Blood Flow Restriction Training (BFR)

What It Is and Who It's For

Blood Flow Restriction Training (BFR) What It Is and Who It’s For Every so often I come across an area in the field of strength and conditioning or rehabilitation that reignites my passion for learning. Earlier this month, I found that topic and I’m excited to explain this new (to me) rehab and performance boosting approach called Blood Flow Restriction Training (BFR).

A few key words here to make your reading easier:

1)Motor Unit Recruitment – basically this refers to the percentage of muscle fibers working during exercise. Typically, you’ll get an increase in percentage of muscle fibers firing as weight is increased. Strength therefore can be gained not by not only building bigger muscle, but by finding ways to get the brain to fire more motor units.

2)Free Flowing exercise – this simply refers to the blood. Instead being restricted like in BFR, it’s flowing freely with no outside pressure obstructing it.

There a few major uses of BFR in the work of health and performance, and there are over 800 studies performed over this topic in the past decade alone to back up these claims.

- Increase muscle hypertrophy (Competitive Body Builders have been using this technique longer than anyone)

- Increase Muscle Strength (Due to the ability to increase motor unit recruitment)

- Increase V02 Max (great for cyclists or people who need to maintain gains during injury) (Abe, et al., 2006)

- Decrease Post-Surgical Healing Time of torn tissues and broken bones (medical grade tourniquets are often used pre and post-surgery to decrease ill effects of muscle loss post-surgery.


When performing exercises with BFR, the cuffs are put on with a specific amount of pressure that will prevent venous return of the blood, but not enough pressure to occlude arterial blood flow to the limb. To accurately measure this point, it’s necessary to use doppler to osculate the artery.

In free flowing exercise, the muscle creates “waste” metabolites that trigger certain cellular responses, but this BFR the muscles stews in these waste metabolites longer to produce a more exaggerated response.

Growth Hormone is king when it comes to building muscle and repairing damage. When more growth hormone is present, you’ll see more rapid recovery and more strength gains. GH levels have been shown to jump nearly 300% from baseline during BFR training which is nearly TWICE the amount with more intense free flowing exercise. (takarada 2000)

When speaking specifically about muscle protein synthesis, most research looks at two key players: mTOR (builds muscle) and Myostatin (breaks muscle down). The Yin and Yang of these two metabolic players will keep muscle growth from getting out of control.

Side note: If you’re thinking “I want all of the muscle! Why would I want any myostatin”, I suggest googling; Myostatin Cow.

In BFR, research has shown an UP-regulation in mTOR and DOWN-regulation in myostatin following workouts. This equates to more protein synthesis! Aka, muscle growth.

(Loenneke, et al. 2010)

In the context of rehab and recovery there are a few major benefits to adding BFR into your routine.


Due to the increased amounts of growth hormone produced with BFR and less need to load tissues up with weight or volume to achieve this increase, we can improve healing times of things like tennis elbow, planar fasciitis, muscle strains and even broken bones/stress fractures.

Even in post-surgical cases when the patient is not weight bearing, BFR has been shown to decrease muscle wasting which gives that patient a head start in rehab when they are ready.


When you experience tissue damage from an injury, whether it’s acute trauma or repetitive use trauma, the body learns ways to move around these injured tissues by using them less. It makes sense why the brain would do this. If I can decrease the amount of force going through an injured tissue, it will have more of an opportunity to heal. However, this decreased muscle activity often becomes part of a longer lasting compensation that begins to put other areas at risk of pain or injury.

When this occurs, people strengthen this compensation with exercise or daily activities and push themselves closer to injury. However, with BFR training, we can promote more strength gains in a targeted muscle with less risk because we don’t have to lift as much weight OR as much volume to get that “lazy” muscle to increase it’s motor unit recruitment. Once the muscle has learned to fire better, we can use traditional rehab to integrate this strength into more complex functional patterns.


If you push yourself to your max for sport or for personal gains, you must rest. Without this rest, you’ll run into inevitable injury. The main complaint you’ll get from these Type A hard driving athletes is that they don’t want to lose the gains they’ve made from the daily grind.

With BFR you’re often working with 20% of your one rep max and performing a traditional 30/15/15/15/15 rep sequence (5 rounds spit up with about a minute of rest). Using this protocol, it’s been shown in the literature to have similar strength gain effects as performing high intensity training methods using 70% of your one rep max.

So whether you’re traveling and don’t have heavy weights, you’re an athlete in season who doesn’t want to risk over training, or you’re just needing to rest the joints from all the intense exercise/lifting, BFR and bridge that gap without risking losing performance.


For more information on treatment or online programming for sustainable exercise and pain relief, visit or call the office 931-321-1414 to schedule your complimentary consultation with Dr. Dunaway.

Request more information

Request Information Now!