Blood Flow Restriction in Physical Therapy

As a physical therapist, providing patients with beneficial rehab techniques has its constant challenges, especially for patients recovering from significant injuries or surgeries. For them, their road to recovery is a long process. A growing trend looking to speed up recovery is blood flow restriction (BRF). Its low impact loads combined with producing an ideal environment for muscle strength makes it a revolutionary approach to rehab therapy.  

Let’s take a closer look at BRF training, how it works, and the benefits of this process.

What Is Blood Flow Restriction?

Blood flow restriction therapy, also known as occlusion training, is the process of mitigating blood flow to and from a working muscle while performing low resistance training. The process was first developed by Dr. Yoshiaki Sato in Japan as “kaatsu training,” or “training with added pressure.”1 Through continuing research and hands-on experience, blood flow resistance training is proving itself to be a worthwhile form of rehabilitation training in addition to its uses in weight training. 

How to Perform BFR

To perform BFR, a blood flow restriction band or cuff, such as Smart Tool’s Smart Cuffs set, is affixed onto a limb to reduce the amount of venous blood flow from a muscle while allowing blood to flow to the muscle. The pressure applied by the cuff is typically between 40%–80%; factors that determine pressure percentage include the cuff width, cuff material, and the limb’s characteristics.1 After the cuff has been applied with the appropriate pressure, patients then typically perform low load exercises, where the load weight can be as low as 20% of the one-rep max.2

Benefits of BFR Training

The addition of this pressure causes a cascade of events, including “metabolic stress and cellular swelling,” to occur, providing the right environment for “increased growth hormone, muscle hypertrophy, and muscle strength.”3 In this environment, patients recovering from injury or surgery can experience improved recovery with lower resistance training in a shorter period of time. 

In her article, “Blood-Flow Restriction Therapy Rapidly Rebuilt My Body,” Terry Cook describes her experience with BFR training following knee surgery: 

Within six weeks, the initial two-inch difference between my lower thigh circumferences had shrunk to 0.75 inch, and my quad and calf muscles were so noticeably larger that several people at the gym complimented me on my progress. 

According to one of her physical therapists Brad Grgurich, clinic director at Front Range Physical Therapy in Longmont, Colorado, “this much improvement would typically take at least three to four times longer with traditional rehab” (Cook). 

Next Steps 

As with any rehabilitation program, appropriate implementation is essential. With BFR training, inappropriate pressure application can have damaging effects without proper care. For more information about blood flow restriction therapy, how it is performed, and its benefits, Smart Tools offers BFR courses all over the United States.

In addition to training, the APTA recommends checking with your state’s practice act or with your state’s laws for confirmation about including blood flow restriction training in your practice.4

Get access to professional pricing when you create an account or contact your account manager at 1.866.528.2144 for more information. 


1 Patterson, Stephen D, et al. “Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety.” Frontiers in Physiology, Frontiers Media S.A., 15 May 2019,

2Cook, Terri. “Blood-Flow Restriction Therapy Rapidly Rebuilt My Body.” Outside Online, Outside Magazine, 22 May 2019,

3“Smart Cuffs.” Blood Flow Restriction Cuffs – Smart Cuffs | Smart Tools Plus,

4“Blood-Flow Restriction Training (BFRT).” APTA, 24 May 2019,

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