiaki Sato in Japan. Initially named kaatsu training, which stands for “training with added pressure,” it was later termed blood flow restriction training since it requires a cuff or tourniquet to restrict blood flow to the working muscles. 

Despite its fame for improving strength and recovery, the benefits of BFR do not end there. There is a growing pile of research to show that BFR can also improve the integrity of your tendons, bones, and even blood vessels. Other fascinating studies have found blood flow restriction therapy to lower pain levels, especially after surgery. Research has found that BFR has the ability to reduce pain for up to 24 hours after just one exercise. 

How to Use Blood Flow Restriction (BFR) Training to Build Muscle

blood flow restriction training BFR to treat shoulder and elbow pain

Like we mentioned before, BFR uses a cuff (or tourniquet) to limit the amount of blood flow to the working muscles. When applied correctly, blood flow restriction bands can be wrapped around the upper part of your arms and/or legs. Then, the bands are inflated with air, like a blood pressure cuff, to personalized pressures that restrict blood flow to your vessels underneath. The ultimate goal is to apply enough pressure to restrict the blood leaving the muscles while allowing some blood flow into the muscles that are working.

In addition to reducing blood flow, blood flow restriction bands lower the oxygen supply and trap lactic acid in the working muscles. A buildup of lactic acid in the muscles actually encourages muscle growth, which is another reason why blood flow restriction training is so effective. Without going into too much detail, this environment is intensified when the muscles contract, thus creating an anaerobic effect. Under anaerobic settings, the body recruits more muscle fibers that are normally needed for more intense physical activity. 

It is generally accepted that muscles need to be stressed, or loaded, in order to change, adapt, and grow. Traditionally, this is accomplished by lifting a specific percentage of your 1 repetition maximum (1RM). Most guidelines suggest that you need to lift at least 65% of your 1RM to see moderate improvements in strength. 

But, blood flow restriction therapy bypasses traditional recommendations since it builds muscle at loads lower than 65% of your 1RM. This makes it ideal for physical therapy, rehabilitation, and recovery after injury. By loading the muscles at less than 65% of your 1RM through blood flow restriction training, you’re producing a muscle “burn” or “pump” that is typically only seen with higher training sessions. The muscle pump, which is a consequence of the lactic acid buildup, low oxygen supply, and reduced blood flow, triggers a natural release of hormones that are needed for muscle growth. And, the best part is, these hormones circulate throughout the entire body and create a system-wide response. 

Who Can Benefit from Blood Flow Restriction (BFR) Training?

Interestingly, blood flow restriction training was initially studied in older adults as a means to slow down the effects of aging. Now, it’s been shown to be safe for almost all ages and a growing number of health conditions. 

Blood flow restriction training is most effective when used in combination with other physical therapy treatment techniques: accurate diagnosis, dry needling, cupping therapy, corrective exercises, and joint manipulation. After a thorough evaluation by your doctor of physical therapy, he or she will decide if you are an appropriate candidate for BFR training. 

An ideal candidate for BFR therapy is someone who cannot lift heavy loads, like after surgery or injury. This is particularly useful for people who have weight-lifting restrictions or experience pain as they progress through a strengthening program. In general, blood flow restriction therapy helps to lower the amount of stress that is placed on the working body part.

Importantly, BFR training has been shown to be effective after surgery and, in most cases, can be safely done during post-op. This is great news since most procedures limit the amount of weight you can lift while the surgical area heals. Plus, it’s not uncommon for muscles to atrophy, or lose strength, over time after surgery. Blood flow restriction training prevents that from happening while protecting the area from further stress and strain.

On the other hand, those who have a history of deep vein thrombosis, varicose veins, high blood pressure, and certain types of cardiac disease may not be appropriate for this type of treatment. And, while there have been no reports of damage to the blood vessels, one must always be mindful of the effects of blood pooling in the arms or legs. Therefore, any of these conditions warrant further discussion with your physical therapist before proceeding with blood flow restriction training.

Research Behind Blood Flow Restriction (BFR) Training

blood flow restriction bands sitting on the floor

At Peak Physiotherapy and Performance, we pride ourselves on providing treatments that are backed by robust research, and choosing to become one of the only physical therapy clinics to offer blood flow restriction training in Columbus is no different. 

There has been a recent surge in research supporting the use of BFR training in physical therapy. Nowadays, adding BFR to one’s rehab program can produce results that were previously seen only with traditional weight training. These results may be the reason why BFR is popping up in sports medicine offices and physical therapy clinics around the country. 

A review of 16 published articles that looked at the use of BFR training in athletes found strong evidence to support the use of BFR in both injured and healthy athletes. Here’s what they found: 

  • They confirmed that athletes can safely undergo BFR while recovering from an injury, regardless of whether surgery was performed. 
  • Injured athletes can lift low intensity loads and still see results with BFR. Low intensity weight training with BFR produces gains that would otherwise only be achieved through high intensity loads in these athletes. 
  • BFR training can be used in athletes without an ongoing injury. BFR increases stimuli to the working muscles to enhance muscle growth without causing undue stress or muscle damage. In other words, with BFR, athletes can add strength training to their workout programs without the fear of injury or muscle strain. 

But, what about the people who don’t necessarily need to rush back to high intensity physical activity? BFR training can produce eye-opening results in those individuals, too. New research shows that using BFR can safely be done in older adults who are unable to perform high intensity exercise due to health conditions, like sarcopenia or painful joints. In those individuals, using blood flow restriction training in combination with low-intensity (<60% of one’s 1RM) can promote muscle strength and growth similar to strength training at higher intensities. 

Risks Associated with BFR Training

As with any treatment technique, there are always risks associated with blood flow restriction training. However, the doctors of physical therapy at Peak Physiotherapy & Performance are well-equipped to handle your needs and take every precaution to ensure your safety. Plus, Drs. Junak and Billings are expertly trained in finding your 1RM to prescribe the right exercise dosage and reps that are safe for BFR. 

It’s important to understand that, while blood flow restriction training does not hurt, it may initially feel uncomfortable, especially for those who are deconditioned. Some possible side effects after treatment may include: 

  • Muscle soreness
  • Lightheadedness
  • Mild bruising
  • Fatigue 

Otherwise, studies have shown little-to-no risk from using BFR training during physical therapy.

Blood Flow Restriction Training in Columbus, Ohio

  • Under the close supervision of a trained physical therapist, blood flow restriction training is safe and effective, with some caveats. Those with a history of cardiovascular disease, pregnancy, or high blood pressure may not be appropriate for this treatment method.
  • When done correctly, blood flow restriction training can enhance muscle growth and strength without the risk of further injury. 
  • BFR is appropriate for almost everyone during the recovery stage and can even be used to supplement healthy athletes’ training programs. 
  • Research supports the use of BFR, and it is shown to be most effective when done with low intensity (low loads) weight training in conjunction with other physical therapy treatments.

Peak Physiotherapy & Performance is excited to be one of the only physical therapy clinics to provide blood flow restriction training in Columbus, Ohio. Call us today for a free phone consultation and to learn more about how BFR could benefit you.

About the Author

blood flow restriction training BFR to treat shoulder and elbow painDr. Andrew Junak is a Doctor of Physical Therapy and Board-Certified Orthopedic Specialist.  Dr. Junak received his Doctorate of Physical Therapy from Walsh University and completed his Orthopedic Specialist training at the Cleveland Clinic Orthopaedic Residency Program. He is the owner of Peak Physiotherapy and Performance, a physical therapy clinic in Canal Winchester, Ohio where he serves the local communities of Lancaster, Reynoldsburg, Grove City, Pickerington and Columbus. In his practice, Dr. Junak helps clients with jaw pain, neck pain, and headaches find relief without resorting to medications, injections, or surgery.

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