Blood Flow Restriction Training | Physical Therapy

Getting Stronger: Work Smarter, Not Harder

Published July 22, 2019
By Health Loft

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Have you ever heard the expression “no pain, no gain”? Personal trainers, coaches, and fitness enthusiasts like to use this expression, or other variations of this expression, to motivate their athletes or clients to push themselves past perceived limitations. While there is nothing wrong with this hard-nosed approach to training, there is a method of training that debunks this mentality. Blood flow restriction training is a method of exercise that facilitates improvements in strength and muscle mass, without unnecessarily high levels of pain or discomfort.

Blood Flow Restriction Training: How it Works

If you have ever had your blood pressure checked, you have likely already been exposed to an aspect of blood flow restriction training. Blood flow restriction training consists of limiting blood flow to one of your arms or legs with a pressurized cuff, similar to the one that is used to check your blood pressure. The cuff can be placed around your upper arm or your thigh. The cuff is inflated to a predetermined set-point, and exercises are performed with the arm or the leg that the cuff is on. The exercises can vary depending on which muscle groups are to be targeted.

Although blood flow restriction training may sound scary, after all blood flow is generally a good thing, it’s very safe and has been shown to have a positive effect on muscle growth. It’s important to note that blood flow restriction does not mean blood flow occlusion, or no blood flow. This type of training involves temporarily reducing the blood flow to specific working muscles.

Is Blood Flow Restriction Training better than regular exercise?

In order to build strength muscles must undergo some degree of stress. Stress can come in the form of an external load, such as lifting a heavy weight, or it can come from of a repetitive activity, such as running. If the load is heavy enough or if the repetitions are high enough muscle growth will occur overtime. Typically, strength training is focused on lifting heavy loads, requiring near maximal effort. However, there are other ways to stress your muscles. Blood flow restriction training facilitates improvements in strength, without the need for uncomfortably high loads, here’s why:

  • Less oxygen: Restricting blood flow limits the amount of oxygen that reaches the muscle. The lack of oxygen induces stress to the working muscles, and as we know when muscles are stressed appropriately muscle growth occurs overtime.
  • More muscle activation: During exercise as the oxygen gets used up by working muscle fibers, surrounding muscle fibers must be recruited to help out. You can think of a muscle fiber as a single twine in a rope, with the rope being the entire muscle. The muscle becomes stronger as more fibers get recruited.
  • Muscle damage: With a limited amount of oxygen and a limited amount of muscle fibers available, fatigue occurs quickly and muscle damage occurs. Muscle damage is a good thing, it is the end result of stress. Muscle damage is essential to eventual muscle growth, as it kick starts the rebuilding processes. With an appropriate amount of time to recover, the muscle will undergo a rebuilding phase until it is stronger than before.

Benefits of Blood Flow Restriction Training:

Blood flow restriction allows for muscle growth to occur by exercising with light weights and lower loads. Lower loads are generally more comfortable to work with than heavier weights, and the low loads allow for a faster recovery phase after exercising. Blood flow restriction training is especially beneficial if you are injured and trying to recover. Often times an injury leads to avoidance of a painful activity in an attempt to allow healing to occur. While it is important to avoid aggravating activities while you are injured, it is not necessary to stop all activity. Blood flow restriction training allows you to perform activities and exercises at low loads without the risk of aggravating your injury. In this way you can still build strength and stay active while you are recovering.

Who is Blood Flow Restriction Training appropriate for?

Anyone can benefit from blood flow restriction training, whether you’re a seasoned athlete or just looking to get started with an exercise program. This method of exercise is also highly effective as part of a rehabilitation program, following injury. A trained physical therapist can help get you on the right path towards you optimal performance with blood flow restriction training.



  1. Lixandrão M, Ugrinowitsch C, Berton R, Vechin F, Conceição M, Damas F, Libardi C, Roschel H. Magnitude of Muscle Strength and Mass Adaptations Between High-Load Resistance Training Versus Low-Load Resistance Training Associated with Blood-Flow Restriction: A Systematic Review and Meta-Analysis. Sports Med. 2018 Feb;48(2):361-378.
  2. Pearson S, Hussain S. A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy. Sports Med. 2015 Feb;45(2):187-200.
  3. Patterson S, Hughes L, Warmington S, Burr J, Scott B, Owens J, Abe T, Nielsen J, Libardi C, Laurentino G, Neto G, Brandner C, Martin-Hernandez J, Loenneke J. Blood Flow Restriction Exercise Position Stand: Considerations of Methodology, Application, and Safety. Front Physiol. 2019 May 15;10:533.

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