Blood Flow Restriction Training: Does It Work?

In Japan in 1966, Yoshiaki Sato, a then 18-year-old man, was sitting during a traditional Japanese ceremony and felt his legs go numb beneath him. He realized that the blood circulation was cut off in his calves, and at this moment, he began wondering how the restriction of blood flow might affect the results of lifting weights.

Key takeaways:

This moment of wonder led to many years of research and, ultimately, the development of blood flow restriction (BFR) training, which has become quite popular in the last few decades.

What is blood flow restriction training?

Blood flow restriction training is a muscle-strengthening technique often used for physical rehabilitation after injury to prevent muscle atrophy, or wasting. This technique involves tight bands or cuffs, similar to “tourniquets”, that are placed on the arms or legs to cut off blood flow while lifting weights. The theory behind this practice is that the same benefits associated with lifting heavy weights can be obtained with less intense workouts and lifting lighter weights. The use of BFR training is especially beneficial when individuals are unable to train at an intense level, such as after an injury or surgery, so this practice is often used as part of physical therapy regimens.

Several factors contribute to the underlying mechanism behind BFR training, but the main factor is muscle stress. First, muscle hypertrophy, or growth, occurs because of the excess stress and tension placed on the muscle from the tourniquet. When the blood flow to the muscles is cut off, the muscle is stressed and hypoxic, meaning that it is not receiving enough oxygen. This is similar to the stress and hypoxia that muscles experience when lifting heavy weights, so this phenomenon is imitated with the use of the tourniquet around the extremity.

Does BFR training work?

With the widespread implementation of BFR training in physical therapy clinics and its use among Olympic athletes, it is clear that it offers some physical benefits. One notable study compared findings from several smaller studies and reported that using BFR training in patients after anterior cruciate ligament (ACL) reconstruction surgery resulted in moderate strength increases. However, the effectiveness was slightly less than the strength gained with heavy training as part of the rehabilitation process. These results may indicate that while heavy lifting may provide slightly greater muscle strength improvement, BFR training is a good option for patients who cannot incorporate heavy lifting into their recovery process.

What equipment is needed?

In addition to the weights, the only other equipment needed to perform BFR training is the cuffs that go around the arms or legs. These are the typical areas for wearing the cuffs because they're used most commonly to strengthen the legs, glutes, and shoulders. These bands resemble blood pressure cuffs and can be pumped up to the desired pressure, depending on your specific needs and preferences or what has been prescribed by your healthcare provider or physical therapist (PT).

These cuffs are commercially available at most large sports equipment retailers. However, it is always best to check with your provider or PT to see if they have any brand recommendations to ensure you purchase a user-friendly, safe band option.

How to use blood flow restriction bands

First, place the BFR band around the arm or leg you will be working out. Next, pump the cuff to the desired air pressure. This will vary depending on your needs, but typically this value is around 180 millimeters of mercury (mmHg). Once the cuff has been inflated appropriately, you can begin lifting weights with that arm or leg. It is important to hold the muscle contraction for at least five seconds and slowly release it each time to achieve maximum benefits. Again, the number of reps will vary depending on your needs, but typically it ranges from 15-20 before deflating and removing the band.

What are the pros and cons of BFR training?

There is an ongoing argument whether to get involved into BFR training. There are definitely pros and cons to it.

What are the dangers of BFR training?

Though safe for most, some inherent risks are associated with BFR training. Because this technique involves cutting off arterial blood flow, this may not be a great option for individuals with vascular problems such as diabetes or high blood pressure.

Another potential danger of using BFR training is its potential to cause cardiac problems such as an increased heart rate or blood pressure and palpitations. For this reason, individuals with underlying heart conditions may be advised not to try BFR training. Regardless of your pre-existing conditions and health status, it is always best practice to consult your healthcare provider before beginning any new type of exercise, including BFR training.

Who should try BFR training?

Individuals in overall good health without pre-existing medical conditions are the best population to attempt BFR training. This technique is especially beneficial for those who have recently undergone a musculoskeletal type of surgery and are looking for a way to prevent postoperative muscle atrophy. Additionally, individuals looking for a way to maximize muscle growth but are unable to perform high-intensity workouts should consider giving BFR training a try, after appropriate consultation with a qualified healthcare provider.

Overall, BFR training provides an excellent muscle strengthening option for individuals looking to prevent muscle atrophy after injury. This technique involves the use of tight cuffs that are placed around the limbs, limiting blood flow to the extremities. This allows for lower-intensity exercises to be performed with nearly the same results as from high-intensity workouts. Though a safe option for most, it is best to consult with your healthcare provider before trying BFR training to be sure that it is a good option for you.


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