A New Treatment for Arthritis – Blood Flow Restriction Training

If you have arthritis, you know how debilitating it can be.


You dread those first agonizing steps and stiffness when you get out of bed each morning.


Arthritis prevents many of us from enjoying simple pleasures like taking walks, gardening, bicycling, and playing with grandkids.


What if you can eliminate the pain and stiffness of arthritis without dangerous drugs or surgery?


A recent discovery and new treatment allow just that.


It’s a relatively new therapy called Blood Flow Restriction or BFR. Another term for this technique is Personalized Blood Flow Restriction or PBFR.


BFR therapy can help reduce pain and increase range of motion by strengthening the muscles around the joint and allowing increased cellular and healing capabilities.


I’m using BFR in our clinic and seeing some great results for treating patients with arthritis, elbow, and knee injuries, as well as athletic training.


If you want to see if you’ll benefit from this treatment, this article will explain what BFR is and who can benefit from this innovative therapy suffering from arthritis.


The Problem With Arthritis That Makes It Hard to Treat…


Arthritis is inflammation and degeneration of the joints due to excessive wear and tear. As the muscles around the joint become weaker, the tendons holding the joint together become loose.


The bones move around too much, damaging the cartilage and causing arthritis.


Strengthening the muscles around the joint should help, except the joint is already irritated.


Adding heavy weights or lots of repetitions will only cause further damage.


Overcoming this complex issue is where the Blood Flow Restriction training comes into play.


It allows you to exercise your muscles harder, without compressing your joints or making your arthritis worse!


What is Blood Flow Restriction Training?


Blood Flow Restriction requires the application of a pneumatic cuff.


It’s like a blood pressure cuff, only wider and reduces blood flow to the limbs down to 20%.


It cuts off the outflow of blood short term . The band is essentially a tourniquet.


For this reason, it’s critical to have someone trained in this therapy to assist and monitor the process.


The therapist inflates the cuff to a pressure level specific to the patient’s body and physical condition.


Then the patient will exercise at a low intensity, typically using weights of 300 to 100% less of what they would use under normal conditions.


It works equally well for athletes who want to build muscle and people with arthritis or those recovering from muscle or joint trauma.


For instance, I personally can squat close to 500lbs. I don’t use any weights when using BFR because it makes my muscles fatigued and tired.


How Does Blood Flow Restriction Work?


BFR forces the blood to stay in the muscle longer, expediting the process of muscle fatigue and failure.


The process stimulates the body’s ability to repair the muscle fibers, so recovery takes less time.


Your Muscles Contract Harder


Studies demonstrate that when doing BFR with low-intensity exercise, pressures around the limb range between 50 to 230 mmHg. However, during high-intensity exercise, the muscles contract so hard that intramuscular pressures can rise to around 500 mmHg, and even over 1000 mmHg!


It’s important to understand that traditional resistance exercise already constricts blood vessels during moderate-force movements and contractions. BFR safely mimics this response at lower intensity levels.


Increased Blood Flow & Cellular Healing


As we begin a BFR workout, our arms and legs sense the temporary lack of normal oxygen levels.


The lack of oxygen to our limbs makes our muscles fatigue more quickly and allows for our anaerobic muscles’ training. We use anaerobic muscles to jump high and run faster. These muscles are our calves, quads, hamstrings, biceps, triceps, and other muscles.


The lack of oxygen in these muscles stimulates protein synthesis which is key to repairing the cells.


BFR can improve blood flow and capillary growth, leading to better muscle performance and blood flow.


Enhanced Nervous System Development


The direct fatigue that BFR causes to the muscle forces the nervous system to enlist the largest fast-twitch muscle fibers to help take over the restricted muscle’s duties.


Overall, the nervous system is not affected by BR and is a safe therapy method.


But, when using BFR, the nervous system helps your muscles contract harder which means overtime your muscles will become stronger.


Growth Hormones May Be a Factor In Faster Healing


One hypothesis of why BFR builds muscle faster is growth hormone (GH). GH is a natural hormone that stimulates growth, cell reproduction, and cell regeneration.


A recent study showed that growth hormone levels increase after a BFR session.


Another study published in the Journal of Applied Physiology revealed that the concentration of GH reached a level approximately 290 times higher than the resting level 15 minutes after the exercise.


Personalized blood flow restriction reduces both the stress placed on tendons and the risk to soft tissues.


However, this modality improves muscle strength at similar levels as that of high-intensity training.


How People With Arthritis Benefit From Blood Flow Restriction Training


BFR benefits people living with arthritis in two ways.


Benefit #1: Increased Strength


With only 20% of regular weights, there is much less strain and grinding on joint surfaces. Yet, it makes muscles work as hard and grow as if fully loaded with weight or resistance.


Benefit #2: Increased Healing Capabilities


Perfusion is a medical term referring to the delivery of blood to the capillaries in tissue and the passage of fluid through the circulatory system or lymphatic system. BFR therapy increases blood perfusion to the joints and nearby cartilage. For people with arthritis BFR helps heal cartilage and joints along with strengthening the surrounding muscles.


People Who Will Benefit from BFR


BPR training creates remarkable muscle strength and size gains using low loads and fewer repetitions.


The man responsible for introducing this technique to the U.S. was a physical therapist, Johnny Owens.


At the time, he used this technique to help wounded veterans at the Brooke Army Medical Center. These patients made dramatic strength gains.


The positive results caught the attention of medical research centers and sports therapists for professional and collegiate teams across the U.S.


BFR is ideal for helping people to reduce the recovery time from joint injuries, arthritis, or surgery, whether professional athletes, veterans, or elderly patients.


Don’t Try This at Home!


It takes proper training and FDA-approved equipment to have this modality work.


Everyone’s blood pressure is different, and you need a trained therapist at your side to monitor the pressure and length of time the cuff stays on your limb. BFR is not a do-it-yourself project.


It can create health issues if not performed correctly.


You Shouldn’t Use BFR If…


Blood Flow Restriction therapy only works on the extremities. Obviously, you can’t cut blood flow to the head or torso without causing immediate harm.


Additionally, you should avoid BFR if you have one of the following conditions:


  • Deep vein thrombosis (DVTs)
  • Hypertension (HTN)
  • Varicose veins
  • Blood clots
  • Cardiovascular disease (CVD)
  • Pregnant
  • Antiphospholipid Syndrome (Recurrent Thrombin’s)
  • Family history of VTE or on long term warfarin use
  • Thrombophilia
  • Infection within limb
  • Cancer currently
  • Vascular graft
  • Lymphedema
  • Antithrombin deficiency


Blood Flow Restriction should not be used during the early stages of an injury, the inflammation cycle, because it adds to the swelling.


At our clinic, Back In Motion Physical Therapy & Performance, we use only FDA-approved devices. If you have any questions and need answers regarding the safety of BFR for your training or therapy, contact us for a free consultation.


Some BFR Arthritis Success Stories


Recently, I interviewed Dr. Adrian Dixon for my podcast. Dr. Dixon is the Rehab Coordinator and Assistant Athletic Trainer for the Tennessee Titans football team. He is a specialist in blood flow restriction training and an expert physical therapist with over 16 years in athletic training for NFL teams. He was the first to advocate using BFR for both training and as a therapy to overcome sports-related injuries rapidly. You can find out more about Dr. Dixon by reading his biography here.


Dr. Dixon uses blood flow restriction training with his players and believes it will revolutionize the way therapists treat older patients with knee or hip replacement and arthritis.


Professional sports athletes endure injuries and joint stresses every week that would put the rest of us in the hospital. The expectation for injury rehab for professional football and other pro sports is that the player needs to get over their injuries as fast as possible. Careers and millions of dollars hang in the balance.


Dr. Dixon described one player’s experience of how BFR helped him make a complete recovery in just a few days.


“I had one case where a starting offensive lineman tripped, and another player landed on his arm, hyperextending it. It was excruciating for him, and the projections were he would be out from 2 to 6 weeks.


We didn’t start BFR exercises until Wednesday, three days after his injury, and he had a game coming up that Sunday. On Thursday, he did some strengthening with BFR. 4 sets, the first with 30 reps and three more sets doing only 15 reps with a 30-second break in between. On Friday, he did traditional weightlifting using BFR and lower weights.


That Sunday, the lineman was able to play the entire game with no residual soreness. Not only that, but he played for the entire season, never missed a game, and went on to be all-pro. The only thing different with his therapy was the BFR.”


Dr. Dixon described athletes he treated who have Chronic tendonitis. All his patients say they feel considerably better or pain-free as soon as the session ends. He considers BFR to be both a rehabilitation tool and a performance tool for elite-level athletes. It works for soft tissue injuries like groin, hamstrings, and biceps.


Another high-profile success story for BFR is with the Houston Rockets Dwight Howard. In a video documentary about BFR, Dwight explains how this process keeps him on the court when other players have retired. If it weren’t for BFR, he would have been forced to retire years ago.


Dr. Walt Lowe is the team physician for the Houston Rockets and Houston Astros. He sees knee cartilage issues as particularly threatening for NBA players. He said that NBA players run about five miles per game and put tremendous loads on their knees due to the excessive jumping and twisting on the hard basketball courts.


Dr. Lowe says that not all knee injuries require surgery. BFR allows players to use much lower loads, putting much less pressure on the joints, yet achieving similar results as a fully loaded workout.


A separate study in the Journal of Science and Medicine in Sport covered 400 participants in 19 individual studies. The report concluded that adding BFR to dynamic exercise increases muscle size and strength.


Both Dr. Lowe and Johnny Owens say that supervised clinical use of BFR is safe. It’s the best way to maintain strength with very light loads.


BFR is an Excellent Therapy for Arthritis Patients & So Much More…


Older patients with arthritis tend to have other health issues along with knee, ankle, elbow, or hip problems.


Is BFR safe for patients in this age group?


Yes, as long as there are no contraindications.


Other than the contraindications listed above, it’s a valuable modality due to the low stress put on the joints and tendons.


Personalized blood flow restriction rehabilitation can add muscle size and strength without causing damage or inflammation, associated with traditional high weight or repetitive exercises.


An Excellent Way to Recover After Surgery


One of the biggest problems with most surgery is muscle loss during recovery. For example, short periods of inactivity while recovering can result in substantial muscle loss, with some reports showing 20% to 30% volume reduction within three weeks after knee arthroscopy.


Patients recovering from musculoskeletal injuries, or postoperative patients, cannot tolerate typical high load exercises prescribed to combat muscle loss. Muscle growth is why BFR is so promising when rehabilitating older patients after knee, elbow, or hip surgery. We haven’t experienced nor seen reports of safety concerns or adverse events with older patients.


Preventing Knee and Hip Replacement with BFR Training


The primary factor in avoiding joint surgery is strengthening the muscles that support your joints. For example, the best way to prevent knee surgery is to strengthen the hamstrings in the back and the quadriceps in the front of the thigh. The quads absorb the shock each time you walk, run, or carry something heavy. The stronger your quads are, the more they protect the joint


Clinical trials of BFR on older patients have shown improved muscle gain. It helps stop muscle atrophy and improves bone density like regular exercise without excessive weight or loading.


BFR increases blood flow, which aids in healing and stimulates specific hormones for muscle mass and strength. Stronger muscles maintain better posture and keep joints in position. Stabilized joints mean a reduced chance for injury or the need for joint replacement.


For our patients, I recommend starting with a lighter load initially, with a goal to complete up to 75 reps. I want my patient to “feel the lactate burn” but not be too uncomfortable. Once you know your limitations, we can work together to add load to achieve muscle-building results gradually and safely. Typically, we will begin with cycling or walking exercises.


Regardless of your age or condition, BFR works for almost anyone.


See If You’ll Benefit From BFR…


If you have arthritis, muscle weakness, joint pains, or have recently had knee, hip, or elbow surgery, you should call us.


We can help you improve your strength and reduce your pain using BFR. This proven modality works for elite athletes, teenagers, and elderly patients.


To begin, schedule an evaluation session so I can understand the unique details of your situation. It’s a free consultation, and there is no obligation.


Once I have the test results from your evaluation session, I will create a personalized treatment plan.


If you are experiencing constant pain now, want to avoid surgery, or already had it, I urge you to call me today at 239-829-6215. To schedule a no-obligation evaluation, please click the button below or visit our Blood Flow Restriction Treatment page to see for yourself how we've helped patients just like you with BFR.



About the Author: Harminder

“Physical Therapy, Fitness, & Performance Tips From Dr. Scott & the Back in Motion Team”
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