By Joseph Abadir PT, DPT and Jessica DeFrancesco PT, DPT

Blood Flow Restriction Training (BFRT) is the use of a blood pressure cuff or tourniquet that intermittently occludes, or restricts venous blood flow to the upper or lower extremity while you exercise.

The device used in BFRT is similar to a blood pressure cuff that modulates blood flow to the extremity. It creates pressure to restrict a certain percentage of blood that flows to the extremity. Research has demonstrated that BFRT creates beneficial changes to both the extermity and the entire body, including:

• Improved strength
• Increased muscular hypertrophy
• Reduced atrophy
• Improved cardiovascular function

How Was BFRT Created?

BFRT originated in Japan during the 1960s, when Yoshiaki Sato fractured his ankle and injured the ligaments in his knee while on a ski trip. He was placed in a plaster cast and told he needed six months to heal.

Sato decided to take his rehabilitation a few steps farther by wrapping his thigh with different tubings and performing isometric exercises a few times a day. This prevented his muscles from atrophying and shortened his recovery to six weeks.

Following his full and speedy rehabilitation, Sato began looking into using BFRT as a way to rehabilitate other types of injuries and developed KAATSU training using this technique. Thanks to Sato’s pioneering work, BFRT has been extensively researched and developed even more since its origin during the 1960s. It was brought to the United States around 2011 when the military began using it to rehabilitate veterans. Widely accepted protocols and FDA-approved devices that involve the use of BFRT continue to be implemented by health care professionals for rehabilitative purposes.

How Is BFRT Used?

BFRT has been shown effective at treating a variety of both non-operative and post-operative conditions. It is currently used to help patients, clients, and athletes throughout the entire rehab and performance spectrum.

Primary uses for BFRT include:

• Preparing for surgery
• Post-operative recovery and rehab 
• Diminishing atrophy
• Improving aerobic capacity
• Improving overall muscle strength
• Increasing muscle size

While these changes typically happen when undergoing high-intensity exercise, patients who use BFRT are able to complete exercises at a lower-intensity or at 20 to 30 percent of a one-rep max. Patients who benefit from BFRT the most perform exercises using the BFRT system two to three times a week with the cuffs inflated for no longer than 20 minutes. Nearly any exercise can be incorporated with BFRT to improve strength or aerobic capacity.

What Is the Safest Way to Use BFRT?

BFRT should be performed only under the supervision of a licensed medical professional. It is a safe intervention and presents no increased risk of developing a blood clot when used properly. However, it’s important to understand that not every person is a candidate for BFRT.

Individuals who have certain medical conditions—including any vascular compromise or history of clotting, uncontrolled hypertension or history of certain cancers—are not candidates for BFRT. Additionally, certain medications that affect the risk of clotting may preclude a patient from being an appropriate candidate.

Contact the University Orthopaedic Associates (UOA) Center for Rehabilitation and Sports Excellence if you have an orthopaedic injury and want to learn more about your treatment options—including BFRT. We can perform an evaluation and develop a customized treatment plan for you that can help you get back to your usual activities as quickly as possible.