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Blood Flow Restriction Training
Blood Flow Restriction (BFR) Training is a type of training intended to enhance muscle growth and force. BFR training involves placing a band on the arm or leg, which acts as a tourniquet, to partially restrict the blood flow while performing an exercise. Blood still enters the muscle through the arteries. But the tourniquet blocks it from leaving through the veins.
According to research in the Journal of Sports Medicine and Physical Fitness, BFR training in athletes has been shown to increase muscle size and improve strength and sports performance when performed with traditional resistance training.
BFR training has also gained popularity among rehabilitation experts as a way to stimulate muscle growth with decreased tissue resistance and overload. But is it effective, and is it safe for everyone?
This article examines BFR training, including its effectiveness and risks. Educating athletes and rehab professionals can help them decide whether to implement this type of training into their regimen.
How does it work?
The exact physiological mechanism of action is not entirely clear. However, a research article published in Frontiers in Physiology theorized that partially restricting the blood flow to the muscle possibly stimulates muscle protein synthesis and mTOR pathway. According to research in The Journal of Sports Medicine and Physical Fitness, blood flow restriction has also been found to potentially benefit aerobic capacity and bone health in both males and females. It appears to induce hypoxia, and its metabolic effects include increased anabolic processes and reduced proteolysis. This leads to strength gains and hypertrophy.
Restricting normal blood flow helps the muscle experience oxygen depletion and fatigue more quickly. It can be a good option for certain populations that may not tolerate high-load training. For instance, older adults with arthritis or other musculoskeletal conditions may benefit from blood flow-restrictive training.
Risks of BFR Training
Although it appears BFR training may have some benefits, it also has some risks. Possible risks include:
- Dizziness
- Numbness
- Subcutaneous hemorrhage
- Rhabdomyolysis
Research also indicates that BFR training has the potential to cause certain cardiovascular effects in some people. For instance, it may lead to increased blood pressure and also has a potential risk of thrombosis. This may especially be an issue in people with established cardiovascular diseases, such as hypertension, chronic kidney disease, and diabetes.
Despite the risks, BFR training can be used safely and effectively when clients are screened appropriately. A qualified professional must also administer the training.
However, there are also contraindications for blood flow restriction training. According to the Cleveland Clinic, it should be avoided in people with the following conditions:
- Pregnancy
- Infections
- Blood clotting issues
- Bone fractures
- Cancer
The Best Way to Implement BFR Training into Your Regimen
According to the journal Science and Medicine in Sport, low-load BFR training can replace or be used along with traditional strength training to provide muscle overload stimulus without muscle damage. When considering implementing BFR training, it is helpful to keep several things in mind, such as the following:
Adjust the tightness of the bands. Although it may vary, the following is a general recommendation:
- Use bands tight enough for the arms to allow a 30%-50% restriction.
- Use bands tight enough for the legs to allow between a 50%-80% restriction.
Do not wear the bands too long: According to the Cleveland Clinic, you should wear the bands between eight and 20 minutes when working your arms or legs.
Take an individualized approach: BFR training should not be implemented as a one-size-fits-all regimen. Individuals using it for themselves should consider starting slowly and sticking to recommended levels of restriction.
When considering BFR training for a client or patient, clinicians should have knowledge of relevant risks and provide adequate screening. Using good judgment based on clinical experience is also invaluable.
It is also important to remember that BFR training is only one tool in the training toolbox. It can be an effective way to improve strength and be part of a comprehensive training regime.
< Recommendation by Our Experts>
- Boosts Strength and Muscle Growth – BFR training enhances muscle hypertrophy and strength, even with lighter loads.
- Requires Proper Screening – Supervision by a trained professional is essential to minimize risks.
- Needs Individualized Application – Proper pressure, duration, and training goals should be tailored for safety and effectiveness.
< Reference >
- Laurence P, Hanney WJ, Purita J, Graham A, Kolber M. Blood Flow Restriction Training: A Potential Adjunct to Orthobiologic Procedures. Bio Orthop J. 2023;4(SP1):e142-e163. doi:22374/boj.v4iSP1.57
- Wortman RJ, Brown SM, Savage-Elliott I, Finley ZJ, Mulcahey MK. Blood Flow Restriction Training for Athletes: A Systematic Review. Am J Sports Med. 2021;49(7):1938-1944. doi:1177/0363546520964454
- Heitkamp HC. Training with blood flow restriction. Mechanisms, gain in strength and safety. J Sports Med Phys Fitness. 2015;55(5):446-456.
- Loenneke JP, Abe T, Wilson JM, Ugrinowitsch C, Bemben MG. Blood Flow Restriction: How Does It Work? Front Physio. 2012;3. doi:3389/fphys.2012.00392
- Anderson KD, Rask DMG, Bates TJ, Nuelle JAV. Overall Safety and Risks Associated with Blood Flow Restriction Therapy: A Literature Review. Military Medicine. 2022;187(9-10):1059-1064. doi:1093/milmed/usac055
- Nascimento DDC, Rolnick N, Neto IVDS, Severin R, Beal FLR. A Useful Blood Flow Restriction Training Risk Stratification for Exercise and Rehabilitation. Front Physiol. 2022;13:808622. doi:3389/fphys.2022.808622
- Kelly MR, Cipriano KJ, Bane EM, Murtaugh BT. Blood Flow Restriction Training in Athletes. Curr Phys Med Rehabil Rep. 2020;8(4):329-341. doi:1007/s40141-020-00291-3
- Hanke AA, Wiechmann K, Suckow P, Rolff S. Effektivität des „blood flow restriction training“ im Leistungssport. Unfallchirurg. 2020;123(3):176-179. doi:1007/s00113-020-00779-6
- Scott BR, Loenneke JP, Slattery KM, Dascombe BJ. Blood flow restricted exercise for athletes: A review of available evidence. J Sci Med Sport. 2016;19(5):360-367. doi:1016/j.jsams.2015.04.014
- Wortman RJ, Brown SM, Savage-Elliott I, Finley ZJ, Mulcahey MK. Blood Flow Restriction Training for Athletes: A Systematic Review. Am J Sports Med. 2021;49(7):1938-1944. doi:1177/0363546520964454
- What is blood flow restriction training? (2022). https://health.clevelandclinic.org/blood-flow-restriction-training
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