Blood Flow Restriction (BFR)

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Jointli Resources
24 August 2026

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BFR training or often also referred to as occlusion training is a method of strength training that utilises equipment to partially restrict the blood supply to the muscles targeted in exercise.

• The method of occluding outward blood supply creates metabolic stress, a pooling effect in the blood and triggers the release of growth factor and hormones to facilitate muscle growth.

The simplest form of BFR training involves wearing a cuff in the upper arm or upper leg set at individualised specific occlusion levels. These levels can be adapted based on the individual and targeted response aiming for. These cuffs are worn throughout the entire time during exercise or more specifically rehabilitation.

• At Jointli, your physiotherapist may prescribe BFR throughout your entire rehabilitation session or potentially only for certain components of your session, depending on the goal.

When can BFR training be used?  

While BFR is a great additional tool that can be used during rehabilitation, there are some contraindications for its use. Those who have a medical history of peripheral artery disease, hypertension, blood clotting disorders and peripheral neuropathy may not be suitable for its use  (Australian Institute of Sport, 2021). Prior to BFR application at Jointli all patients will complete a pre screening questionnaire which includes a comprehensive medical history.

BFR is a low risk form of training, to which post people carry very low risk of contraindicators however certain medical conditions may limit its use.
 

Why should I consider using BFR training? 

BFR is a great tool to use throughout early stage rehabilitation. Especially following knee orthopaedic surgeries as it allows you to train at lower intensity with the added benefits similar to working at higher strength intensities.

Early stage post surgery pain, swelling, inhabitation and post surgery protocols may limit your ability to complete rehabilitation at high intensities needed to elicit strength improvements.

• Therefore BFR can be used when working at lower strength intensities (20-40% 1RM)  to help elicit higher strength improvements making it a fantastic adjunct to rehabilitation in the early stage following surgery. (Australian Institute of Sport, 2021)

How do I know if BFR is useful for me? 

BFR is best used through consultation with your rehabilitation specialist. Their assistance in the prescription, use, settings and suitability should all be considered when utilising this training method.

• Typical use in rehabilitation can feature exercise prescription of high volume but low intensity eg working exercise sets of 15-30repetitions utilising low strength intensities (20-40%1RM).

BFR can also be used during aerobic endurance prescription to improve cardiorespiratory endurance. Typical use here is application of the BFR training cuffs on the upper thigh during a cycling session targeted and aerobic conditioning. BFR has been extensively researched to determine the benefits and best utilisation.

• BFR training has been seen to decrease quadricep atrophy post surgery (Hughes et el 2018) eliciting increases in strength working at lower intensities. BFR training has also been seen to produce favourable results in controlling pain during exercise, improving bone health and reducing disuse muscular atrophy (Hughes et el 2019).

Final say on BFR training 

BFR training is a tool that can help you get ahead during your rehabilitation. High intensity strength training is best practice when trying to improve strength following injury, but following surgery or after acute injuries its not practical or possible to train at high intensities from the beginning.

Following injury you need to respect tissue healing, reduce your load so working at lower intensity might be more suitable. Therefore why not work smarter not harder, use BFR training to get similar effects as working at higher strength intensities.

BFR could also be used along the rehabilitation journey when treating lower limb tendinopathies. Tendon injuries can be irritable with strong pain but require high intensity strength to make tendon improvements, there BFR could assist with pain reduction and strength gain.

 

References:

Australian Institute of Sport, Blood Flow Restrictions Guidelines. 2021

Hughes, L., Paton, B., Haddad, F., Rosenblatt, B., Gissane, C. and Patterson, S.D. (2018). Comparison of the acute perceptual and blood pressure response to heavy load and light load blood flow restriction resistance exercise in anterior cruciate ligament reconstruction patients and non-injured populations. Physical Therapy in Sport, 33, pp.54–61. doi:10.1016/j.ptsp.2018.07.002.

Hughes, L., Patterson, S.D., Haddad, F., Rosenblatt, B., Gissane, C., McCarthy, D., Clarke, T., Ferris, G., Dawes, J. and Paton, B. (2019). Examination of the comfort and pain experienced with blood flow restriction training during post-surgery rehabilitation of anterior cruciate ligament reconstruction patients: A UK National Health Service trial. Physical Therapy in Sport, 39, pp.90–98. doi:10.1016/j.ptsp.2019.06.014.