Blood Flow Restriction Training In Physical Therapy

With Drew Morcos of MOTUS Specialists

All the buzz right now in the world of Physical Therapy seems to be about Blood Flow Restriction Training. I’m not usually one to be all about the buzz, believe me. When a new technique, product, or idea enters the stage, I’m typically very skeptical. With so much hype out of the gate, few of these ideas survive the test of time and slowly become a thing of the past. This is usually due to scholarly research refuting evidence of the benefits compared to the consequences. When Blood Flow Restriction training came onto the scene a few years ago, initially I was suspicious. Why would you want less blood flow to muscles to strengthen them? However, the more traction Blood Flow Restriction Training has gained and the more research that’s been conducted, the more I’ve come to understand the benefits.

Here’s what I’ve learned…

What Is Blood Flow Restriction Training?

Blood Flow Restriction (BFR) Training has been around since the 1970’s, but didn’t catch on in the sports world until around 2015. BFR Training involves placing a pneumatic restriction cuff (similar to a blood pressure cuff) proximal to the target muscle. The muscle is then trained at a low intensity (20-30% of your maximum capacity or 1 Rep Max).

The result…

This type of training shows increased muscle hypertrophy (size), increased strength, and increased endurance1. It is also a game-changer for rehabilitative purposes, as it has been shown to attenuate muscle atrophy2.

So, what is actually happening during Blood Flow Restriction training that allows all of these desired effects? Without getting too technical, here is one explanation. In order to maintain force output and protect the exercising muscle from nerve conduction failure during BFR training, reduced oxygen and the buildup of metabolites in the muscle stimulates fast-twitch muscle fiber recruitment3. Fast twitch muscle fibers are the type that produce strength and power.

The reason these recent findings are such a big deal is that traditionally, increases in muscle size and strength were thought to only be achievable by lifting weights of at least 70% 1 Rep Max4.

You may be thinking, as I was, that this sounds kind of dangerous, right? Applying a tourniquet to an exercising limb to restrict blood flow…it just doesn’t sound safe.

However, research shows that BFR poses no greater risk to the cardiovascular system, muscles, oxidation, and nerve conduction velocity when compared to regular high intensity resistance exercise5.

This all sounds great on paper, but what does BFR look like in action?

I’d like to introduce you to someone…

Drew Morcos of Motus Specialists on Blood Flow Restriction Training

Drew Morcos, PT, DPT, SCS, OCS, DNSP, ATC, CSCS, FAAOMPT is the founder of MOTUS, a functional movement approach to clinical rehabilitation for amateur and professional athletes such as Russell Wilson, Carmelo Anthony, Antonio Brown, and Geno Smith.

I asked him some questions about BFR training and how he implements it in his practice, including most notably in recent news with Russell Wilson and Carmelo Anthony. The New York Post recently reported that “Jets quarterback Geno Smith…is spending this offseason in the apartment below Morcos’ training room while he recovers from ACL surgery.”

Here is our conversation…

Who is Blood Flow Restriction Training For?

“BFR is for anyone who is looking to increase muscle strength rapidly without strain on a particular joint. Such as someone with arthritic knees, post-operative cases, and atrophied muscles.”

What is a typical dosage for BFR training?

“BFR has a specific protocol they recommend based on their research and clinical outcomes. When applying the BFR system to the lower extremity, the occlusion percentage is set at 80%, and 50% for the upper extremity. The recommended dosage for a specific muscle being trained is:

  • Set 1: 30 reps
  • Set 2: 15 reps
  • Set 3: 15 reps
  • Set 4: 15 reps
  • 30 seconds rest between each set. That’s it!”

When implementing BFR training, do you use it in isolation or in combination with other strengthening techniques?

“To start, I use it in isolation and then progress with other techniques as it becomes easier for the client.”

What body regions do you typically perform BFR training on?

“Lower and Upper Extremity – It’s all dependent on which muscle you want to target.”

What is the most effective body region you’ve had results with?

“Quadriceps and Hamstrings.”

Any notable patient/client results you can share?

“Great for quad strengthening post-op ACL (first 2 weeks) when typically the patient cannot do much due to pain and limitations in Activities of Daily Living.”

Anything else you feel like people should know about BFR training?

“Great tool to have in the toolbox, when trying to strengthen a muscle quickly with hypertrophic gains.”

The Future of Rehabilitation

I’m continuing to research BFR training and seeing that more and more Physical Therapists and sports teams are using it successfully.

It’s good to be skeptical, especially when a new theory involves concerns about health and safety. This is why research is so important. The beauty of peer-reviewed research is that it sheds light on those concerns and proves a theory one way or the other. When this process is repeated over and over, for several years, we can hang our hats on the efficacy of the system being tested.

That being said, not just anyone should perform Blood Flow Restriction training. There is a BFR certification that teaches how to treat in a safe and effective way. Full disclosure: I am not currently certified and, therefore don’t practice this technique, although I would like to try it – my aim in writing this post is to inform you about the research and its potential benefits.

My hope for the future of Physical Therapy is for us to embrace and implement the best evidence-based practices that provide safe and effective treatment for our patients/clients.”

Question: What are your thoughts on Blood Flow Restriction Training? You can leave a comment by clicking here.

  1. Loenneke, J.P. et al. The anabolic benefits of venous blood flow restriction training may be induced by muscle cell swelling. Medical Hypotheses 78 (2012) 151-154 ↩︎
  2. Kubota A, Sakuraba K, Sawaki K, Sumide, T, Tamura Y. Prevention of disuse muscular weakness by restriction blood flow. Med Sci Sports Exerc 2008; 40:529-34 ↩︎
  3. Yasuda T, et al. Venous blood gas and metabolite response to low-intensity muscle contractions with external limb compression. Metabolism 2010;59:1510-9 ↩︎
  4. ACSM. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc 2009; 41:687-708 ↩︎
  5. Loenneke JP, et. Al. Potential safety issues with blood flow restriction training. Scan J Med Sci Sports 2011; 21:510-8 ↩︎
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Please note: I reserve the right to delete comments that are offensive or off-topic.

  • Michael Curtis

    BFR allows you to work muscles to fatigue with less weight and less strain on the joints. Therefore, yes it would be beneficial.

  • randal glaser

    Thanks Dr. Curtis,
    Are you taking any Con Ed for this in the future?
    Great write up!

    • I’m interested, does Jetset Rehab Education have any upcoming courses?

    • Michael Curtis

      Thanks Randal! I’m interested…does Jetset Rehab Education offer any upcoming courses?