What is BFR or Blood Flow Restriction Training?

Blood Flow Restriction (BFR) training involves wrapping an elastic band or cuff around your limbs to partially block blood flow during a workout. The technique has been growing in popularity among bodybuilders in recent years and new research suggests that it may have potential to enhance endurance and assist in injury rehabilitation. Proper education and effective application for efficacy and patient safety is the key.

The goal of BFR training is to increase the metabolic stress on your muscles without doing intense work that causes muscle breakdown. To accomplish the goal, one wraps a tourniquet-like cuff around the top of the arm and/or leg. The cuff is tight enough to block the veins returning blood from the muscles to the heart, but loose enough to allow fresh arterial blood into the muscles.

Under normal conditions, the metabolites produced in your muscles during hard exercise serve as cellular signals that trigger adaptations in your body – bigger muscles after resistance training, for example. With blood flow restriction, your muscles are forced to stew for longer in these metabolites, triggering bigger adaptations.

The most robust evidence for BFR training is in increasing strength and muscle mass using relatively light weights. A typical BFR protocol involves lifting between 20% – 40% of your one rep maximum (1RM), with one set of 30 repetitions followed by three sets of 15 repetitions each, with 30 to 60 seconds of rest between. The muscle gains from this protocol are similar to what you’d get from a standard high intensity training (H.I.T.) protocol usually required to stimulate strength and hypertrophy gains (approximately 70% of your 1RM).

While the weight will still seem light, you’ll feel the localized burn in your muscles more acutely. With more training sessions, my patients start to tolerate the burn much better.

The main attraction of BFR is you stress the muscles without accumulating as much wear-and-tear as you would with normal training. For a serious athlete, adding a set of BFR lifts after you’ve already maxed out your normal workout could be a way of getting an extra training boost. Healthy individuals can substitute traditional strength training sessions as an, “active recovery day” or when equipment is not available to do heavy-load like during travel or vacations.

If you’re rehabbing an injury (or someone else’s), you can get enhanced metabolic training effects without putting too much mechanical stress on a healing muscle or joint. Small clinics can use minimal weights, resistance bands or body weight to achieve gains usually reserved for heavier weights.

BFR training is a novel approach to increase active participation in patients without the need for large amounts of space or resistance equipment. BFR can be used to increase strength and hypertrophy of muscle groups and cardiovascular capacity.

Look for upcoming articles on how I specifically use BFR with my patients to improve their functional capacity and recover from injuries.

Below is additional simplified info on the topic of BFR…

What is Blood Flow Restriction (BFR) Training?

Blood flow restriction (BFR) training is a training and rehabilitation strategy involving the use of cuffs or bands placed around a limb during exercise, to maintain arterial inflow to the muscle while preventing venous return (venous occlusion).

How does it work?

  • Lack of venous return creates a swelling effect of the muscle.
  • Metabolites, such as lactate, accumulate and stimulate muscle growth.
  • Hypoxic environment promotes strength and muscle growth.
  • Direct muscle fatigue forces the nervous system to recruit the largest fast-twitch muscle fibers, which have the greatest capacity to grow.
  • Increase to Growth Hormone (GH) and Insulin Growth Factor 1 (IGF-1).

What are the benefits?

  • Increased muscle size (Hypertrophy)
  • Increased muscle strength
  • Increased cardiovascular capacity
  • Increased GH, IGF1 and maybe testosterone
  • Decreased joint/tissue stress
  • Little to no muscle damage
  • Little to no recovery needed
  • Little to no soreness or delayed onset muscular soreness (DOMS)
  • Low Intensity needed (resistance or cardio)

Who benefits?

  • Immobile or mobility-restricted populations:
    • Bed ridden
    • Casted
    • Post-operation rehabilitation patients
    • Elderly
  • Athletic populations:
    • Active recovery
    • Decrease joint/tissue loads
    • Isolated exercises for “weak link” region

What are the risks?

  • Injury resulting from this type of training is rare
  • Possibility with inappropriate implementation:
    • Subcutaneous hemorrhage
    • Numbness
    • Always consult your physician prior to any new exercise program

Loenneke JP, Abe T, Wilson JM, Ugrinowitsch C, & Bemben MG (2012) Blood flow restriction: how does it work? Frontiers in Physiology, 3, 392.

Loenneke JP, Wilson GJ, & Wilson JM (2010) A mechanistic approach to blood flow occlusion. International Journal of Sports Medicine, 31(1), 1-4.

Nakajima T. Key considerations when conducting KAATSU training. Int J KAATSU Train Res. 2011;7(1):1-6

Nakajima T. Use and safety of KAATSU training; results of a national survey. Int J KAATSU Train Res. 2006;2(1):5-13

About the Author:

Dr. Le Cara, a former Army Combat Medic, has worked as a strength and conditioning coach, athletic trainer, and chiropractor for over 20 years. He holds a PhD in Athletic Training from Rocky Mountain University of Health Professions. His original research on the structure and function of the lumbar multifidus muscle and how it relates to lower back pain was published in 2014. He has authored or co-authored numerous peer reviewed articles and dozens of non-peer reviewed articles. Ed holds an MBA in Transglobal Education from St. Mary’s College of California. In addition to being the director of education for Smart Tools and teaching internationally, he treats patients every day with manual therapy and fitness training.

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