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Blood Flow Restriction for Post-Operative Rehab!

BFR athlete

Updates in Foot and Ankle Rehabilitation

Recover Faster with PFAI!


Are you looking to recover from your Achilles rupture repair or peroneal tendon repair? Faster?

Check out the article below written by our SPOONER Physical Therapy colleagues (Ryne Foster and Brett Fischer)

Blood flow restriction (BFR) training allows us to continue to help our patients in new and dynamic ways. 

With the use of a medical tourniquet, similar to a blood pressure cuff, pneumatic pressure is used to create a decreased blood flow situation to a limb. Through low intensity exercise training with BFR, patients see results in similar muscular adaptations that could be expected if one was performing high level intensity training. It is important to note that blood flow circulation is not being cut off completely and is administered by following percentage guidelines unique to each patient.  

BFR can be used pre-surgery for ischemic preconditioning. This helps to reduce the amount of muscle mass and strength lost immediately following surgery. 

In post-surgery, injury rehabilitation and strength training, BFR allows patients to reach significant improvements in muscle hypertrophy and increased strength. Since BFR does not require lifting heavy weights, it makes it a viable method of rehabilitation for patients at all levels. It is a great option of treatment for any type of patient looking to hit their high performing athletic goals, to recover from surgery or to improve their everyday movement. 

The many benefits of BFR include:

Should You Try Blood Flow Restriction Therapy?

Blood flow restriction (BFR) therapy, also known as blood flow restriction training, is a relatively new method of injury recovery therapy that promises dramatic results. But what exactly is it, when is it used, and is it safe? 

We asked Brett Fischer, founder of the Fischer Institute of Physical Therapy & Performance (a division of Spooner Physical Therapy) to give us the lowdown on BFR. 

What exactly is BFR therapy? 

In BFR, a physical therapist applies a specialized surgical tourniquet system to your arm or leg, and inflates the tourniquet to a specific pressure (which is personalized to you) to reduce or cut off blood flow to that extremity. 

Your PT will leave the tourniquet on for about 6 minutes (again, the exact duration is personalized). During that time, you’ll use a “super low weight” to exercise the muscles that are being deprived of blood. Because blood flow to the muscle is restricted, your brain is essentially tricked into thinking the muscle is lifting a much heavier weight or exercising much harder than it actually is. 

The result? Big gains for a muscle that otherwise can’t support heavy training. 

Those gains sound nice, but is BFR painful?

“It feels like you’re getting your blood pressure taken,” explains Fischer. “And you can expect to feel like you’re working out.” 

He says that’s one of the things that surprises patients most: That despite the low weight, they actually feel the muscle working to fatigue. Athletes who are accustomed to lifting heavier weight “always roll their eyes at the low weight. And usually at the end of that first five minutes they say it felt like they did a million repetitions. Then they say, ‘Oh, I get it now. I understand’,” Fischer says. 

Are there any risks? 

BFR has been proven safe in multiple studies, but Fischer cautions that its safety depends on who administers the therapy and whether or not they’re certified and using the right equipment. Even though BFR is popping up in fitness studios and spas, it’s important to find a certified provider who is a physical therapist. 

A certified provider will use the pneumatic tourniquet system that is classified and regulated as Class 1 by the FDA, and that is specifically intended for BFR. Fischer uses a Delfi PTS system that can only be purchased by certified providers. 

These tourniquet systems measure exactly how much pressure is required to restrict blood flow for a specific patient. Fischer says this is called “occlusion pressure,” and your occlusion pressure will be different than that of your mom, your training partner, or the patient next to you. Using an incorrect occlusion pressure could lead to blood clots, nerve or artery damage. 

How can this help me as an athlete? 

BFR is common among pro and collegiate athletes, who use it as low-load resistance training to enhance muscle growth as a supplement to high-load training. Fischer uses BFR to help all kinds of athletes, including the Arizona Cardinals (he is the staff PT for the Cards). He says it can help with recovery, flushing out that heavy feeling in the legs after a particularly punishing workout, as well as rehabbing a muscle to prevent atrophy after an injury or surgery. 

Is BFR just for athletes?

BFR is for anyone who has an injured limb or loss of muscle mass in a limb. “For us in physical therapy, we’re able to take people who have deteriorated to the point that they are bone-on-bone and do things they otherwise couldn’t do to get stronger,” says Fischer. 

Some patients shouldn’t use BFR, including those with a history of blood clots, active cancer in the affected area, impaired circulation, sickle cell anemia, and severe hypertension. This is another reason BFR should only be administered by certified PTs in a clinical setting. 

Beyond athletes, Fischer says that other good candidates include those with osteoarthritic knees or knee injuries, rotator cuff, shoulder or achilles tendon injuries, and post-op patients following knee or shoulder injuries. Usually after injury or surgery, the affected muscles can’t tolerate weight bearing or lifting, but BFR can be used early on in recovery, speeding recovery time and limit atrophy. 


Dr. McAlister and his PFAI Team focus on speedy but safe recovery.  We have found that BFR assists with a optimal outcome not only for our high-end athletes, but for our 'weekend warriors' too.


Come explore your options at Phoenix Foot and Ankle Institute - Call 602-761-7819!!

Jeffrey E. McAlister DPM

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