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Blood Flow Restriction (BFR) Training


What Is BFR?

To improve muscular strength and size, it has been assumed that heavy loads must be lifted. Unfortunately, in certain populations such as older individuals, post-operative patients, or those rehabilitating an injury, high-load exercises may not appropriate due to increased risk of injury and pain.

Blood Flow Restriction (BFR) training was initially developed in the 1960’s in Japan and is known as KAATSU training. BFR training is a technique that combines safe, low-intensity exercise with blood flow occlusion/restriction.  Occlusion is reducing the amount of blood flow into the upper arms or legs by using a recommended medical tourniquet or pneumatic cuff. The cuff is inflated to a specific Limb Occlusion Pressure (LOP) with the aim of partial arterial and complete venous occlusion to the applied limb(s). BFR can be applied during resistance training, aerobic training or passively without exercise.

BFR has been supported by scientific literature and is known for enhancing muscle growth, muscle strength, oxygen delivery and utilization (VO2 max), collagen-dependent tissue repair, and increased bone healing. BFR allows individuals to use low loads yet achieve results similar to high intensity training.

Mechanisms of Blood Flow Restriction (BFR)

By decreasing the amount of blood flow into the muscle (from cuff restriction), 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 adaptations from BFR training:

  • Metabolic Stress
  • Activation of Myogenic Stem Cells
  • Release of Growth Hormone and Insulin Growth Factor (IGF-1)
  • Cellular Swelling

Side Effects & Contraindications to BFR  

When applied appropriately, BFR is an extremely safe exercise modality but it is always good to be aware of the side effects and contraindications. Its safety greatly depends on who administers the therapy and whether or not they are certified and using the appropriate BFR equipment.

Reported common side effects while performing BFR exercises are pain, discomfort, soreness, delayed onset muscle soreness (DOMS), fainting and dizziness, and numbness.

All individuals should be assessed for the risks and contraindications to tourniquet use before BFR application. Clients possibly at risk of adverse reactions are those with poor circulatory systems, history of DVT, pregnancy, obesity, diabetes, arterial calcification, sickle cell trait, severe hypertension, or renal compromise. Potential contraindications to consider are venous thromboembolism, peripheral vascular compromise, sickle cell anaemia, extremity infection, lymphadenectomy, cancer or tumor, extremity with dialysis access, acidosis, open fracture, increased intracranial pressure vascular grafts, or medications known to increase clotting risk.

Who Can Benefit From BFR Training?


BFR for Performance

Whether it’s getting stronger, bigger or recovering, BFR offers an opportunity to do it faster. It can amplify performance by taking advantage of the missed opportunities your muscles, hormones and training have to offer. BFR technology has been utilized by professional athletes for many years, and is completely customizable towards various performance-related goals. Here are some ways BFR training can compliment an athlete’s current training program and enhance results:

  • Recover faster between training sessions by increasing the body’s natural repair hormones
  • Prevent excess muscle loss as training volume increases during peak season
  • Improve VO2Max
  • Increase resilience and improve healing by increasing collagen formation
  • Increase anabolic pathways and hormones that promote protein synthesis for muscle growth
  • Increase motor fiber recruitment and activation
  • Eliminate pain limiting your ability to lift by using lighter loads to give you heavy load-like results
  • Decrease muscle breakdown (inhibiting Myostatin)

BFR for Rehabilitation

Rehabilitation is where many BFR studies showed the potential to change injury recovery. BFR offers an opportunity to start recovering sooner, safely and more effectively. It can help:

  • Decrease muscle atrophy immediately after an injury/surgery
  • Maintain blood flow to limb to ensure proper delivery of nutrients
  • Improve tissue healing and limit scar tissue formation
  • Increase muscle strength and hypertrophy
  • Increase tendon and bone healing (including fractures and osteopenia/osteoporosis)
  • Ensure limb symmetry


Blood Flow Restriction (BFR) training is an extremely safe and useful tool for athletic and rehabilitation populations, and is considered the ultimate “biohack”. BFR allows individuals to lift light weights and still achieve muscular gains and aerobic capacity changes similar to high intensity training. BFR can be a complete game-changer for those who can not tolerate heavy loads in order to maintain strength and muscle size.

Our team at Push Pounds Sports Medicine are certified in utilizing BFR training for various rehabilitation and performance goals. The pneumatic cuffs we use are registered as a Class 1 Medical Device with the FDA. Potential individuals utilizing BFR training will undergo a screening assessment to determine whether BFR training is safe and appropriate for the desired goals.

We would be happy to respond to any inquiries or questions regarding Blood Flow Restriction (BFR) training. Please call (416) 722-3393 or e-mail hello@studioathletica.com for more information.



  • Jessee et al. (2018). Mechanisms of blood flow restriction: the new testament. Techniques in Orthopaedics. 33(2): 72-79.
  • Hughes et al. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. DOI: 10.1136/bjsports-2016-097071
  • Scott, B. R., Loenneke, J. P., Slattery, K. M., & Dascombe, B. J. (2016). Blood flow restricted exercise for athletes: A review of available evidence. Journal of science and medicine in sport, 19(5), 360–367. https://doi.org/10.1016/j.jsams.2015.04.014