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Blood Flow Restriction

What is Blood Flow Restriction (BFRT)?

Blood Flow Restriction Therapy (BFRT) is a tool we use to increase strength and muscle mass, aide in recovery, and improve cardiovascular function for our patients. It is defined as a brief restriction of arterial and venous blood flow by the use of a tourniquet on the extremity. The tourniquet restricts blood flow from the veins to the heart and limits the blood flow to the working muscles from the arteries. This creates an artificial high intensity environment while only using low loads of resistance and sub-max levels. Basically, the body is “tricked” into releasing chemicals that are released during high intensity exercise, allowing these benefits at low intensity exercise.

History of Blood Flow Restriction

Blood flow restriction therapy is a treatment that has been studied and proven effective, and has been becoming much more popular in the US since 2011. BFRT has been utilized in professional sports, collegiate sports, the department of defense, etc. In 2018, blood flow restriction therapy was added to the scope of practice for physical therapists. Specific training is provided to physical therapists and physical therapist assistants to become certified in the application of BFRT to patients.

How is Blood Flow Restriction Performed?

As a patient, here is what you can expect if BFRT is part of your plan of care. A cuff (tourniquet) will be applied to either your arm or leg, or both. Because a positive systemic (whole body) effect takes place, an arm cuff may be utilized for a lower extremity injury, or vice versa. A doppler will be placed on the limb in order to find a pulse. The cuff will then be inflated until the pulse is no longer heard via doppler (loss of pressure), and then the cuff will be deflated again. Low intensity exercises, or rest, will be completed at a percentage of the loss of pressure value. Blood flow restriction therapy will be utilized in combination with traditional treatment strategies in order to provide our patients with the greatest benefits. By using low intensity resistance and sub-max levels, blood flow restriction therapy is safe and effective for a multitude of diagnoses from those who are placed on bed rest to those who are cleared for high performance exercise. BFRT can be safely used on patients of any age.

Conditions that Can Benefit From Blood Flow Restriction Therapy

  • Post-operative:
    • Rotator cuff repair
    • Labral repair
    • Bicep tenodesis
    • Subacromial decompression
    • Hip replacements
    • Knee replacements
    • ACL/PCL/MCL/LCL repair/reconstruction
    • Meniscus repair
    • Achilles repair
  • Non-operative:
    • Chronic pain
    • Shoulder impingement
    • Tendonitis
    • Rotator cuff tears
    • Hip impingement
    • Knee pain
    • Patellofemoral pain
    • Ankle sprains
    • Ankle/foot instability

Precautions To Consider Prior to Blood Flow Restriction Therapy

  • Poor circulation, varicose veins, abnormal clotting times, atherosclerotic vessels, arterial calcification, diabetes, cardio-pulmonary conditions, hypertension, sickle cell trait
  • The PT and Physician will communicate and decide whether BFRT is appropriate for patients with the above risk factors.

Contraindications to the use of Blood Flow Restriction Therapy

  • Acidosis, Cancer, excessive post-op swelling, infection in extremity, impaired circulation, lymphedema, open fracture/wound, pregnancy, previous revascularization, sickle cell, anemia, severe hypertension, vascular graft, venous thromboembolism

For further information regarding Blood Flow Restriction and to find out if this treatment is appropriate for you, please reach out to one of our physical therapists who will be happy to discuss this option with you.


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