Blood flow restriction training: benefits and uses in the rehabilitative setting

Published - Nov 16, 2021

Blood flow restriction training: benefits and uses in the rehabilitative setting

By Dr. John Quinn, PT, physical therapist and clinic director at IRG Physical Therapy – Snoqualmie Ridge

Clinically reviewed by Darren Crout, PTA

What is blood flow restriction (BFR) training?

BFR is a training method that involves the use of a tourniquet to restrict blood flow from returning to the muscles that are of the region being targeted by treatment. This application of non-mechanical stress facilitates the building of strength — by restricting venous inflow of blood to the targeted muscles while a patient performs low-load resistance or aerobic exercise, these muscles will respond in the same way as if they were performing high-intensity training (e.g., increased muscular strength and growth).

What type of equipment is used in BFR training?

The tourniquet used in BFR training is comparable to a blood pressure cuff. When used appropriately, these cuffs promote a setting of decreased oxygen to the muscles that mimics anaerobic exercise. This environment increases the presence of growth hormones that lead to muscle growth and improved strength. The amount of pressure applied to obstruct blood flow is measured by the cuff and pump.

It is important to note that the only safe and targeted way to perform BFR training is through the utilization of the proper cuffs. Resistance bands are typically too small and are not capable of measuring the level of pressure used to obstruct blood vessels.

When is BFR training used in the rehabilitative setting?

BFR training can be beneficial in many forms of rehabilitation including “prehabilitation,” post-operative rehabilitation, aerobic training and sports injury rehabilitation. There are also settings that BFR training can be utilized in for patients who are non-weightbearing and are unable to walk.


BFR training can be introduced as a component of a patient’s pre-surgical treatment. In this setting, training is aimed at reducing the loss of one’s muscle mass and increasing the strength of muscles surrounding their future surgical site to contribute to improved surgical outcomes.

Post-operative rehabilitation

BFR training can be implemented immediately into a patient’s post-operative rehabilitative plan of care. Soft tissue healing, the prevention of muscle loss, and the stimulation of the presence of a growth hormone that can potentially lead to a quicker recovery are benefits of BFR training in this stage of rehabilitation.

The method can also be beneficial as post-operative patients begin to bear weight and start walking. BFR training has been shown to improve cardiovascular health in individuals who experienced a time during their recovery that they were unable to walk.

Aerobic conditioning

BFR training can be used to contribute to the rehabilitative process of patients with non-surgical injuries. The technique allows for continued strengthening to occur without stressing the presently injured joint.

Once a patient has been cleared for unrestricted exercise, BFR training can be used to address the strengthening of an impacted joint and later be utilized in the progression of more complex movements and functional exercises. These movements and functional exercises can be performed using little to no weight to reduce mechanical stress on the injury while still providing muscular changes as though the patient was performing high-intensity training.

Sports injury rehabilitation

BFR training can be used in the return-to-sport and performance stage of healing by providing a specific focus on the targeted muscles to boost the strength, power and explosiveness that are needed to return patients back to their pre-injury level of performance.

This treatment has also been shown to facilitate improvement of bone growth and health following fractures and repetitive stress injuries.

What are the benefits of BFR training?

BFR training has been found to increase skeletal muscle adaptation; promote systemic, whole-body changes; and improve one’s cardiovascular response.

IS BFR training safe?

Yes! Although the restriction of blood flow sounds intimidating, the method has been shown to be very safe when performed in the right setting with the right equipment. The cuffs used in IRG clinics have been designed with safety as the primary concern – our units are the only version of this equipment that has been approved by the Food and Drug Administration as a Class I medical device.

When utilizing BFR training, it is critical to follow a protocol that is based on evidence and research. IRG providers who perform BFR training are certified in the use of the necessary equipment and the prescription of an associated exercise regimen. It is always best to consult with a medical professional that is certified in the use of BFR training before incorporating the training method into your rehabilitative program.

Dr. John Quinn, PT is a physical therapist and clinic director at IRG Physical Therapy – Snoqualmie Ridge specializing in BFR training; Astym® therapy; balance and falls prevention; sports injury rehabilitation; and temporomandibular joint disorder treatment. To learn more about the services provided at IRG Physical Therapy – Snoqualmie Ridge, please contact 425.292.1477; or click here to schedule an appointment with John.

Click here to request an appointment with an IRG therapist specializing BFR training — Washington is a direct access state that allows patients to self-refer to physical therapy. Call 425.316.8046 to find the clinic nearest you and learn more about starting the journey back to your best self.