By: Lindsay Butterfield, PT, DPT, CSCS

Muscle weakness is one of the most common issues that we see when a patient begins physical therapy. General weakness can be found accompanying both acute and chronic injuries and can also be seen in healthy populations, such as older adults or those with a previous injury. Consequences associated with loss of muscle strength can be life-changing and lead to reduced function and decreased quality of life for an individual. Strength training is the best way to combat this loss of muscle strength.

Historically, heavy-load training (lifting 80% of the load that you can maximally lift 1 time (AKA 1 repetition max) has been seen as a necessary means to elicit muscle growth and strength gains. Heavy-load strength training may not always be feasible for every person during the early stages of rehabilitation due to post-surgical weight bearing precautions or inability to tolerate these heavy loads. This is where training with blood flow restriction therapy (BFR) comes into play.

BFR Therapy

So what is BFR therapy? This form of training involves the use of a pneumatic restriction cuff (similar to a blood pressure cuff – pictured above) placed on the upper or lower extremity that you are aiming to target. The cuff will be set to a pressure specific to each individual that will partially occlude blood flow. The cuff occludes venous outflow while restricting arterial inflow, which reduces oxygen delivery to muscle cells, which has been shown to promote increased muscle size and strength. The environment created within the muscle is similar to that created with performance of high intensity exercise. Once the cuff is inflated to the desired pressure, specific exercises will be performed at a low-intensity (~20-30% of the 1 repetition max). The exercises performed will be selected by your PT based upon our findings during the initial evaluation.

So why would this be helpful to you? BFR resistance training is for anyone who wants to increase muscle strength while reducing the stress put on a particular joint (i.e. osteoarthritis of the knees, post-operative cases, etc.). BFR therapy can be used for both upper extremity and lower extremity cases. The combination of BFR therapy and low-load resistance training has been shown to increase muscle hypertrophy (size), muscle strength, and muscle endurance. These increases have been shown in some studies to have good carryover into functional tasks, including being able to reach farther, stand up from a seated position with greater ease and walk at a quicker pace. Training using BFR therapy may also allow individuals with symptomatic conditions, such as osteoarthritis to perform exercises with decreased pain.


BFR has been found to be especially useful in the rehabilitation of the postsurgical patient. In the early stages following surgery, the patient is usually restricted from performing resistance exercise at the intensity necessary to increase muscle size, strength and endurance. This inability to train at higher intensities may lead to an incomplete restoration of presurgical muscle mass and strength. Use of BFR following surgery can be used for two primary reasonsresisting muscle atrophy (wasting) and building muscle strength.

BFR Therapy

BFR Therapy

You may be thinking that applying a tourniquet to an exercising limb can’t be safe, right? However, research shows that BFR poses no greater cardiovascular risk to healthy, active individuals than regular high-intensity exercise without BFR. BFR training also uses specific protocols based on research and clinical outcomes so it is important to work with someone who will utilize these evidence-based protocols. It is important to consult with a medical professional who has experience with BFR training, access to the proper equipment and knowledge of your medical history prior to beginning this type of training to help decide if BFR therapy is the right choice for you.

BFR Therapy

At Evolve Physical Therapy and Sports Rehabilitation, we offer BFR as a part of our comprehensive approach to treating musculoskeletal injuries and post-surgical cases. According to the American Physical Therapy Association, BFR therapy is within the scope of practice for physical therapists. We are able to answer any questions you may have regarding BFR therapy and help to decide if it may be something that would be beneficial as part of your individualized treatment approach. Check out this video that explains BFR training in a little more depth. Want to know more about BFR and if it would work for you? Contact us at (212)-439-1596 to schedule an evaluation to determine if BFR is right for you!

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