How When & Why BFR



Why & When?

Occlusion training for bodybuilders only?

No, not at all! In fact, there are important research on miscellaneous muscle and skeletal pathologies which proves that occlusion training has significant effect on both strength and Patient Reported Outcome Measures (PROM)!

As a rule of thumb occlusion training is indicated if you have an acute or overload injury where you cannot do conventional resistance training i.e. lift heavy. For example, following orthopedic surgeries with relevant weight-bearing restrictions. Or more chronic conditions such as arthritis, as a majority will find joint pain worsens during heavy training. In theses cases occlusion training should be “first-line therapy”.

One can wonder why few private or public providers offers BFR? – But as with so much other new technology, thus evidence-based by research, the implementation is always delayed. Especially considered the amount of high quality research i.e. randomized controlled trials and the meta-analysis, occlusion training is here to stay and grow in popularity.

Below is listed some of the relevant issues and pathologies in which scientific litterature suggests that occlusion training is an effective treatment strategy.

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The 4 Pillars of BFR

BFRE can be effectively combined with training, in several different ways and even without training! These different “applications” should be used accordingly to the objective of the training, this is called “implications”. In popular science we identify these applications as “the 4 pillars of Blood Flow Restriction”:


1. Application

Passive BFR: Short intervals with partial or complete occlusion with or even without muscle work. Follow this link for an abstract on how to slow down loss of muscle mass in even in the absence of muscle work.
Implications: For example, as partially bedridden after major orthopedic surgical operations with severe restrictions, e.g. reconstruction of cruciate ligament or traumatic shoulder luxation’s.
Relevant products for you or your client will be “Rehab – Lower Body” or “Rehab – Upper Body”.

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2. Application

Combined with cardiovascular exercise: Performed continuously or in intervals with your preferred exercise.
Implications: In extension of 1st application when weight bearing is aloud, simple walking on a treadmill or bike in combination of BFR are useful. You can actually improve your muscle mass, strength and aerobic function depending on the starting point even at this stage. In daily speech, this means that one can improve rapidly, i.e. “fast-track rehabilitation”.
Relevant products for you or your client, primarily: “Performance – Lower Body”, but also “performance – Upper Body” e.g. in the case of exercises with relevant fatigue of the upper body muscles.


3. Application

Combined with low- or moderate load resistance training: Many know BFRE primarily as supplement to low load training.
Implications: For all who wants to increase or maintain their strength but especially for those who want to build or maintain muscle mass often as supplementation to lifting heavy loads.
Relevant products for you or your client: “Fit Cuffs – Complete”.

4. Application

Ischemic pre-conditioning and restitution modality (before or after sports performance): Recent research shows that short-term intermittent occlusion can be used to augment sports performance. Post sports you can optimize recovery time.
Implications: Primarily within elite sports.
Relevant products for you or your client: “Performance – Lower Body” or even “Performance – Upper Body” especially used in the professional climbing/bouldering community.


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  • Unspecific knee and hip pain (1,2,3)
  • Arthritis i.e. osteoarthritis and rheumatoid arthritis (4,5,6)
  • Prehab and Rehab after ACL injuries (7,8)
  • Patella femoral pain (PFP) aka. anterior knee pain (9,10)
  • Joint replacements i.e. artificial shoulder, hip or knee (11,12)
  • Degenerative and acute meniscus injuries (13,14)
  • Hip impingement (FAI) (15)
  • Unspecific shoulder pain (16,17)
  • Osteoarthritis of the GH and AC joint (different shoulder pains) (18,19)
  • Frozen Shoulder (16,17)
  • Bone fractures (18,19)
  • Tendon injuries and tendon surgery (15,20,21)
  • Disc herniation and non-specific back pain (22,23)
  • Cartilage Injuries (17,24)
  • Various muscle injuries (1)
  • Sarcopenia, osteopenia and osteoporosis (24)
  • General muscle building for the elderly as an alternative or supplement to other training methods (25)
  • Sports specific performance and support training (26-28)
  • Aerobic Performance (VO2max) – Cardiovascular training – low-load exercise i.e. on bike or treadmill (29-32)
  • Patient Reported Outcomes Measures (PROM) – Especially relevant for the elderly or impaired (5)
  • Tendon Health – Though not yet known if BFR is feasible in the treatment of tendinopathy (33)
  • Football aka. Soccer Performance (34)
  • Immobilized limbs – Contra Lateral Effect on strength and hypertrophy (35)
  • Hand Strength relevant for hand and finger arthritis (36)
  • Sprint Speed / Running Velocity (37)
  • Hypoanalgesic responce aka. acute pain reduction (38)
  • Improved Cardiovascular Health (39)
  • Hip arthroscopy rehab (research study in progress) (40)
  • Physical function indicative of Activities of Daily Living (ADL) (41)



(1a) Natsume et al. 2015 – Effects of Electrostimulation with Blood Flow Restriction on Muscle Size and Strength

(2a) Slysz et Burr 2018 – The Effects of Blood Flow Restricted Electrostimulation on Strength and Hypertrophy

(1) Hughes et al. 2017 – Blood flow restriction training in clinical musculoskeletal rehabilitation a systematic review and meta-analysis

(2) Slysz et al. 2016 – The efficacy of blood flow restricted exercise A systematic review & meta-analysis

(3) William et al. 2017 – Blood Flow Restriction Training- Implementation into Clinical Practice

(4) Segal et al. 2015 – Efficacy of Blood Flow Restricted Low-Load Resistance Training in Women with Risk Factors for Symptomatic Knee Osteoarthritis

(5) Ferraz et al. 2018 – Benefits of Resistance Training with Blood Flow Restriction in Knee Osteoarthritis

(6) Roschel et al. 2016 – Low-intensity Resistance Training With Blood Flow Restriction Increases Muscle Function And Mass In Rheumatoid Arthritis

(7) Hughes et al. 2018 – Blood Flow Restriction Training in Rehabilitation Following Anterior Cruciate Ligament Reconstructive Surgery A Review

(8) Ohta et al. 2003 – Low-load resistance muscular training with moderate restriction of blood flow after anterior cruciate ligament reconstruction

(9) Giles et al. 2017 – Quadriceps strengthening with and without blood flow restriction in the treatment of PFP

(10) Korakakis et al. 2018 – Blood Flow Restriction induces hypoalgesia in recreationally active adult male anterior knee pain patients allowing therapeutic exercise loading

(11) Franz et al. 2018 – Blood flow restriction training as a prehabilitation concept in total knee arthroplasty: A narrative review about current preoperative interventions and the potential impact of BFR

(12) Gaunder et al. 2017 – Occlusion training- pilot study for postoperative lower extremity rehabilitation following primary total knee arthroplasty

(13) Blood Flow Restriction Training in Patients With Weight Bearing Restrictions After Knee Surgery. (Not finished)

(14) The Effect of Blood Flow Restriction Training on Muscle Atrophy Following Knee Surgery. (Not finished)

(15) Scott et al. 2015 – Exercise with blood flow restriction: an updated evidence-based approach for enhanced muscular development

(16) Dankel et al. 2016 – The Effects of Blood Flow Restriction on Upper-Body Musculature Located Distal and Proximal to Applied Pressure

(17) Yasuda et al. 2010 – Effects of low-intensity bench press training with restricted arm muscle blood flow on chest muscle hypertrophy- A pilot study

(18) Loenneke et al. 2013 – Rehabilitation of an osteochondral fracture using blood flow restricted exercise – a case review

(19) Cancio et al. 2018 – Blood Flow Restriction Therapy after Non-Operative Management of Distal Radius Fracture- A Randomized controlled pilot study

(20) Mohmara et al. 2014 – 5 Effects Of Low-intensity Concentric Combined With Blood Flow Restriction On Achilles Tendon

(21) Yow et al. 2018 – Blood Flow Restriction Training After Achilles Tendon Rupture

(22) Amano et al. – Effectiveness of blood flow restricted exercise compared with standard exercise in patients with recurrent low back pain: study protocol for a randomized controlled trial (not finished)

(23) Stavres et al. 2018 – The Feasibility of Blood Flow Restriction Exercise in Patients With Incomplete Spinal Cord Injury

(24) Bittar et al. 2018 – Effects of blood flow restriction exercises on bone metabolism: a systematic review

(25) Clarkson et al. 2017 – Blood flow restriction walking and physical function in older adults- A randomized control trial

(26) Takarada et al. 2002 – Effects of resistance exercise combined with vascular occlusion on muscle function in athletes

(27) Behringer et al. 2016 – Low-Intensity Sprint Training With Blood Flow Restriction Improves 100-m Dash

(28) Abe et al. 2015 – Eight days KAATSU-resistance training improved sprint but not jump performance in collegiate male track and field athletes

(29) Bennett et al. 2019 – effects of blood flow restriction training on aerobic capacity and performance: A systematic review

(30) Kim et al. 2016 – Comparative Effects of Vigorous-Intensity and Low-Intensity Blood Flow Restricted Cycle Training and Detraining on Muscle Mass, Strength, and Aerobic Capacity

(31) Daeyeol et al. 2016 – Comparative Effects of Vigorous-Intensity and Low-Intensity Blood Flow Restricted Cycle Training and Detraining on Muscle Mass, Strength, and Aerobic Capacity

(32) Tanaka et al. 2017 – The impact of aerobic exercise training with vascular-ESC_Heart_Failure

(33) Centner et al 2019 – Low-Load blood flow restriction training induces similar morphological and mechanical Achilles tendon adaptations compared to high-load resistance training

(34) Amani et al. (2019) BFR During Futsal Training Increases Muscle Activation and Strength

(35) Bowman et al. (2019) Proximal, Distal, and Contralateral Effects of Blood Flow Restriction Training on the Lower Extremities: A Randomized Controlled Trial

(36) Velic & Hornswill (2014) KAATSU Training and Handgrip Strength

(37) Paton at al. (2017) The effects of muscle blood flow restriction during running training on measures of aerobic capacity and run time to exhaustion

(38) Hughes & Patterson (2019) Low intensity blood flow restriction exercise: Rationale for a hypoalgesia effect

(39) Nascimento et al. (2019) Effects of blood flow restriction exercise on hemostasis: a systematic review of randomized and non-randomized trials

(40) Rush University Medical Center 2020 – in progress – Blood Flow Restriction Following Hip Arthroscopy

(41) Clarkson et al. 2019 – Chronic Blood Flow Restriction Exercise Improves Objective Physical Function- A Systematic Review


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