What Is Blood Flow Restriction Training?

Dr. Britt Wickett, PT, DPT, CSCS
Dr. Rhianna Wickett, PT, DPT, CSCS

Blood Flow Restriction Training (BFRT) is quickly becoming a very popular tool in the world of Sports Medicine to improve muscle strength, size, and functional aerobic capacity in shorter amounts of time with less stress on the body than typical training.

Smart Cuffs Set.jpg

Blood flow restriction training utilizes a medical grade tourniquet on the upper or lower extremity to provide brief and intermittent occlusion of venous and arterial blood flow while at rest or exercising. With the use of blood flow restriction, you can achieve strength gains and muscle growth using significantly less weight than traditional resistance training. This can be very beneficial to reduce the negative effects of injury and surgery during specific phases of rehab until high load resistance training is possible.

Although the concept has been around since the 1960’s, new technology has allowed for  extensive research and reproducible techniques and results. BFRT is actively used by the Department of Defense, large medical systems, and Professional Sports Teams (NFL, NBA, MLB, MLS, NHL) and Elevate Performance couldn’t be more excited to bring it to YOU! Whether it is used for rehabilitation, fitness, performance training, or recovery, BFRT is a safe, effective, and portable solution for many ability levels, ages and goals.

Traditional strength training requires high load training of 70% of 1 rep max for strength & hypertrophy gains. Research on BFRT shows that loads as low as 20-40% of 1 rep max can produce “an exaggerated response for maximizing muscle strength & hypertrophy.”, meaning those previously unable to tolerate resistance training will now be able to see strength & hypertrophy gains. Evidence also suggests BFRT can improve “bone health, improve cardiovascular health including VO2 max , and can even improve muscle activation, perfusion, and endurance following surgeries such as ACL reconstruction.”

BFR Can Benefit Almost Everyone.png

How Does It Work?

Blood flow restriction training essentially tricks the brain and body into thinking one is performing high intensity exercise. Restriction results in physiological changes that mimic changes associated with high intensity exercise. The results are gains in muscle size, muscle strength and increases in cardiovascular function at much lower intensities than are usually required for adaptation.

How Is It Performed?

BFR is performed by first placing a Smart Cuff on your upper or lower extremity, as close to your trunk as possible. The clinician will inflate the cuff and use an ultrasound doppler to find limb occlusion pressure (The minimum pressure needed to sufficiently occlude deep arteries and the superficial veins). The cuff will be inflated to the appropriate percentage of limb occlusion pressure, where you will either rest or exercise depending on the desired outcome.

BFRT is applied for a maximum of 25 minutes per session. A minimum of two sessions per week for 4-6 weeks is recommended to see the best results.

What Are The Benefits?

  • Increased muscle size (Hypertrophy)

  • Increased muscle strength

  • Increased cardiovascular capacity/VO2 Max

  • Increased Growth Hormone, IGF1 and possibly testosterone

  • Decreased Post-Surgical Recovery Time

  • Decreased joint/tissue stress

  • Little to no muscle damage

  • Little to no recovery needed

  • Little to no soreness or delayed onset muscular soreness (DOMS)

  • Low Intensity needed (resistance or cardio)

Who Can Benefit?

  • Immobile or mobility-restricted populations:

    • Bed ridden

    • Casted

    • Post-operation rehabilitation patients

    • Elderly

  • Athletic populations:

    • Active recovery

    • Decrease joint/tissue loads

    • Isolated exercises for “weak link” region

Can Everyone Use BFRT?

While Blood Flow Restriction Training can benefit a wide variety and of people across the lifespan, there are some contraindications and precautions that must be taken. Your safety is our utmost priority. We may contact your primary physician prior to administering BFRT if you have precautions, such as Diabetes, Vericose Veins, or other health conditions. Those with the following should not use BFRT:

  • Acidosis

  • Cancer

  • Extremities with dialysis port

  • Excessive swelling in post surgical limb, often UE (i.e. lymphedema)

  • Infection within extremity

  • Increased intracranial pressure

  • Impaired circulation

  • Lymphedema (on limb)

  • Open fracture/open wound

  • Pregnancy

  • Previous revascularization of limb

  • Sickle cell anemia

  • Severe hypertension

  • Severe crush injury

  • Vascular graft

  • Venous thromboembolism

  • Women who have had a mastectomy with or without radiation and/or an axillary node dissection. Avoid BFRT on the affected arm.

  • People in hemodialysis who have arterial venous fistulas. Avoid BFRT exercise on the affected limb.

Why We Use Smart Cuffs

The cuffs we use are FDA Listed Class 1 Pneumatic Tourniquets, meaning they are FDA approved and well researched to give you the safest results. They are 4 inches wide, which means they are safer and require lower pressures to achieve the Limb Occlusion Pressure for increased comfort when compared to a narrower cuff. They also use a single-chambered bladder system to allow for reliable limb occlusion pressure measurement in the clinic. We choose the most trusted brands and products to keep you as safe and comfortable as possible and give you the best results.

Are you ready to start YOUR BFRT Journey?

Call 605-484-9019 Today to schedule your BFRT session!


  1. Cara, Ed et al. Blood Flow Restriction Level 1 - Smart Tools Lecture Presented at BFR L1 Colorado May 4, 2019.

  2. What We Know About Blood Flow Restriction Training - Physio Network. (2019, February 26). Retrieved from https://www.physio-network.com/what-we-know-about-blood-flow-restriction-training

  3. Hughes L, Paton B, Rosenblatt B, et al. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med 2017:bjsports-2016-097071

  4. Ozaki H, Sakamaki M, Yasuda T, et al. Increases in thigh muscle volume and strength
by walk training with leg blood flow reduction in older participants. J Gerontol 56 2011b;66:275–263.

  5. Žargi T,Drobnič M, Stražar K, Kacin A.Short-Term Preconditioning With Blood Flow Restricted Exercise Preserves Quadriceps Muscle Endurance in Patients After Anterior Cruciate Ligament Reconstruction. Front Physiol. 2018 Aug 24;9:1150. doi: 10.3389/fphys.2018.01150

About the Authors
Dr. Rhianna Wickett, Physical Therapist, graduated from the University of South Dakota (USD) with a Doctorate of Physical Therapy. She is also a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association and an EMT. While at USD, Dr. Wickett researched the effects of various treatments including manual therapy and exercise on trigger points, which is a common cause of pain within the shoulder girdle. She has also completed The Otago Exercise Program: Falls Prevention Training, an evidence-based fall prevention certification. Her clinical studies emphasized Women's Health, Neurological and Vestibular Conditions, and Orthopedics. She graduated with a Bachelor of Science in pre-medicine from the South Dakota School of Mines & Technology after completing two years of Industrial Engineering education. Rhianna grew up with a love of ballet, dancing for almost 20 years. She is passionate about providing each patient individualized care backed by the latest research and educating patients about their condition to make lifelong changes. She also has completed continuing education in women's health physical therapy to treat a wide range of conditions relating to pelvic floor health throughout the lifespan, including pre/post-natal conditions, incontinence, prolapse, sexual dysfunction, pelvic pain. In her free time, Rhianna enjoys spending time outdoors with her husband, family, friends, and dog Zippy. You may contact the author with questions at Rhianna@ElevatePerformanceSD.com.

Dr. Britt Wickett, Physical Therapist, graduated from the University of South Dakota with a Doctorate of Physical Therapy and is also a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. Dr. Wickett has also completed The Otago Exercise Program: Falls Prevention Training, an evidence-based fall prevention certification. At the University of South Dakota, Dr. Wickett conducted research involving the flexibility of aging athletes at the National Senior Games. He has also volunteered at USD athlete screenings and Special Olympics FUNfitness. His clinical studies emphasized Sports & Orthopedics, Rural Medicine, and Geriatric Health. Britt is a Brandon, SD native and participated in football, basketball, and track at Brandon Valley High School. He graduated from Division II Southwest Minnesota State University with a Bachelor of Science degree in Exercise Science and minor in Coaching. While attending SMSU he was a wide receiver for the football team and helped the Mustangs to their 1st ever Mineral Water Bowl appearance in 2013. In his free time Britt enjoys spending time outdoors with his family, friends, and dog Zippy.