How I Use Blood Flow Restriction (BFR) in Physical Therapy

Blood flow restriction (BFR) has been a hot topic over the last couple of years in the physical therapy profession.

There are so many physiological benefits from using BFR with patients who are in pain or recovering from surgery or major injury. The growth hormone release, analgesic effect, etc, etc. The psychological benefits are awesome for patients too, especially for athletes. Most athletes I'm using BFR with are recovering from a surgery or major injury and they haven't been able to get that muscular fatigue feeling they're used to from the weight room or conditioning drills. BFR can give them that with low intensity exercise with the cuff on. None of them seem to absolutely love it while they're doing it, but they almost all leave with a smile knowing they were able to get some good work in.

From a PT perspective, BFR has benefits too. The machine is simple to run, you're likely only doing 3-5 exercises at most, you can use it for strength training or conditioning, it's a relatively easy treatment to carry out. But I think for some, it's a little too easy and convenient. It's really easy to fall into the trap of BFR-ing for longer than the patient needs to. I think I've discovered the optimal timing for BFR after a major lower body injury is probably from week two to around the 8-10 week mark. Obviously there are some variables there, but usually by 8-10 weeks the patient can do heavy enough lifts that are better than BFR. Over the course of that 6-8 week window for BFR I think twice per week has been the least amount you can do to see some good, measurable, benefits. Any less and you might as well be doing something else. In our clinic we have 45 minutes patient slots, so that means if the patient is stiff, painful, or having a hard time walking, there isn't much time left for BFR. For me, the patients that are doing BFR are the ones that are doing the best. Maybe that's wrong of me, but I've fallen into that trap once or twice where we were sailing along on BFR and some stiffness cropped up and I didn't catch it as early as I would have liked. Now - that's not to say we didn't overcome that problem and end up with a good outcome, but it could have been more smooth for sure. It can be a slippery slope for some patients and PTs!

So keep in mind the best situations for BFR that you've found and use them to your advantage. Do you have specific timeframes you like to use BFR? What challenges have you come across?

Brett