Definitive Guide to Blood Flow Restriction Training (2023)

In this guide, I'm sharing everything you need to know about blood flow restriction training, also known as occlusion training or just BFR training.

Here's everything we currently know about the science of blood flow restriction training, including some of the scientific evidence on the safety and effectiveness of BFR training. Read or skip to the next section:


  • What is Circulation Restriction Training?
  • How are muscles strengthened?
  • How does circulatory restriction training work?
  • Blood flow restriction in physical therapy
  • Does circulation restriction training work?
    • BFR after ACL reconstruction
    • BFR for knee pain
    • BFR after immobilization
    • BFR in the geriatric population
  • Is blood flow restriction training safe?
  • What are the contraindications of BFR training?
  • Do you need certification to perform blood flow restriction training?
  • What are the best cuffs to restrict blood flow?
  • How to start blood flow restriction training

What is Circulation Restriction Training?

Circulatory restriction training is a technique that allows you to perform exercises with reduced blood flow to the arm or leg. This is usually done with a cuff or brace placed snug around the limb to reduce but not completely obstruct blood flow. The advantage of training to restrict blood flow is that a person can exercise at a lower intensity but still have the benefits of high intensity exercise.

  • Keep reading: Best BFR bands, armbands and gear
Definitive Guide to Blood Flow Restriction Training (1)

Unless you've been living under a rock, we're assuming you've heard of, and maybe even practiced, blood flow restriction training. Its popularity has exploded in recent times, largely due to the media and stories of professional athletes relying on so many "fly at night" treatments.

The point, however, is that the BFR is neither new nor just a fad.

BFR research has been going on for over 20 years, and we're here to say it's solid. And as we continue to learn more, it continues to show promise.

When I first heard about circulation restriction training, I must admit I was a little skeptical. Over the years, I've seen many fads come and go in our professions.

For example, let's play a little game...

As soon as possible, think of something we do in the rehabilitation or fitness professions that DOES NOT have a strong scientific basis or clinical research to support its use.

Wait wait…

Pretty easy, right? There are too many of them to be sure.

Now let's think of some that are the exact opposite. What has solid scientific basis and clinical evidence?

Hopefully the first thing that comes to mind is exercise and strength training. There is strong scientific evidence and clinical research to support strength training.

Now, another modality that should come into this discussion is blood flow restriction training.

(Video) Blood Flow Restriction: Biohack Your Training

I'm not one to jump on the bandwagon, but as more and more evidence comes out, it's clear that BFR is something to consider.

How does BFR training work? Let's dig a little deeper.

How are muscles strengthened?

It's probably a good idea to start with the basics of how muscles get bigger and stronger.

Simply put, muscles adapt through neural, mechanical, and metabolic mechanisms.

Many of these mechanisms involve multi-step pathways that will likely put you to sleep if we go into too much detail in this post, but it's still important to understand.

Simply put, it's all about load and volume.

on onehormonal point of view, Testosterone increases with high-impact compound exercise, while growth hormone increases with high-volume compound exercise.

This is an important concept...

High volume and moderate intensity will increase growth hormone, but low volume and high intensity will not.

Insulin-like growth factors (IGFs), myogenic stem cells (MSCs), vascular endothelial growth factor (VEGF), and the mTORC1 signaling pathway are activated during normal high-impact exercise.

Note above that the key term is "high rate". We need high loads to get stronger.

In short, all of these different pathways and "ingredients" are vital to muscle growth.

How does circulatory restriction training work?

there are severalproposed mechanisms for the functioning of the BFR.

Ourcurrent understandingis that exercise with blood flow restriction works through the indirect effect of metabolite accumulation and the hypoxic environment of exercise with arterial flow restriction. This results in greater fatigue, muscle activation, and also anabolic pathways that result in muscle adaptations compared to exercise without BFR.

So, knowing that it takes a combination of loads and volume to get stronger, what do we do in cases where people aren't fit or can't handle high loads? For example, after an injury or surgery. Or maybe someone who trains at home without access to weights to reach high loads.

This is where BFR training can help.

Blood flow restriction training can be a great addition to training because the same muscle building ingredients take place in a low impact environment.

(Video) The ULTIMATE BFR Tutorial (Blood Flow Restriction)

With immobilization or atrophy, muscle protein breakdown occurs. In BFR training with low loads, and in some studies without load, several signaling pathways are activated to increase muscle protein synthesis.

Talking about the hypoxic environment and the mechanisms involved is basically a “snowball effect”. Less oxygen in the area accelerates fatigue and recruitment of higher threshold motor units. In other words, "start working" on the muscle. The reduced pH of the hypoxic environment is a hypertrophic stimulus.

There is also an added benefit of the "muscle pump" of cellular inflammation. In fact, compression causes metabolites to build up, and we've already discussed the benefits of increasing metabolites. Essentially, when compression is reduced or relieved, the floodgates open and put all those "muscle building ingredients" into the muscle.

Blood flow restriction in physical therapy

Definitive Guide to Blood Flow Restriction Training (2)

Regardless of the injury you're dealing with, muscle atrophy and weakness is a common impediment.

Methods to correct these shortcomings are usually performed immediately. Neuromuscular electrical stimulation, biofeedback, isometrics and cross-education are just a few of the methods we use to start building strength early while engaging tissues.

Unfortunately, heavy loads are not appropriate in the early stages of healing as they can overwhelm and damage the healing tissues.

This becomes an issue when someone is trying to recover from injury while gaining strength.

Resistance training guidelinesEncourage high loads that exceed 60% of one repetition maximum (1RM) for 8 to 12 repetitions.

We need reasonable burdens to achieve the desired adjustments. To make matters worse, the 1RM test is not appropriate at the beginning of rehabilitation. There are estimation models for 1RM, but they are not ideal.

BFR offers an option to cushion post-injury atrophy as well as increase strength in a low-impact environment. Essentially with training loads of 20-30% 1RM with 15-30 repetitions per set. This is much more true for training with healing tissues that are not yet ready to receive a more intense load.

Does circulation restriction training work?

Extensive research has been published documenting the effectiveness of BFR training.

Exercise to restrict blood flow has been shown to helpto mitigate atrophy, improve hypertrophy, increase strength and improve aerobic capacity, all in a low-impact environment.

This all sounds great, but what about specific diagnostic evidence?

If blood flow restriction training has so many benefits, we would expect positive results in certain diagnoses, right? Well that would be correct!

BFR after ACL reconstruction

We know from years of research that the quadriceps lose strength after knee surgeries such as ACL reconstruction. Happily,The BFR is well suited to assist with loss of strength and hypertrophy following ACL reconstructionit is anumber of studiesdemonstrated benefit from the use of BFR.

While there may not be many studies of BFR for other specific diagnoses, intuitively every post-op knee needs quadruple strength and hypertrophy, so you should feel good that you're getting similar benefits.

(Video) Blood Flow Restriction Training | What It Is & How To Use It

BFR for knee pain

Arguably, one of the most important things in any city that people come to us for is pain relief. Clearly, higher loads can aggravate already irritated tissue (or the patient!), making low-load BFR training attractive.

ONEnumber of studiesdemonstrated the benefit of BFR in relieving painpatellofemoral pain,knee osteoarthritis, and they work laterACL reconstructionjknee osteoarthritis.

BFR after immobilization

We all know the detrimental effects immobilization has on a muscle. You've seen it in patients (and maybe yourself if you've had surgery!). You guessed -BFR can also help with immobilization🇧🇷 Even if your patient is bedridden or can't do much, the BFR can help! how amazing is this

BFR in the geriatric population

If athletes are not your target audience and you are treating elderly or geriatric patients, the good news is that BFR is helping this population too.

Several studies have found that BFR helped with this.pain reliefjfunctional notesin elderly patients.

You certainly need to take more precautions (see below) and know who you are treating in this population, but when you think about it, if you can reap the benefits of strength training with lower loads, it's a win-win!

The only issue we've seen with this population is discomfort, and in our experience, a little more persuasion is needed.

Definitive Guide to Blood Flow Restriction Training (3)

Is blood flow restriction training safe?

Before diving into security, it's important to note that anything in the wrong hands or used inappropriately or in the wrong population can be potentially unsafe.

after i said thatBFR training has proven to be safe.

BFR has been used in a variety of musculoskeletal conditions and to date has not resulted in any serious adverse events for those who have no contraindications to BFR training.

Common side effects of BFR training are usually short-lived and include things like numbness, bruising, discomfort, bleeding from petechiae, skin abrasions, and delayed onset muscle soreness (DOMS).

These are usually not a concern. However, caution should be exercised in patients with heart disease or clotting problems.

Happily,A recent review has shown that the risk of blood clots or DVT is extremely low..

At this point, we recommend that BFR training begin about 2 weeks after surgery to reduce the risk of adverse events.

What are the contraindications of BFR training?

Based on previous safety guidelines, contraindications for BFR are focused on individuals with vascular insufficiency or cardiac involvement.

There may be an increase in cardiac stress due to the increased stroke volume and heart rate of the body trying to pump arterial blood to the tissues.

(Video) Benefits of Blood Flow Restriction Training—DMC Trainer Tips

People with hypertension, diabetes, history of stroke or DVT, heart disease, active infections, pregnancy, bleeding disorders or other vascular insufficiencies (such as varicose veins) are contraindicated.

That said, it is wise to speak with the GP to determine if a patient is suitable for BFR training. However, when you think about it, there are often contraindications to other treatment modalities and approaches.

Basically, use your head.

Clinical thinking and decision making are just as important with BFR as they are with any other treatment approach you use.

Do you need certification to perform blood flow restriction training?

As with anything new, there are always a number of misconceptions surrounding BFR training. One that was specifically reported is the need for a specific certification to start BFR training.

The short answer is no, you don't need certification to use blood flow restriction training. BFR is for both in the context of practicephysiotherapistsjathletic trainer🇧🇷 Local authorities may have different policies, so it's always best to check your state's laws of practice to ensure you can use the BFR.

As with any other intervention you use, it is important to learn about the mechanism, how the treatment is administered, and the absolute and relative contraindications.

What are the best cuffs to restrict blood flow?

There are many blood flow restricting bands, bracelets and devices on the market: some good, some bad.

There are several factors to consider when choosing the best BFR cases. I have an in-depth article that goes into more detail, so be sure to check out my complete guide for all my recommendations:

  • The best bands, bracelets and equipment to restrict blood flow

How to start blood flow restriction training

Now that you understand a little about the science of blood flow restriction training, I'm sure you're interested in learning more about how to get started using BFR safely and effectively.

Fortunately, learning BFR doesn't have to be complicated or expensive! You can even start with affordable cuffs that restrict blood flow.

Dan Lorenz and I teamed up to create aBlood flow restriction online trainingTo teach you exactly how we use BFR training for rehabilitation and training.

We truly believe that BFR is a technique we should all be using, the science is there. That's why we want to help you learn everything you need to know to get started with BFR training quickly and easily.

We'll cover the history and science in detail, discuss safety and effectiveness, and then show you exactly how we select BFR cuffs, determine the proper amount of pressure, and incorporate them into our programs.

You can start BFR training safely and effectively right away

(Video) All things Blood Flow Restriction Training in under 60 Minutes | Physiotutors Podcast Ep. 008

This article was co-written with me by Dan Lorenz, my co-author of our newOnline Training Course on Circulation Restriction🇧🇷 Dan Lorenz, DPT, PT, ATC, LAT, CSCS is currently the Director of Sports Medicine at Lawrence Memorial Hospital/OrthoKS in Lawrence, KS. Dan specializes in performance enhancement, strength training and using exercise to restrict blood flow. He has published widely in professional journals, authored or co-authored several home-study courses and book chapters, and has been a guest speaker at local, state, and national conferences on these subjects across the United States.

Definitive Guide to Blood Flow Restriction Training (7)


How long should I do blood flow restriction training? ›

It is safe to use BFR for more than 20 minutes, but not recommended. Because BFR is such a potent muscle building stimulus, there is no need to complete more than one exercise per body part. Therefore 5 minutes is enough to work one body part to its limit and produce maximal gains.

How many reps should I do for BFR training? ›

The intended repetition scheme for BFR exercise is 30-15-15-15 for a total of 75 repetitions for one BFR exercise.

How many times a week should you do BFR training? ›

For optimal results, resistance training should ideally be done 2-4 times per week. In theory, strength training with BFR can be done daily, however, this may not be the best long term strategy and training 1-2 times per day should only be done for shorter time periods of 1-3 weeks.

What are the dangers of BFR? ›

Cardiovascular disorders, hypertension, and a history of thrombosis were the main concerns of professionals regarding BFR technique users. Stasis (i.e., impaired blood flow) is one of the risk factors for thrombogenesis.

What are the cons of BFR? ›

Potential negative side effects are numbness, dizziness, and delayed onset muscle soreness are possible. A handful of reports describe people developing rhabdomyolysis after BFR training.

Do you loosen BFR bands between sets? ›

It's also important to keep the limbs continually restricted for the duration of the exercise. Research shows that untying the wraps between sets significantly reduces metabolic stress, thereby inhibiting the growth stimulus. Remove the wraps only after you've finished the final BFR set.

What pressure should I use for BFR? ›

The goldilocks zone for BFR pressure during resistance training is typically somewhere between 40-80% of arterial occlusion pressure [the pressure where blood flow completely ceases (AOP)]. Whilst cuff material (elastic vs nylon) does not impact required pressure (1), cuff width (5-18cm) does.

Do you remove BFR bands between sets? ›

A typical training scheme for BFR involves completing four sets of an exercise at 20 to 50 percent 1RM at 30, 15, 15, and 15 repetitions respectively with a 30 to 60-second rest interval between sets. The cuff will remain intact during the rest intervals but should be removed or deflated in between exercises.

How long does it take to see results from BFR? ›

Does it really work? How long will it take to see results? The literature demonstrates positive results for BFR in physical therapy. Muscle hypertrophy occurs at 4 weeks or less, where strength gains happen at 10 weeks or later.

Can BFR training cause blood clots? ›

Does BFR Cause Blood Clots? This is the first and most obvious concern with the implementation of BFR. Does placing a tourniquet and restricting blood flow increase-clotting risk? Fortunately, several studies have examined these questions, and all support that BFR does not increase clot risk.

What are the side effects of BFR training? ›

  • Perceptual Type Responses.
  • Fainting/Dizziness.
  • Numbness.
  • Ratings of Perceived Exertion, Pain, and Discomfort.
  • Delayed Onset Muscle Soreness.
  • Markers of Muscle Damage.
  • Other Reported Side-Effects.

Should you lift heavy with BFR bands? ›

With heavyweights come equally big muscular contractions. These contractions are too strong for a properly inflated cuff to have its proper effect on the involved arteries and veins. Lifting lighter weights is the best way to get the most out of BFR training.

Can you lift heavy with BFR? ›

BFR is also used in elderly patients who need to get stronger, but can't lift heavy weights.

Does BFR increase vascularity? ›

Research suggests that BFR training may be able to achieve an increase in blood-vessel elasticity as well as improve vascular function—key factors in managing cardiac disease and diabetes.

Who shouldn t use BFR bands? ›

People who have a history of blood clotting disease like a history of venous thromboembolism (VTE), unstable hypertension, heart disease, varicose veins, or are pregnant shouldn't do BFR training. People with a high risk of nerve injury, such as those with diabetes, should approach with caution.

Does BFR increase testosterone? ›

Results from this study revealed that both BFR and RES groups recorded a significant increase in myogenic-related hormones post-exercise, which was significantly higher compared to that of the CON group. Notably, the BFR group demonstrated higher testosterone secretion levels compared to the RES group post-exercise.

How often should I use BFR? ›

Don't Over Do It

To begin with, only use BFR training once or twice a week until you feel your muscles are recovering around the 24-hour mark.

Is BFR training legit? ›

Most are overblown or unproven. Blood flow restriction training, however, is a legitimate, science-based way to squeeze more muscle growth out of your training. By itself, it can produce similar results to traditional strength training, and when combined with it, the overall results are magnified.

Is blood flow restriction training worth it? ›

Blood flow restriction (BFR) training has been reported to have significant benefits on local skeletal muscle including increasing local muscle mass, strength, and endurance while exercising with lower resistance. As a result, patients unable to perform traditional resistance training may benefit from this technique.

Does BFR increase hypertrophy? ›

Vascular blood flow restriction (BFR) training stimulates muscle hypertrophy by increasing muscle activation and muscle swelling.

Can you do BFR two days in a row? ›

You can use BFR training on consecutive days for different body parts, such as the chest one day and legs the next day, but it is not recommended to train the same body part two days in a row. This is so you can give each body part enough time to recover before you train it again. It also helps prevent overtraining.

Can BFR training cause varicose veins? ›

Another safety concern for some populations exposed to BFR exercise is that the occlusive conditions may promote the undesired coagulation at sites of vascular damage or atherosclerosis (ie, venous thromboembolism, peripheral vascular disease, blood clotting disorders, vascular endothelial dysfunction, and varicose ...

Can you do cardio with BFR bands? ›

BFR can be used with resistance training, or with other modalities, including endurance activities such as walking and cycling. When combined with exercise (and even without it) BFR magnifies the metabolic stress of exercise.

How thick should BFR bands be? ›

BFR bands are usually either 1” or 2” wide, with the 1” bands intended for the arms and the 2” bands intended for the legs.

How often should you do occlusion training? ›

Low load occlusion training is most effective when done 2 to 3 times a week. More frequent training is less effective because your muscles don't have time to recover. Significant results become apparent after around 10 weeks of training.

Can you use BFR bands while walking? ›

Since BFR used in combination with low-intensity walking exercise can confer significant improvements in muscle strength and hypertrophy (Takarada et al., 2000; Abe et al., 2005), there is great potential for use with clinical populations for fitness and rehabilitation.

How tight should occlusion training be? ›

It's important not to wrap it too tightly that you're restricting too much blood flow, but still tight enough that it's effective. For your arms, you'll want to aim for about a 6 out of 10 for the level of tightness, where 10 is as tight as you can go. For your legs, you'll want to aim for a 7.

Where do you put BFR bands on glutes? ›

The band should be just under the fold between your glutes and hamstrings on your backside. Occlusion training has a positive effect on the muscles below and above the cuff, so putting them on your upper arm does affect chest or back strength and muscle growth, as well as your biceps, triceps, etc.

Does BFR increase muscle size? ›

Findings from previous studies have indicated that low-intensity resistance exercise in combination with blood flow restriction (BFR) promotes muscle mass increases similar to what is seen after high-load training with 80% 1RM (Vechin et al., 2015).

Does blood flow restriction training really work? ›

There's evidence that BFR training can indeed boost athletic training, and may even help patients with chronic pain or other conditions build muscle more easily, as long as it's performed correctly.

What happens if you lift heavy with BFR bands? ›

With heavyweights come equally big muscular contractions. These contractions are too strong for a properly inflated cuff to have its proper effect on the involved arteries and veins. Lifting lighter weights is the best way to get the most out of BFR training.

Does BFR make you more vascular? ›

Researchers have found that resistance training with BFR not only increases muscle size without too much subjective fatigue and discomfort,5,8 but also significantly increases vascular endothelial growth factor (VEGF) expression,9 promotes vascular function,10 enhances vascular conductance11 and partially alters ...

Can you walk with BFR bands? ›

Since BFR used in combination with low-intensity walking exercise can confer significant improvements in muscle strength and hypertrophy (Takarada et al., 2000; Abe et al., 2005), there is great potential for use with clinical populations for fitness and rehabilitation.


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