Blood Flow Restriction Therapy (BFRT)

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What is BFRT?

BFRT is the brief and intermittent occlusion of both arterial and venous blood flow using a tourniquet(s) while exercising at low intensities. Low intensity is 20-35% of one repetition maximum (RM) for the selected exercise. The American Physical Therapy Association approved BFRT for physical therapists in 2018. Global Physiotherapy is the first clinic in East Edmonton and Sherwood Park offering this treatment.

What are the benefits of Blood Flow Restriction Therapy?

  1. Increase muscle strength – normal training takes 12-16 weeks to increase strength and muscle hypertrophy
  2. Increase muscle hypertrophy – can see a change with regular use of BFR in as little time as two weeks
  3. Improve cardiovascular function: walking, cycling
  4. Accomplish goals with lower loads than traditional strength training that requires 65 to 100% of one RM
  5. Prevent muscle atrophy during injury recovery
  6. Reduce sarcopenia – age related loss of muscle mass and function

Is Blood Flow Restriction Therapy Safe?

Studies have confirmed that BFRT is very safe. The incidence of injury during the reduced blood flow exercise is .01% in 12,000 cases. In the USA, BFRT is being used in professional and collegiate sport athletes and in rehabilitation.

Contraindications to BFRT

  • Acidosis
  • Cancer
  • Extremities with dialysis port
  • Excessive swelling in post surgical limb, often UE (i.e. lymphedema)
  • Infection within extremity
  • Increased intracranial pressure
  • Impaired circulation
  • Lymphedema (on limb)
  • Open fracture/open wound
  • Pregnancy
  • Previous revascularization of limb
  • Sickle cell anemia
  • Severe hypertension
  • Severe crush injury
  • Vascular graft
  • Venous thromboembolism
  • Women who have had a mastectomy with or without radiation and/or
  • an axillary node dissection. Avoid BFRT on the affected arm.
  • People in hemodialysis who have arterial venous fistulas. Avoid BFRT
  • exercise on the affected limb.
  • Known clotting risk

How does BFRT work?

  1. Increased growth hormone 3X more than normal activity
  2. Increases growth hormone 2X more than high intensity interval exercise

The following summary of the benefits of growth hormone is from:

GH acts on many tissues throughout the body. In children and adolescents, it stimulates the growth of bone and cartilage. In people of all ages, GH boosts protein production, promotes the utilization of fat, interferes with the action of insulin, and raises blood sugar levels. GH also raises levels of insulin-like growth factor-1 (IGF-1).

What type of tourniquet is used at Global Physiotherapy Sherwood Park?

Smart Tools Cuffs were selected because they are FDA listed. The size of the cuffs allows for lower pressures to accomplish the reduction of blood flow with less risk to the underlying tissue. The physiotherapist uses an ultrasonic doppler to determine the “limb occlusion pressure” (LOP). LOP is the pressure where your radial pulse at the wrist or the dorsalis pedis pulse or tibialis posterior pulse at the ankle disappears. The cuffs are applied to either the arms or the legs.

Examples of when BFRT can be added to your physiotherapy treatment program

  1. Cuffs alone without effort for passive maintenance of muscle
  2. Cuffs with electrical muscle stimulation
  3. Cuffs with isometric muscle effort – no motion involved
  4. Cuffs with body weight exercise or TRX to reduce body weight
  5. Cuffs with weights

Protocols in 2019 Literature review

  1. Prevention of Strength loss and Atrophy – passive BFR
  2. Aerobic – Cardiovascular improvement
  3. Enhanced muscle strength and hypertrophy – resisted exercise BFR