Blood Flow restriction


AUGUST, 2019

Brett Hayes, MSPT

Brett Hayes, MSPT

Pat Ivey Performance - Guest Author

Blood flow restriction utilization is a pretty hot topic right now. Here at the Missouri Orthopaedic Institute and Mizzou Therapy Services, we have been utilizing the technology in rehabilitation for about 5 years. I can tell you after being an orthopaedic and sports medicine PT for nearly 25 years, I haven’t seen a more promising modality to date. After an entire career being exposed to literally hundreds of gimmicks and flat out snake oil products designed to speed up rehab this is saying a great deal.


Simply speaking, BFR is what I like to call “bio-hacking”. We are manipulating the body’s physiologic response to intense exercise without the heavy weight and stress on the body. This sounds counterintuitive but its relatively simple.

We know what happens when we work out to failure under heavy loads. The physiologic release of growth hormone, muscular hypertrophy, and cellular division are clear. Blood flow restriction simply slows the limbs ability to rid itself of lactate and other metabolites and forces the body into an anaerobic state with only a fraction (as low as 10%) of the loads required to reach that state under normal workout conditions. So 4 sets of body weight squats feels like you did a compound lower body workout finishing with 3 sets of 1 RM.

By no means is this an easy shortcut. In fact, the intensity of fatigue and failure rivals some of most intense lifts I have ever had. But once the cuff is deflated, the recovery is rapid even though you do continue to feel a bit fatigued for the rest of the day as you would any workout. However, delayed onset muscle soreness is significantly less if not non-existent.


This is a significant scientific breakthrough in order to maintain and even progress an athletes strength who is, for example, a 1-2 weeks post-operative ACL repair. With this athlete, we can get a near normal workout with the same muscular generation effect doing something as simple as leg lifts as if he or she were back in the squat rack. This is a little over stated, but it’s still a game changer when we can do little to no weight bearing exercise and send a spike of growth hormone surging through the body as if we were doing full weight squats. Repair and recovery moves very fast and once full weight bearing is tolerated the workout can be even more comparable to what is accomplished in the gym.

However, this technology is new and although research is coming in fast we are still not sure about everything. That is why taking this directly to the gym and fully integrating it (and some would say substituting heavy lifting) is a bit premature. Does this “manipulation” of the normal anaerobic system translate into the same response when the athlete heads out to the field? Do the connective tissues strengthen at the same rate as the muscular tissues being the load is less? If not, can the connective tissue handle the new strength under full load or will they fail? The results thus far suggest these concerns aren’t significant. But they are real concerns.

“…we can do little to no weight bearing exercise and send a spike of growth hormone surging through the body as if we were doing full weight squats.”

Honestly, I am used to waiting for the “other shoe to drop” when this type of technology comes forward. And while rehab utilization is a no-brainer, I am hesitant to release it to the training environment. The main reason is that the wrong device in the wrong hands can be dangerous and can result is irreversible tissue damage. This has happened already in the literature to some athletes that decided to take a tourniquet and “guess” the right pressure to use. This is irresponsible and frightening. If there was ever a true depiction of “less is more” then BFR sets this standard. The technology must be able to automatically sense and adjust the correct pressure continually or you are asking for an incident.

However, spend your time examining the research for yourself and scrutinize it. There is much to develop, but the brilliance of the concept shows incredible promise. I don’t have the blog space to discuss the implications noted for recovery, vascular sufficiency, and overall circulatory and nervous system research that is starting to surface. Some of it seems too good to be true. So as true strength and conditioning scientists, we must allow the scientific method to dictate its long term use as a modality. But for now, I am excited to accept its use for rehab and help develop its use for the future of strength and conditioning.


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