BLOOD FLOW RESTRICTION TRAINING: FAD OR FACT? Sarah Klein, PT, DPT

Short answer: FACT

Blood flow restriction (BFR) training originated in Japan in the 1960's.  but has recently taken off in the rehabilitation and fitness world. Is there weight behind this popularity? Is it another fad or is there truth amongst the chatter? The short answer is: YES, there is strong factual evidence to support its use. When used correctly in the appropriate setting, BFR is an effective method proven to increase local muscle mass, strength, and endurance - all while using less resistance. Let’s dive a little bit into how this tool works. BFR uses a strap or cuff that applies intermittent and brief pressure around a limb, similar to a tourniquet, to occlude venous flow while allowing arterial flow. Now in English: blood and oxygen continue to enter your arm/leg muscles while the cuff blocks them from exiting. My thoughts when I first heard this: “That doesn’t sound like a good thing…” But, alas, the research is consistently positive. Let’s break it down a little further for my fellow nerds. Oxygen is delivered to the muscles via oxygenated blood and the deoxygenated blood remains in the limb that you are strengthening because of the cuff. This hypoxic (i.e. oxygen lacking) environment within a muscle group is likely the catalyst for a metabolic cascade of events that research has shown to: 

• stimulate muscle protein synthesis (build muscle), 
• alter gene regulation of muscle satellite cells (these cells build muscle and repair muscle in response to stress), and 
• increase muscle fiber recruitment (producing a stronger muscle contraction). (Pignanelli, et al. 2021).

With the research to back it up, BFR is being used by many rehabilitation professionals and is included in the physical therapy scope of practice. Major organizations such as the NFL, NBA, MLB, MLS, and NFL, and universities use BFR to rehabilitate their athletes. But you do not have to be a professional or high level athlete to benefit. In the rehabilitative setting, BFR can combat the negative effects of immobilization in the early phase of healing and accelerate the rehabilitation process for many different conditions and post op protocols. (Bielitzki R, et al. 2021). Furthermore, research has shown that the benefits of BFR stretch beyond the effects on skeletal muscle. A systematic review published in 2021 by Miller, et al concluded that the majority of studies they reviewed reported favorable effects on the cardiovascular and endocrine systems in addition to the musculoskeletal effects noted above. (Miller BC, et al 2021). To sum it up, BFR training can be used as an effective tool to gain muscle strength, muscle size, and aerobic capacity for many different patient populations, including those who may be unable to perform a traditional resistance program. If you want to learn more or if you would like to see if this could benefit you, reach out to one of the physical therapists at Stability Pilates and Physical Therapy Atlanta.  *Medical disclaimer: There are certain conditions your practitioner should screen for to determine if this is right for you. This information is for educational purposes only and should not be used to replace medical advice.  References:Pignanelli C, Christiansen D, and Burr JF. Blood flow restriction training and the high-performance athlete: science to application. J Appl Physiol. 2021;130:1163–1170. Bielitzki R., Behrendt T., Behrens M., Schega L. Time to Save Time: Beneficial Effects of Blood Flow Restriction Training and the Need to Quantify the Time Potentially Saved by its Application during Musculoskeletal Rehabilitation. Phys. Ther. 2021;101:pzab172. doi: 10.1093/ptj/pzab172.Miller BC, Tirko AW, Shipe JM, Sumeriski OR, Moran K. The Systemic Effects of Blood Flow Restriction Training: A Systematic Review. IJSPT. 2021;16(4):978-990. doi:10.26603/001c.25791 Author information: Sarah Klein is a physical therapist at Stability Pilates and Physical Therapy Atlanta. Her passion in clinical work is developing positive relationships with her clients and creating individual treatment plans that consider the body and mind holistically rather than solely on the affected body part or region. She combines her knowledge of Physical Therapy, Athletic Training, her studies from National Taiwan Sport University, Pilates, Myofascial Trigger Point Dry Needling, and personal experience with a connective tissue disorder to help her clients achieve their goals.