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Blood Flow Restriction Training

BFRT for aerobic Training

Blood flow restriction for aerobic conditioning

One thing we try to maintain as much as possible in the early stages after injury is aerobic conditioning/cardiovascular endurance. This way when the tissues are appropriately healed, we can hit the ground running.

Abe et al. (2010) looked at two groups that performed a biking protocol. One group biked at 40% of their VO2max for 45 mins, while the other group biked at 40% VO2max for only 15 minutes but with BFR.

The BFR group demonstrated significant improvements in VO2max in addition to increased muscle size and strength in their quads. Whereas the group that did not utilize BFR biked for a longer duration and didn’t show any differences.

For patients coming back from upper extremity issues, we will utilize BFR on their legs while cycling in order to build and maintain their aerobic capacity.

If a patient is dealing with a lower extremity and they are not yet cleared to begin biking with their involved side, we will utilize BFR while they bike with only their uninvolved side. And once they are able cleared, we do it on both!


ABOUT Blood Flow Restriction Training

Blood Flow Restriction (BFR) training is a technique that combines low intensity exercise with blood flow occlusion that produces similar results to high intensity training. It has been used in the gym setting for some time but it is gaining popularity in clinical settings

It has been long been assumed heavy loads must to be lifted to improve muscular strength and size. For some populations, like older individuals, post-operative patients, or those rehabilitating an injury, high-load exercises can cause injury and not be tolerated.

Blood flow resrtriction training is initiated by inflating the pneumatic cuff to a specific pressure with the aim of obtaining partial arterial restriction and complete venous occlusion.


The client performs resistance exercises at a low intensity of 20-30% of 1 repetition max (1RM), with high repetitions per set (15-30) and short rest intervals between sets (30 seconds).

There are quite a few mechanisms of BFR that create strength and muscle size gains.  Many of these mechanisms are the same as from high intensity lifting.  By decreasing the amount of blood flow into the muscle the limb becomes hypoxic (lack of oxygen). In addition, the cuffs prevent blood from leaving the limb so swelling of the limb occurs. The following mechanisms have been described as contributing to adaptations from BFR training: 

  • Metabolic Stress

  • Activation of Myogenic Stem Cells 

  • Release of hormones like Growth Hormone and Insulin Growth Factor

  • Hypoxia

  • Cellular Swelling


BFRT and Sports Injuries

Treatment of sports injury


A common application of BFRT is for sports related injuries. After any injury there is usually a period of time of disuse or rest. With surgeries and injuries such as fractures or sprains that time can be extended. Blood flow restriction therapy can help to reduce muscle atrophy and improve the ability to gain muscle back after injury.

The great thing about BFRT is that we can get those muscle gains with much lighter resistance with exercises. That means that even if you are unable to bear full weight or tolerate normal loads, we can do exercises to help you prevent loss of muscle mass while you heal.

BFRT is often applied post operatively as early as 2 weeks after surgery. There are also studies that show BFR applied before surgery can reduce the negative effects of the surgery by a significant amount.

Common surgeries we treat

  • ACL reconstruction

  • Achilles repair

  • Total knee replacement

  • Total hip replacement

  • Meniscus surgery

  • Rotator cuff repair

  • Lower leg fractures

  • Wrist fractures

  • Labrum repair 

  • Bunionectomy 

  • Other arthroscopies 

  • Joint fusion



At HIDEF Physical Therapy we treat athletes of all levels. We take the same approach whether you are a pro or recreational athlete. We have treated athletes who have played for:

  • Seattle Seahawks

  • Seattle Mariners

  • Seattle Kraken

  • Seattle Sounders

  • Minnesota Timberwolves

  • Las Vegas Raiders

  • Miami Dolphins

  • Indianapolis Colts

  • Detroit Tigers

  • University of Washington

  • Bellevue College

  • And many other Division I-III colleges

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