Safety of Blood Flow Restriction Training for Musculoskeletal Disorders: An Evidence-to-Practice Review


  • Breanna A. Ferguson University of South Carolina
  • Erica H. Schulman University of South Carolina
  • Matthew A. Zimmerman University of South Carolina
  • Zachary K. Winkelmann University of South Carolina



Therapeutic Devices (Modalities, etc.)


Blood flow restriction training (BFRT) is low-level resistance training while partially occluding proximal blood flow. It is well documented that this style of training leads to increased muscle size as well as strength. It is theorized that these size and strength gains are due in part to the decreased oxygen environment. This results in increased muscular stress without the need for increased external load making this style of resistance training ideal for individuals who have restrictions due to musculoskeletal disorders. The guiding systematic review examined the safety of BFRT when used as a therapeutic intervention for patients with a variety of musculoskeletal disorders. Currently, there are no definitive set of parameters for clinicians to follow to ensure safe and effective use of BFRT. The purpose of the guiding review was to evaluate the safety and possible adverse events that may occur from different BFRT parameters in the rehabilitation or musculoskeletal disorders. There are many different types of devices used when implementing BFRT, but safety parameters suggest using a device that can measure the exact pressure so that occlusion can be personalized for each patient. Using a predetermined pressure for all patients could result in full occlusion, depriving the muscle of all oxygen and creating too much muscular stress. Conversely, not enough occlusion could result in a lack of muscular stress occurring to lead to muscular adaptations, ultimately rendering the treatment pointless. Additionally, timing of the exercises, which is work-to-rest ratios, as well as the frequency of training, is an important component for safe and effective use. Finally, the movement selection, load, and volume contribute to the parameters for safe and effective use of BFRT. Adverse reactions found in the guiding systematic review ranged from discomfort or dull pain to rhabdomyolysis. Following recommended safety guidelines decreased the risk of adverse reactions.






Evidence to Practice Reviews