Written By: Vint Schoenfeldt PT, DPT, MPT, MTC, CSCS

Almost every patient seen in physical therapy needs to increase their strength to improve their functional ability. The dilemma that exists is that most of these patients are unable to lift the weight necessary to make strength gains due to joint injury, soft tissue injury, recent post-op status, or inability.


The American College of Sports Medicine (ACSM) has stated that a person needs to lift at least 70% of their one repetition maximum to increase strength and hypertrophy.1 This load is often unattainable while they are in therapy. We often think that exercising with light resistance bands and small dumbbells will help our patients achieve the strength gains they need to fully recover and tolerate the demands of life and sport. This goes against the ACSM standards of exercise dosing. So, this creates a problem and disrupts what most therapists have been taught regarding the concepts of strengthening.

The addition of blood flow restriction (BFR) during exercise requires that the patient lift only 20-40% of their one repetition maximum to see strength and hypertrophy gains.2,3 This weight is very light compared to the weight that they would have to lift in a high intensity workout to see comparable gains.

Blood flow restriction (BFR) involves the application of a cuff or tourniquet to the proximal aspect of the limb while exercising with a personalized cuff pressure that is a set percentage of the individual’s limb occlusion pressure (the amount of pressure it takes to fully block all blood flow into the limb).4,5 This partial arterial occlusion allows the limb to become hypoxic, and this decrease in oxygen results in the initiation of several physiological pathways that result in increased muscle size and strength, increased blood capillary formation, bone strengthening, and analgesic effects.5-12

There are many applications for BFR, from athletes to the elderly. It can be used in many ways along a continuum of care beginning with passive BFR for those unable to exercise, during cardiovascular exercises such as a stationary bicycle or treadmill walking, and finally during strengthening exercises.

There is an abundance of research exploring the safety of BFR, and it has been shown to be safe.13-17 Proper training and use of the proper equipment are necessary for safe, effective BFR treatments.

To learn more about blood flow restriction, attend my live workshop, “Blood Flow Restriction for Rehabilitation,” taking place in 2021, to learn the proper use and application of this exciting treatment approach in the clinical setting.




  1. Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;(7):1334.
  2. Patterson SD, Hughes L, Head P, Warmington S, Brandner C. Blood flow restriction training: a novel approach to augment clinical rehabilitation: how to do it. Br J Sports Med. 2017;51(23):1648-1649. doi:10.1136/bjsports-2017-097738
  3. Mattocks KT, Jessee MB, Mouser JG, et al. The application of blood flow restriction: lessons from the laboratory. Curr Sports Med Rep Lippincott Williams Wilkins. 2018;17(4):129-134.
  4. Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 2017;51(13):1003-1011. doi:10.1136/bjsports-2016-097071
  5. Giles L, Webster KE, McClelland J, Cook JL. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med. 2017;(23):1688.
  6. Wilk M, Krzysztofik M, Gepfert M, Poprzecki S, Gołaś A, Maszczyk A. Technical and training related aspects of resistance training using blood flow restriction in competitive sport: a review. J Hum Kinet. 2018;65(1):249-260.
  7. Fujita S, Abe T, Drummond MJ, et al. Blood flow restriction during low-intensity resistance exercise increases S6K1 phosphorylation and muscle protein synthesis. J Appl Physiol. 2007;103(3):903-910.
  8. Korakakis V, Whiteley R, Epameinontidis K. Blood flow restriction induces hypoalgesia in recreationally active adult male anterior knee pain patients allowing therapeutic exercise loading. Phys Ther Sport. 2018;32:235-243. doi:10.1016/j.ptsp.2018.05.021
  9. Korakakis V, Whiteley R, Giakas G. Low load resistance training with blood flow restriction decreases anterior knee pain more than resistance training alone: a pilot randomised controlled trial. Phys Ther Sport. 2018;34:121-128. doi:10.1016/j.ptsp.2018.09.007
  10. Loenneke JP, Young KC, Fahs CA, Rossow LM, Bemben DA, Bemben MG. Blood flow restriction: rationale for improving bone. Med Hypotheses. 2012;78(4):523-527. doi:10.1016/j.mehy.2012.01.024
  11. Larkin KA, Macneil RG, Dirain M, Sandesara B, Manini TM, Buford TW. Blood flow restriction enhances post-resistance exercise angiogenic gene expression. Med Sci Sports Exerc. 2012;44(11):2077-2083.
  12. Evans C, Vance S, Brown M. Short-term resistance training with blood flow restriction enhances microvascular filtration capacity of human calf muscles. J Sports Sci. 2010;28(9):999-1007.
  13. Takarada Y, Nakamura Y, Aruga S, Onda T, Miyazaki S, Ishii N. Rapid increase in plasma growth hormone after low-intensity resistance exercise with vascular occlusion. J Appl Physiol. 2000;88(1):61-65.
  14. Clark BC, Manini TM, Hoffman RL, et al. Relative safety of 4 weeks of blood flow-restricted resistance exercise in young, healthy adults. Scand J Med Sci Sports. 2011;21(5):653-662.
  15. Loenneke JP, Wilson JM, Wilson GJ, Pujol TJ, Bemben MG. Potential safety issues with blood flow restriction training: safety of blood flow-restricted exercise. Scand J Med Sci Sports. 2011;21(4):510-518. doi:10.1111/j.1600-0838.2010.01290.x
  16. Neto GR, Novaes JS, Dias I, Brown A, Vianna J, Cirilo-Sousa MS. Effects of resistance training with blood flow restriction on haemodynamics: a systematic review. Clin Physiol Funct Imaging. 2017;(6):567. doi:10.1111/cpf.12368
  17. Tabata S, Suzuki Y, Azuma K, Matsumoto H. Rhabdomyolysis after performing blood flow restriction training: a case report. J Strength Cond Res. 2016;(7):2064.