In my 6 years as a Physical Therapist one of the biggest problems I have faced is how to strengthen someone that cannot handle heavy loads placed on their muscles. Additionally, how do I achieve this in the most efficient manner? With the way insurance is evolving, physical therapists need to achieve greater results in a shorter period of time. This expectation, however, was at one time unrealistic.

According to the American College of Sports Medicine, to achieve muscular strength and size you need to perform 8-10 repetitions of an exercise at a moderate to high intensity for a period of 12-16 weeks. A moderate to high intensity is deemed to be 65%-80% of the patient’s one rep max (the maximum amount of weight a person can lift one time).

However, the majority of our patients cannot handle this type of load, in turn limiting their ability to build strength. So again we are faced with the question: How do we get achieve hypertrophy and strength without using heavy loads?

The answer involves using a tourniquet to limit local blood flow to a muscle.. This technique is referred to as Blood Flow Restriction Training (BFR). 

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BFR is a rehabilitative tool that uses a tourniquet and doppler system placed on either the upper arm or thigh to restrict blood flow. Once we do this we deny the muscle oxygen and start to produce lactate and hydrogen ions. This is what causes that “burning” feeling when we lift heavy weights. The burn is simply the body’s response to being in an acidic and anaerobic environment. During heavy lifting (65-85%), we make small microtraumas in the muscle that the body then repairs by building more muscle. With BFR, we are not creating microtraumas in the muscle, so our body does not have to spend the energy to repair the muscle; instead our bodies just focus on building the muscle.

Secondly, we do not experience soreness as we would if we were lifting heavy weights. This means we can now lift at low loads (15-30%) and essentially gain more muscle strength and size, in a faster fashion, as if we were lifting at a heavier load.


How does this work? When we produce lactate, we trigger growth hormone release. Once growth hormone is released, we then stimulate the release of IGF-1. IGF-1 then allows our own natural stem cells to bind to the muscle; this in turn increases muscle protein synthesis, or your muscles ability to grow. Again as mentioned above, if we were to have muscle break down these stem cells would have to first focus on repairing muscles then building. With BFR we skip the muscle repair and focus purely on muscle building. This effect is not only for the muscles targeted during the exercise, but effects the surrounding muscles and tissues to make the benefit of BFR even greater. BFR has also shown to be able to help in bone healing, tendon healing, and endurance training.

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In many recent studies , we are seeing the same effects as high intensity training, if not greater effects with BFR in a shorter amount of time (60% faster).

In a therapy setting, this helps us get the results for our patients faster, and in sports allows the gains to be achieved with less intensity and less damage to the muscle. This is why many pro and college teams are turning to BFR as a training guideline. In sports, athletes are trying to return to the field quicker after an injury. In doing so, some athletes re-injure themselves by lifting heavier than their body is ready for. This is where BFR can come into play, by lifting lower loads and receiving the same, if not better gains. Additionally to this, immediately following an injury, we cannot exercise at high levels so we tend to lose strength. With BFR, we can now not only maintain the strength during an injury but even build strength in the process.

Stratton Rehabilitation now has this technology and is implementing it into our patient care. Stratton Rehab is one of the first clinics in San Antonio to incorporate this into our practice. We are excited to be able to bring this technology to the city of San Antonio and will continue to strive to better ourselves for the benefit and health of our patients.  Making San Antonio #StrattonStrong one patient at a time.

san antonio stratton rehabilitation matthew jendrusch

Matthew Jendrusch, PT, CKTP