Blood Flow Restriction


Blood Flow Restriction is a cutting edge training modality that can provide strength & hypertrophy gains, increased Growth Hormone release and improved VO2 max at low loads and sub maximal intensities.

PERSONALIZED BFR provides the safest, most regulated BFR experience by finding your personal limb occlusion pressure.  There is no guess work, just the results you are looking for provided by a trained clinician.

Check out the following content for how PBFR can help YOU.

This a recent interview at CSM 2018 featuring Johnny Owens, MPT of ORS and Stephania Bell, PT from ESPN. They discuss the history and future of PBFR in sports rehab and training.

BFR Training is performed by placing a medical grade tourniquet around the upper arm or upper thigh in order to restrict blood flow to and from the limb. By restricting blood flow into the limb, less oxygen is available to fuel muscle contractions. This hypoxic environment forces the recruitment of type 2 muscle fibers. The byproduct of type 2 muscle contractions is lactate.

Completely restricting venous return flow leads to cell swelling and the accumulation of lactate as it gets trapped behind the tourniquet. The metabolic stress associated with high amounts of lactate leads to the up-regulation of growth hormone in an attempt to heal the stressed tissues via collagen synthesis.

The metabolic stress also leads to the up-regulation of IGF-1, which helps satellite cells fuse with muscle fibers and initiates protein synthesis. Myostatin, which is a gene that prevents muscle growth, is down-regulated.

This is how BFR training causes protein synthesis➡️hypertrophy, and collagen synthesis➡️tissue recovery to occur at at low loads.

Currently the protocol for BFR induced hypertrophy is to use 20% of your 1RM for 1 set of 30 reps followed by 3 sets of 15 reps. There is a 30 second rest period between each set with the cuff inflated.

Working at 20% of your 1RM will not lead to the muscle breakdown that normally occurs with loads in the 65-85% range.

This means that with BFR training you can work towards muscle hypertrophy without muscle breakdown and gain the benefits of endogenous growth hormone release.

As a Certified Clinical provider I only recommend using medical grade FDA approved personalized tourniquet systems to perform BFR training.


BFR Benifits for Endurance Athletes
Post in collaboration with @liftersclinic Mario Novo, DPT

One of the most intriguing benefits of BFR is it’s effect on VO2 max. Traditional VO2 max gains are made at a minimum of 50% and training times greater than 35 minutes. Studies have shown that endurance training with BFR can produce VO2 max gains at a lower intensity over shorter bout durations, AND produce muscle hypertrophy.

While under BFR there is less return flow to the heart which will cause a decreased stroke volume, in order to maintain the same cardiac output, heart rate needs to increase. So in reality the training intensity may be at 40% but the body perceives it is training at 60%. Additionally the increase in muscle hypertrophy also plays a role in peak oxygen uptake. As muscle volume increases there are more mitochondria available to produce peripheral aerobic capacity.

Abe et al. Studied cycling at 40% VO2 max for 15 min 3x/week over 8 weeks and found increases in VO2 max, thigh muscle cross-sectional area and muscle volume.

A study by Park et al. showed that highly trained Basketball Players made VO2 max gains of 11.6% by walking for 15 min 2x/day for 2 weeks.

In the pursuit of obtaining results similar to these studies in the real world how you apply BFR is important.

Personalized Blood flow restriction (PBFR) is a safe method of applying BFR that takes into account individual limb girth, blood pressure, and

These individual variables are important as the current body of evidence suggests that single prescribed pressures yield different ranges and mechanisms for an adaptive response. What is currently agreed upon is that once an individuals total occlusion pressure has been measured the highest effect when performing BFR is noted to be 80% of limb occlusion pressure for the lower extremity and 50% of limb occlusion pressure for the upper extremity.

This dynamic and individual pressure range is the key for basing any BFR claims with the greatest of reproducibility, standardization and safety.

The effects witnessed thus far are very promising for PBFR which on one end of the spectrum can allow injured athletes the opportunity to augment healing and on the other end of the spectrum allow healthy athletes an additional competitive edge.

Abe, Takashi et al. Journal of Sports Science & Medicine (2010)

Park, S. et al. Eur J Appl Physiol (2010)


One of the biggest challenges in ACL rehab is regaining adequate strength in the surgical leg. Even at 1 year post-op, many patients still demonstrate significant strength deficits compared to the non-surgical leg. Traditional early post-op ACL rehab consists of ROM, swelling control, gait training, muscle activation and proprioceptive exercises. Unfortunately the leg continues to atrophy and remain in a state of anabolic resistance caused by the trauma of the surgery and subsequent relative or literal immobilization. Early post-op treatments and exercises, while necessary, do very little to help the muscles hypertrophy. The ACSM recommends that in order for hypertrophy to occur, resistance training needs to be loaded at 70% of 1RM. While in the early stages of rehab, loads in that range are unrealistic and potentially dangerous.

Blood Flow Restriction Therapy can be introduced as early as a few days post-op and can also help stop anabolic resistance by initiating protein synthesis, which leads to muscle hypertrophy even at loads of 30% of 1RM and lower. This is possible because the tourniquet creates a hypoxic environment which forces the recruitment of type 2 muscle fibers, even though the load is more appropriate for type 1. Type 1 muscle fibers require oxygen and are important for endurance and low load exercises. While exercising under BFR the stored oxygen becomes depleted and the remaining reps are carried out by type 2 muscle fibers. Type 2 muscle fibers are responsible for speed and power and their byproduct is lactate. The cuff not only restricts the venous return flow, it also holds the lactate in the limb which initiates a systemic response that causes the pituitary gland to release Growth Hormone. Growth hormone is responsible for collagen synthesis which is how muscle, tendon, ligament, cartilage and bone heal.


Tourniquets are considered medical devices and their use needs to be monitored, there are inherent dangers to improper use of tourniquets. Currently a few types of BFR tourniquet systems and wraps are available and present on social media, but only one is FDA approved as a medical device. The Delfi Personal Tourniquet System contains a Doppler that can accurately measure the amount of blood flow restriction and can adjust for pressure changes during exercise. The Delfi System comes with 3 cuff sizes, each one is wide and tapered for comfort and safety. When deciding to incorporate BFR into your rehab, look for a certified provider on the Owens Recovery Science website.

Treatment Session

A typical treatment session will usually consist of 3-5 different exercises. Each exercise will be performed for 75 reps broken down into 4 sets. 1 set of 30 reps and 3 sets of 15 reps. There is a 30 second rest period between sets with the cuff inflated. The cuff will be deflated for at least 1 minute between exercises. You can expect to see swelling, color change and muscle fatigue after each treatment. Because loads are very low there is no muscle breakdown and little to no subsequent DOMS.

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Hamstring pulls or strains are one of the most common injuries amongst athletes. They have a reputation for lingering and reoccurring throughout the season.

When a muscle is injured, Myostatin and TGF beta act together to fill in the tear with fibrotic tissue. Unfortunately fibrotic tissue or scar tissue, is not as elastic as muscle and tends to break or rip instead of stretch.

BFR has been proven to produce muscle hypertrophy & protein synthesis at loads far below the traditional 65-85% 1RM without the coinciding muscle breakdown, which makes it a great way to load injured muscle tissue.

Low load BFR exercise takes away oxygen as a fuel source and allows aerobic movement tasks to be carried out by the anaerobic system. Anaerobic muscle activity creates lactate build-up which initiates Growth Hormone release and subsequent collagen synthesis essential for tissue healing.

BFR has been found to down regulate Myostatin, this means that if we use BFR with our muscle injuries we may have a better chance of obtaining true non-fibrotic healing of the muscle tissue.

Above is a progression of low load exercises that have been working for my athletes.


Blood Flow Restriction Training/Therapy is an excellent way to manage athletes during the season. As athletes progress in competition level, the volume of sport specific activities increase while recovery and down regulation practices decrease. Over the course of the season, athletes tend to breakdown, loosing muscle mass & strength while developing ligament sprains, muscle strains, stiffness & acute tendinopathies.

In-season periodized strength training, corrective exercises and mobility work can be helpful in maintaining off-season gains and reducing injury risk. However, traditional strength training leads to muscle breakdown prior to muscle growth, and some athletes may be dealing with acute injuries that prevent them from being able to load at an appropriate percentage.

BFR allows athletes to build muscle, prevent atrophy, and load irritated tendons at 10-20% 1RM while reaping the benefits of working at 60-80% 1RM. Because loading takes place around 20% there is no muscle breakdown and is tolerable to achy joints or irritated tendons.

The mechanism of BFR also stimulates the release of Human Growth Hormone which is responsible for collagen synthesis. Collagen synthesis is how muscles, tendons, ligaments, cartilage and bone heal. Meaning athletes will be able to recover quicker, maintain strength and optimize performance throughout the season.

Clinical Application

In the video I am working with a College Baseball Pitcher that is experiencing medial forearm wrist flexor pain and stiffness after pitching outings. The goal of the BFR treatment is to create lactate buildup and cell swelling, stress the irritated tissues at a low pain free load, build posterior cuff strength and strengthen the stride leg in a task specific environment. The 3 UE treatments are specific to the Right arm tissues while the 1 LE treatment does provide specific Left leg benefits but the goal is more of a global Growth Hormone response because of larger muscle group activation.

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