Blood Flow Restriction Training Safety

Background:
Blood flow restriction training (BFRT) is defined as the partial restriction of arterial blood flow into the muscle while venous outflow is occluded during a bout of exercise.

BFRT is used for physical training and performance in healthy individuals, as well as an adjunct to physical rehabilitation in injured individuals.

Current understanding of the physiological mechanisms of BFRT and related performance includes:
Acute muscle cell swelling.
Increased fiber-type recruitment
Decreased myostatin.
Decreased atrogenes.
Satellite cell proliferation.

With the increasing use of BFRT in clinical populations, Minniti et al. (2020) systematically reviewed the research to assess the potential adverse events associated with BFRT when used clinically in the treatment of patients with musculoskeletal disorders.

RESULTS:

• 19 studies with 322 pooled participants
• 9 studies reported no adverse events
• 3 reported rare adverse events, including an upper extremity deep vein thrombosis and rhabdomyolysis
• 3 case studies reported common adverse events, including acute muscle pain and acute muscle fatigue

Individuals exposed to BFRT were not more likely to have an adverse event than individuals exposed to exercise alone.

Adverse Events Overall:

• Overall (14 of 322)
• Rare Overall (3 of 322)
• Rare BFRT (3 of 168)
• Rare Control Group (0 of 154)
• Any adverse BFRT (10 of 168)
• Any adverse control (4 of 154)

CONCLUSIONS:
BFRT appears to be a safe intervention and even more so when used according to evidence-based guidelines and in patients with knee-related musculoskeletal disorders.

Further research is needed to make definitive conclusions about the absolute safety in all patient populations.
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SOURCE:
Minniti et al. 2020. AmJ Sprt Med 2020;48(7):1773–1785 DOI: 10.1177/0363546519882652

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 

Want to learn more or contact him?

Reach out online:

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@Grapplersperformance

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1) Pain is the Common Denominator

The common denominator amongst anyone who seeks physical therapy or rehabilitative care is that they are in pain and they want to reduce that pain. The region, joint, tissue, or movement pattern that is causing pain is likely different, but the fact that the pain impacts their daily life is universal. 

2) How Blood Flow Restriction (BFR) Training Can Help

The use of blood flow restriction (BFR) training as an effective tool shows promise as a pain reduction tool, all while gaining systemic benefits that lead to muscle hypertrophy at a lower load on tissues and joints. 

The current research falls into two categories - use during exercise for immediate pain reduction or use during exercise for longer-term pain reduction. A multitude of diagnoses have been investigated including post-op ACL rehab and meniscal injuries. This is still a developing area of research so the volume of available literature is limited. But let's take a peek at what is out there and how to apply it.

3) Use BFR to Reduce Pain During Exercise

Many individuals have pain during a particular movement pattern or motion, and not solely at rest. In this case, studies have shown that using BFR during exercise does not worsen the pain. I regularly use BFR not just for the systemic hypertrophic effects but as a pain modulation tool during movements. I have found that it a nice way to introduce a threat-free movement pattern and making strength gains too.

In 2015, Segal et al. released two papers. The first paper indicated that males with knee osteoarthritis who utilized BFR with low load training did not have worsening of knee pain during exercise. Similarly, the second paper showed that the greater increases in muscle strength with use of BFR did not exacerbate knee pain symptoms in females. 

Most recently, a study performed by Giles et al in May 2017 found that quadriceps strengthening with low load BFR was more effective at pain reduction with daily function at 8 weeks in patients with patellofemoral pain.

4) Use BFR to Reduce Pain After Exercise

In some instances, particularly with post-operative patients where it is painful to range a joint, or where compound movements are painful but isolated motions are tolerable, I have found it beneficial to use BFR. In fact, some studies have shown that there is a reduction in pain for up to 24 hours post-BFR use. Following the use of BFR, muscles are more fatigued and less likely to guard during motion. This is now the prime opportunity to perform PROM or manual therapy techniques.

Using BFR does not always require exercise to be effective. Hollander et al. demonstrated that ratings of perceived exertion (RPE) and pain were lower in the group of subjects who utilized partial occlusion training (another way to say BFR) without exercise as compared to those utilizing BFR with low load exercise or moderate exercise without occlusion. This result is particularly enticing as using BFR without motion in early post-operative stage could help reduce pain to allow for earlier transition to movement, particularly when MD protocols limit weight-bearing status or ROM.

5) How I Utilize BFR: A Case Study

I recently had a patient with rotator cuff tendinitis. He had classic symptoms; pain with overhead motion and guarding with both passive and active ROM. Early on, I utilized the Occlusion Cuff to perform some simple isometric exercises prior to soft tissue and ROM work. By doing this, it reduces the guarding and provided some systemic effects that led to better pain tolerance during manual therapy. Later on in his program, we utilized it as a adjunct to my exercise prescription for hypertrophy.

Bottom Line

There are a multitude of ways to modulate pain, whether it is exercise, manual therapy, or pain science education. Choose the one that works best for your patient. But having one more tool like BFR in our clinical toolbox to reduce pain is a win-win for everyone. And make sure to think about where you are placing BFR in your session to get the best pain modulation effects.

Kyle Coffey

Lead Instructor, The Eclectic Approach: Modern Strength Training

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Keeping it Eclectic...