A New Treatment for Arthritis: Blood Flow Restriction Training

If you have arthritis, you know the feeling: those first stiff, painful steps out of bed, and the walks, gardening, bike rides and time with the grandkids you have started to skip. You know strengthening your legs should help, but heavy exercise makes your joints hurt more.

Blood flow restriction training for arthritis offers a way around that problem. Here is what BFR is, how it works, what the research shows, who should avoid it, and how we use it in the clinic.

The Problem That Makes Arthritis Hard to Treat

Arthritis is inflammation and wear in a joint. As the muscles around the joint get weaker, the joint loses support, takes more stress and gets more irritated. Strong muscles are one of the best ways to protect an arthritic joint.

The catch is that building strength normally takes heavy weights or lots of repetitions, and an irritated joint often can’t tolerate that. This is where blood flow restriction training comes in. It lets your muscles work hard with very light loads, so your joints aren’t compressed the way they are with heavy lifting.

What Is Blood Flow Restriction Training?

BFR uses a special cuff, like a wide blood pressure cuff, placed around the upper arm or thigh. The cuff is inflated to a pressure set for your body, which partly limits blood flow out of the limb while you exercise. Because it works like a controlled tourniquet, it must be set up and monitored by someone trained in BFR, using proper equipment. At Back In Motion, we use only FDA-approved devices.

With the cuff on, you exercise with light weights, or sometimes just your body weight, walking or cycling. Even for people who lift heavy, it doesn’t take much: I can barely use any weight with BFR because my muscles fatigue so quickly.

How Does Blood Flow Restriction Work?

• Your muscles fatigue faster: blood stays in the working muscle longer, so it tires quickly even with a light load
• Your body recruits more muscle fibers: as the smaller fibers tire, your nervous system calls on the larger, stronger fibers, which is how strength is built
• It triggers a growth response: research has found growth hormone rises after BFR exercise, which may be one reason it builds muscle with light loads (Manini et al., 2012)
• Less stress on joints and tendons: because the weights are light, the joint takes far less load

What the Research Shows

• BFR builds strength and muscle: a review of 19 studies with about 400 people found adding BFR to exercise increased both muscle strength and size (Slysz et al., 2016).
• It works in rehab: a review of clinical rehab studies, including knee osteoarthritis and ACL reconstruction, found light-load BFR built more strength than light-load training alone, though heavy training was still somewhat stronger (Hughes et al., 2017).
• It helps knee arthritis: in a trial of people with knee osteoarthritis, BFR training gave similar gains in strength, muscle and function to heavy training, improved pain, and put less stress on the joint (Ferraz et al., 2018).

Who Can Benefit From BFR?

BFR was brought to the U.S. rehab world by physical therapist Johnny Owens, who used it with wounded service members at Brooke Army Medical Center. Today it is used by sports teams, clinics and rehab programs. It can help:

• People with arthritis: in the knee, hip, ankle or elbow, who can’t tolerate heavy loads
• People recovering from surgery: who need to rebuild muscle lost while they were less active, such as after knee, hip or elbow surgery
• People hoping to avoid a joint replacement: stronger quads and hamstrings help protect the knee
• Athletes: who want to keep strength while an injury heals

Learn more about protecting your joints in our guide to arthritis and natural treatments for arthritis.

Don’t Try This at Home

BFR is not a do-it-yourself project. Everyone’s blood pressure and limbs are different, and the cuff pressure and time need to be set and watched by a trained clinician. Done wrong, it can cause harm.

You Shouldn’t Use BFR If…

BFR is only used on the arms and legs, never the head or trunk. Avoid it, or talk to your doctor first, if you have:

• Blood clots: a history of deep vein thrombosis (DVT), a family history of clots, or a clotting disorder such as thrombophilia, antithrombin deficiency or antiphospholipid syndrome
• Heart or blood vessel problems: uncontrolled high blood pressure, cardiovascular disease, varicose veins or a vascular graft
• Long-term blood thinners: such as warfarin
• Pregnancy
• An infection in the limb: or lymphedema
• Active cancer

BFR also isn’t used in the first, inflamed stage of a fresh injury, because it can add to swelling.

How We Use BFR With Arthritis

We usually start with light cycling or walking, or very light exercises with a goal of up to about 75 repetitions across several sets. You should feel a strong muscle burn, but not discomfort you can’t tolerate. As you get stronger, we add load gradually and safely, as part of a full plan that also improves how your joints move.

Research

• Slysz, J., Stultz, J., & Burr, J. F. (2016). The efficacy of blood flow restricted exercise: a systematic review & meta-analysis. Journal of Science and Medicine in Sport, 19(8), 669–675. PubMed
• Hughes, L., et al. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. British Journal of Sports Medicine, 51(13), 1003–1011. PubMed
• Ferraz, R. B., et al. (2018). Benefits of resistance training with blood flow restriction in knee osteoarthritis. Medicine & Science in Sports & Exercise, 50(5), 897–905. PubMed
• Manini, T. M., et al. (2012). Growth hormone responses to acute resistance exercise with vascular restriction in young and old men. Growth Hormone & IGF Research, 22(5), 167–172. PubMed

See If BFR Can Help Your Arthritis

If you have arthritis, weak legs, joint pain, or you have recently had knee, hip or elbow surgery, our blood flow restriction training can help you get stronger with less strain on your joints. It is part of a full plan built with The Gray Method™, one-on-one with a Doctor of Physical Therapy at our clinics in Fort Myers, Cape Coral and Estero.

Start with our Fixing the Cause & Not Just the Symptoms Assessment, or Inquire About an Appointment →

Call our office at (239) 223-0484 to schedule your appointment.