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June 7, 2015

Blood Flow Restriction Training


So you’ve seen people lifting weights with bands wrapped around their upper arms and sometimes their upper legs. What is it, what does it do, how does it do this, and how can I use it?

Blood flow restriction (BFR) is a method of training that uses occlusive bands as a tool to mimic the body’s natural response of restricting venous blood flow from muscle groups while undergoing strenuous activity and heavy lifting. While doing BFR there are many changes that take place within the muscle tissue that lead to increased muscle mass and strength. There are three notable mechanisms behind why blood flow restriction training works. These include cellular swelling, growth hormone release, and slow twitch muscle pre-exhaustion.

While covering these mechanisms I will keep things fairly simple and try to put them in easy to understand terms. If you feel like reading more in depth into the pathways, you can read through the cited articles. If you are not interested in the mechanisms and just want to get straight down to using BFR, skip down to the summary at the bottom.

When utilizing BFR we are restricting venous blood flow however arterial blood is still being pumped into the extremity. This will lead to an accumulation of blood throughout the sets and cause what is known in the gym world as a massive pump. This accumulation of blood will cause cellular swelling. Cellular swelling will trigger basic cellular survival adaptation mechanisms via the mTOR pathway and trigger transcriptional factor up regulation and protein synthesis. This in essence leads to a bigger and stronger muscle cell that will better handle stress the next time it encounters it.

The release of growth factors caused by BFR training occurs mainly due to the accumulation of lactate, which is a byproduct of metabolism. Many studies show that BFR used with low intensity resistance training (20% of a one rep max) has caused a release of growth hormone similar to or higher than that of high-intensity heavy resistance training. Another growth factor released due to lactate accumulation and hypoxia is vascular endothelial growth factor (VEGF). VEGF is essential for hypertrophy, vasculogenesis, and angiogenesis.

The final mechanism is slow twitch muscle fiber pre-exhaustion. By restricting blood flow and creating a hypoxic environment the slow twitch type-I muscle fibers exhaust very quickly and recruit the fast twitch type-II fibers. Type-II fibers are known to grow much larger than type-I muscle fibers, which will help add size and explosive power to the group being worked.

To quickly summarize everything stated above, research suggests that BFR used with low intensity resistance training produces a very similar response to high intensity resistance training. This is great for those who constantly stress their joints by performing a lot of heavy compound movements, anyone recovering from injuries, and anyone that wants to add muscle size and strength, while minimizing the recovery period.

Now for the good stuff and what you have been waiting for.

Who can use BFR?

BFR is a great tool for anyone trying to add muscle mass and gain strength. It has been studied in my different populations including:

  • Powerlifters
  • Bodybuilders
  • Athletes recovering from injury
  • Elderly

Where to buy

HERE are some on Amazon

How to wrap

BFR is typically used for biceps, triceps, and calves, so this is what we will stick to in this article. However, BFR can be used for quads, hamstrings, and forearms as well. No matter what you are training, you will be wrapping the proximal area of the limb (the area closest to the torso). If you are training calves, you will still wrap at the top of your thigh. If you are working forearms, you will still wrap are the top of the arm.

The goal is to restrict venous blood flow as much as possible while restricting arterial blood flow as little as possible. To do this there is no standard cuff pressure or wrap tension that is appropriate for everyone. Use the following as a guide to help obtain the appropriate pressure for your own application. When using a wider band, such as a knee wrap, it is not necessary to wrap as tightly since the occlusion area is larger. With a thinner band, such as a 1” quick release tourniquet, it is necessary to wrap more tightly since the occlusion area is smaller.

We will use a scale of 1 – 10 to determine tightness, with 10 being as tight as you can possibly wrap.

Arms with a 1” elastic band 9/10

Arms with knee wrap 5/10

Thighs with knee wrap 7/10

If your limb is in pain before the set begins or becomes numb, you are probably wrapping too tight. If you cannot finish all the reps in each set, either you are wrapping too tight or you are using too much weight. Keep in mind that at the conclusion of the sets you will have a massive pump and it takes a lot of mental strength to get through the sets. There will definitely be pain, however it should not be excruciating pain due to wrapping too tight. This is one time that more is better does NOT apply. Wrapping too tightly can be detrimental to your health and your limb!

How to put it to practice

BFR sets can be done at the end of heavy training days such as workouts that consists of mainly deadlifts, squats, or bench press. It is a way to fit a lot of volume into a short period of time, while promoting mass and strength gains in areas not targeted by the compound movements.

You will do 2 BFR sets for each muscle group you choose to work and each set will last approximately 3½ minutes. One set will include 4 mini sets and the weight you are using will be 20% of your one rep max. This example will be for biceps.

  • Wrap each arm
  • Perform 30 reps and rest for 30 seconds
  • Perform 15 reps and rest for 30 seconds
  • Perform 15 reps and rest for 30 seconds
  • Perform 15 reps and rest for 30 seconds
  • Unwrap the arms and rest for 1 – 2 minutes
  • Repeat the sequence one more time

Next, after a 1 -2 minute break, you can wrap the arms again and continue with triceps or go immediately into BFR calf training. You do not need to do all three on the same day and each muscle group can be worked every 2 – 3 days using BFR.

If done properly with healthy individuals, as studies have shown, there are very few possibilities for safety issues.

Example for Biceps



Example for Quads


bfr1 bfr4


Article written by Zachary D.


Cook SB, Clark BC, Ploutz-Snyder LL. Effects of exercise load and blood-flow restriction on skeletal muscle function. Med Sci Sports Exerc. 2007;39:1708–1713.

Godfrey RJ, Whyte GP, Buckley J, Quinlivan R. The role of lactate in the exercise-induced human growth hormone response: evidence from McArdle disease. Br J Sports Med. 2009;43:521–525.

Loenneke JP, Wilson JM, Wilson GJ, Pujol TJ, Bemben MG. Potential safety issues with blood flow restriction training. Scand J Med Sci Sports. 2011;21:510–518

Park, Song-Young et al. “Low Intensity Resistance Exercise Training with Blood Flow Restriction: Insight into Cardiovascular Function, and Skeletal Muscle Hypertrophy in Humans.” The Korean Journal of Physiology & Pharmacology 19.3. 2015: 191–196.

Scott, BR., Loenneke JP. “Exercise with blood flow restriction: an updated evidence-based approach for enhanced muscular development.” Sports medicine. 45.3. 2015. 313-325.

Wilson JM, Lowery RP, Joy JM, Loenneke JP, Walters JA, Amsden CE. Practical blood flow restriction training increases acute determinants of hypertrophy without increasing indices of muscle damage. J Strength Cond Res, 2013. 27(11): 3068–3075.

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    • Good question Travis. Yes, if you’re doing a unilateral (one arm) exercise like bicep preacher curls or one arm tricep press backs, then yes you can restrict one at a time. That way you’re not in pain extra long on the resting arm.

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