Blood flow restriction (BFR) training has garnered growing attention in recent years because of the perspective for individuals to achieve a greater degree of muscle burden as well as physiologic change with a lower amount of resistance training. Blood Flow Restriction training demands using a band or tourniquet device positioned circumferentially around the proximal end of arms and legs and expanded to a predetermined compression to keep arterial flow while limiting vein blood flow. This approach originated in the 1970s by Dr. Yoshiaki Soto who invented Kaatsu resistance exercises; nonetheless, the official presentation of the method dates to 1998 when the first research was published on BFR training. Occluding venous blood flow from the limbs results in an anaerobic environment which promotes muscle enlargement through cell signaling and hormonal changes similar to what is seen at high-intensity practice with more resistance. Recent studies have presented alternatives to the traditional setup, including the use of Kaatsu cuffs or hook-and-loop resistance bands. Such devices provide similar venous occlusion but at individualized perceived resistance rather than a predetermined pressurized level.

BFR has also been applied during physical therapy to give assistance to the recovery of elderly patients after joint arthroscopy or more complex knee surgery. BFR has also been utilized to treat patients who suffer from knee osteoarthritis. For patients going through non- or post-operative rehab, regaining strength by training at high load exercises is not often feasible; thus, many orthopedic surgeons and physical therapists have begun incorporating BFR therapy to facilitate improvements in strength.

How does BFRT work?

Blood Flow Restriction Therapy or BFRT is performed by applying outer pressure on the extremities via cuffs while performing rehabilitation. The applied force is sufficient to maintain arterial inflow, but at the same time occluding vein’s outflow distal to the blocked site. One of the objectives of Blood Flow Restriction Therapy is enabling patients to make greater strength gains while lifting lighter loads, thereby reducing that overall stress put on one of the limbs. BFRT works by decreasing blood flow towards working muscles in order to cause hypertrophy and preventing disuse atrophy of muscles. This treatment is typically used during exercise but can also involve the use of compression devices alone. There have been extreme benefits from this form of rehabilitation in patients that have failed with traditional rehab. Blood flow restriction therapy has to include what is known as limb occlusion pressure. In clinics, the professionals use a machine that can do a calculation and give 80% of the patient's full limb occlusion pressure. It determines the amount of pressure to be applied to the limb for complete occlusion of blood flow. Then between 6 and 8 exercises would be used on those limbs. Specific considerations for BFRT include:

• Band material
• Width of the band
• Limb to put the band on
• Band pressure
• Exercise sequence
• Exercise choice

The science behind the blood flow restriction is completing low load exercises together with heavy load benefits. The safety of such restriction allows low loads to be exercised with the joints and at the same time getting the advantage of higher load lifting. BFR therapy could be beneficial virtually to every patient. Although, patients with ACL reconstruction, nonunion fractures, tendon apathy, and tendon repair have benefited tremendously from this form of rehabilitation.

BFR is usually helpful for patients who suffer from:

• Ruptures that don’t grow back together or heal correctly
• Anterior cruciate ligament tears
• Rotator band tears
• Achilles tendon tears

History of Blood Flow Restriction Training

While BFR therapy is a pretty new approach in injury rehab, this system has been known since 1964 as a workout tool that enabled sportsmen to build muscular mass even without extreme weight loading. In 1966, BFR training was introduced in Japan as Kaatsu resistance training. The method is to put pressure on a limb during exercise in order to reduce the blood flow in veins from an arm or leg while allowing arterial blood flow to run into the muscle.

Before this method was used for rehabilitation, BFRT was popular in military training and professional sports coaching as a training tool. After years of testing and numerous improvements, the BFR approach has extended its popularity and attracted the attention of the rehabilitation community.

In response to the market, specialized equipment and training protocols have come out to guarantee the best rehabilitation and training effect from BFR. If you'd like to get the best from your BFRT class, find a practitioner who has been instructed to implement the most recent BFRT equipment for the best outcomes. BFRT can be used with other rehabilitation methods to provide a complete injury recovery.