Blood Flow Restriction Training – What It Is and Why It Can Be So Effective During Rehabilitation
We see a lot of injuries that need rehabilitation after surgery.
We know to recover from surgery and return to sport we need to be working in the gym developing strength, control and power.
But often straight after surgery, the injured joint is painful and swollen.
And when pain and swelling is present it prevents us from doing heavy loading to try and work on these areas.
And that’s where Blood Flow Restriction Training can be so useful.
The aim is to create a metabolic environment similar to high-load strength training without the mechanical stress on healing tissues.
This is done by using a specialised cuff to partially restrict blood flow to a muscle group while performing low-load exercises.
We see a lot of Achilles Tendon Ruptures and ACL Reconstructions in clinic and we can get some great results in the early stages of rehabilitation using Blood Flow Restriction Training.
Here’s a detailed breakdown of how we use Blood Flow Restriction Training at Peak Health Physiotherapy.
The Process: How We Implement Blood Flow Restriction Training in Rehab
When we introduce Blood Flow Restriction Training into a client’s rehab plan, we follow a structured protocol to ensure safety and effectiveness.
1. Cuff Placement and Pressure Settings
- We use pneumatic Blood Flow Restriction Training cuffs with an automated system that measures Limb Occlusion Pressure (LOP) to determine how much blood flow to restrict.
- The cuffs are placed high on the limb (ie.upper thigh for the quadriceps)
- Occlusion pressure is set between:
- 50-80% of LOP for lower limbs
- 40-50% of LOP for upper limbs
- The goal is to restrict venous return while still allowing some arterial flow, creating the optimal training stimulus without excessive discomfort.
- Using pressure Cuffs we’re generally going for a pressure of 180 mmHg
2. Exercise Protocols
Blood Flow Restriction Training allows us to stimulate muscle growth and strength without needing heavy weights. The typical protocol follows low-load, high-rep sets:
Load: 20-30% of 1RM (one-rep max)
Sets & Reps: 4 sets per exercise
- 1st set: 30 reps
- 2nd set: 15 reps
- 3rd set: 15 reps
- 4th set: 15 reps
- Rest Time: 30 seconds between sets
- Cuff Deflation: After completing the exercise, we release pressure and allow full blood flow to return before moving to the next movement.This method ensures maximal muscle activation while reducing strain on healing structures.
3. Application in Achilles and ACL Rehab
Achilles Tendon Rupture
After an Achilles tendon rupture, patients often struggle to maintain calf muscle strength due to immobilisation and restricted weight-bearing.
Using Blood Flow Restriction Training, we can start early muscle activation with exercises like:
- Seated plantarflexion (heel raises with band resistance)
- Isometric holds in a pain-free range
- Seated calf press with low resistance
This prevents excessive muscle loss while protecting the healing tendon.
ACL Reconstruction
Quadriceps atrophy is a major issue post-ACL surgery due to pain and inhibition.
With Blood Flow Restriction Training, we can stimulate quadriceps activation using:
- Straight leg raises
- Seated knee extensions
- Step-ups or mini squats
These exercises build strength without excessive joint loading.
Why Blood Flow Restriction Training Works in Early Rehab
- Increases muscle activation despite low loads
- Reduces post-injury muscle loss (atrophy)
- Minimises stress on healing tissues
- Boosts growth hormone and recovery response
- Improves endurance and blood flow regulation
Is Blood Flow Restriction Training Safe?
When it comes to Blood Flow Restriction Training, safety is key.
While early research raised concerns around risks like blood clots, muscle damage, and blood pressure, current studies suggest that, when prescribed correctly, Blood Flow Restriction Training poses minimal risk.
Tourniquets, in particular, don’t increase the likelihood of clotting, and can even help break down clots.
However, to avoid risks such as nerve injury or skin damage, Blood Flow Restriction Training must be applied using wider cuffs, lower pressures, and limited to no more than 20 minutes.
To ensure safety, Blood Flow Restriction Training should be done cuffs which allow for personalised settings and prescriptions.
Is Blood Flow Restriction Training Right for You?
Blood Flow Restriction Training is a game-changer in rehab, but it needs to be done safely.
At Peak Health Physiotherapy, we tailor the settings, pressures, and exercises to each client’s needs.
If you’re recovering from an Achilles rupture, ACL reconstruction, or any injury where high-load training isn’t an option, Blood Flow Restriction Training could help you stay strong while protecting your recovery.
Want to know more? Get in touch with us today.
If you want to help with anything injury related then feel free to Book In and we can get you on the journey to becoming pain free again.
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