Blood Flow Restriction: The Holy Grail of Gimmicks?

As this post goes live Lisa and I are en route to Australia.
I’d like to sit here and say I’m doing something productive
with 20 hours on a plane like reading a book, catching up on some
writing, or, I don’t know, looking lovingly into my wife’s

But in reality I’m probably watching John Wick or

Anyway, I didn’t forget about everyone and I do have a bunch
of great content prepared  for while I’m away. Today’s pinch
writer is Baltimore, MD based trainer, Tim

Let’s get jacked.

Blood Flow Restriction Training: The Holy Grail of Gimmicks?

The fitness world is usually full of shit.

What seems like every 30 seconds, a new product pops up in gyms
or online that’s hailed as the next cutting-edge tool to take
your training to the next level. From the thigh master to waist
trainers to oxygen deprivation masks, bullshit peddlers have been
taking advantage of the insecurities of fitness enthusiasts for

Tell someone that it takes ten years of consistency with
training and nutrition to achieve their desired results and you
will struggle in the fitness space. Tell someone to strap a belt
around their waist and magically lose 10 lbs. for three easy
payments of 12.99 and you’re a millionaire.

Unfortunately, that’s where we’re at.


I’m skeptical at this point when I see something gimmicky.

My stance is guilty before proven innocent for almost everything
that doesn’t involve getting stronger using basic core lifts and
eating the right amounts of the right foods for your goals.

When I saw blood flow restriction (BFR) for the first time, my
brain immediately filed it in the category of useless shake
weight’esque type nonsense.

Then I gave it a shot after I saw some trusted coaches (John
Meadows, Ben Pakulski, and others) advocating it.

Ok, maybe there’s something to this.

I gave it a shot and the massive pump it provided my arms was

Keeping blood trapped in the targeted muscle and reaching
failure with an absurdly light weight had to have some legit

It was time to dig deeper.

What is BFR?

BFR refers to a training strategy that employs the use of cuffs,
wraps, bands, or a BFR device placed strategically on the
extremities to occlude venous blood flow away from the muscle while
maintaining arterial flow into the muscle during an exercise.

In other words, blood goes into the muscle when it’s
contracting and gets stuck there while you’re wrapped up.

When done properly and to failure, BFR is quite painful. Want to
see someone humbled? Take the baddest dude at the gym, put him
through a BFR exercise and watch him writhe in pain and hit failure
with 20-35% of his 1 rep max.

To put that in perspective, that’s failing with a 60 lbs.
squat when you max 315.

The duration of the exercise and total time with wraps on is
under 4 minutes, light speed in terms of reaching muscular failure
using a weight you typically warm up with.

What Does the Research Say?

This is all fine and dandy but who cares about the pump (I’m
that guy with his hand raised) if it’s not producing any lasting
results? When you take a closer look though, it turns out BFR
isn’t just a tool for a bro to get a massive arm swell before he
puts on his smedium t-shirt and hits the club.

In a recent meta-analysis of almost 50 studies (Lixandrão
comparing traditional heavy load training and
training using low loads with BFR, it was a wash with regards to
muscle hypertrophy.

Think about that.

Almost 50 studies and the differences between traditional heavy
training and light lifting with BFR were statistically
insignificant when looking at muscle growth.

I guess this isn’t in the shake weight category after all.


It must be stated that in the same meta-analysis, it was
determined that differences in strength were in favor of the heavy
load groups by a wide margin.

Training for specificity still reigns supreme,
especially regarding maximal strength.

In another study (Takarada Y
, patients fresh from ACL surgery were

One group was given traditionally loaded exercises for the
quadriceps and another group were given low load exercises combined
with BFR. The group using BFR showed markedly less atrophy in the
quadriceps when compared with the traditional group and certainly
what is typically seen in patients after an ACL repair.

Another win for BFR as a prehab/rehab tool!

Practical Uses

When programming BFR into your training sessions, it’s
important to keep in mind that its efficacy is limited to the
biceps, triceps, quads, hamstrings, and calves due to the location
of the occlusion sites. Sorry folks, it doesn’t matter where you
put those wraps, you aren’t occluding your glutes or pecs.

Another limitation is its reluctancy to produce strength

Based on the available research, while BFR hasn’t shown to
increase maximal strength anywhere close to traditional lifting, it
could be an effective way to maintain strength when dealing with an
injury or joint issue that inhibits the trainee from lifting with
heavy weight.

Other Scenarios Where BFR is Useful 1. Golfer’s or Tennis Elbow

The dreaded medial or lateral epicondylitis has provided quite a
roadblock for arm gains.

There is nothing quite like attempting an overhead triceps
extension with an inflamed elbow and the searing pain that follows.
One of the more effective strategies I’ve found personally and
with clients is taking the weight down, applying the cuffs, and
pumping away pain free.

Typically, under these conditions, if the weight is light
enough, you can get away with performing the exercise.

Add in the pillow-like effect of blood pooling around the joint
due to BFR, and you’ve created an anabolic environment for the
muscle minus the pain and risk for more inflammation.

2. Knee Issues

Whether it’s arthritis or simply cranky knees from heavy
compound lifts, BFR can be a great way to hammer the quads and
hamstrings without placing more stress on the knees. The same
concept from #1, your inflamed knees will appreciate the low loads
and allow the targeted muscles to reach failure without pain in a
full range of motion.

3. Added Frequency

When working with heavier weights in a strength phase, it may be
helpful to limit the load of isolation work for arms and legs.
Training with BFR can provide an intense stimulus to the targeted
muscles without anywhere close to the amount of muscle damage or
joint stress from high loads. Furthermore, if you are using low
loads and BFR, you can do the isolation lifts more frequently
without sacrificing performance in the heavy lifts.

4. In-Home or On-the-Road

If you are training at home or in a hotel gym working with
weights that resemble “My First Weight Set” by Fisher-Price,
BFR can be a great way to jack up the intensity and train closer to
failure regardless of load.

We’ve all been burned by bullshit online hotel gym pictures.
You book the room thinking it’s an acceptable gym then show up to
lift and they don’t have any dumbbells over 25 lbs.

Pack your wraps or cuffs just in case.

5. Prehab or Rehab As stated earlier, the resulting atrophy from an
injury or operation can be mitigated with low loads and BFR.
6. During a Deload

Taking a week off to recover from an intense training block?
Sprinkle in BFR to provide the muscles a stimulus that won’t
require much recovery or tax the central nervous system.

7. When You Need a Sick Pump Without Sacrificing Recovery from
Programmed Training

Don’t act like you haven’t done this.

You’re about to head to the pool or beach and need to catch a
quick arm swell.

You have exactly 2 ½ minutes to bang out 12,000 reps of curls
and close grip push-ups to get the arms poppin’.

Wrap up, use BFR, and ensure that swell lasts well into the
outing. You’d hate to lose that pump if someone starts snapping
poolside pics for the gram’.

View this post on Instagram

Finally a
pool day!! Happy summer.

A post shared by Dr. Lisa Lewis
(@drlewisconsulting) on Jun 30, 2019 at 10:37am PDT

Note From TG: No BFR was done prior to the
snapping of this pic…;o)

Get the pump you need without digging into your recovery from
programmed training.

How to Wrap Up Safely and Effectively

Upper body: Place the wraps, cuffs, or BFR
device directly under the deltoid tuberosity located at the
attachment of the deltoid and humerus. Wrap your arms with a
perceived tightness of 7/10 as this will provide enough pressure to
occlude the cephalic vein but ensure you are still allowing
arterial flow.

Check for a
distal radial pulse
after you are wrapped to make sure
you didn’t go too tight. Do not perform the exercise if you
can’t find your pulse.

Lower Body: Place the wraps, cuffs, or BFR
device as far up your thigh as you can. Wrap your thigh with the
same 7/10 tightness as upper body. Make sure the wrap, cuff, or
device is lying flat and not wrinkled or bunched up. The goal here
is to occlude the deep vein and femoral vein.

Make sure you have a
posterior tibial pulse
before you perform the

For a more detailed description, head to
Dr. Mario Novo’s guide to everything


The best exercises to use with BFR are isolation movements such
as leg extensions, leg curls, bicep curls, and triceps extensions.
Play around and find your favorite variations.

The most heavily utilized and researched rep/set scheme of
30-15-15-15 is considered the gold standard by practitioners.

Set 1: 30 reps

Set 2: 15 reps

Set 3: 15 reps

Set 4: 15 reps

Take :30 rest between each set. Unwrap after set 4. Breathe.

Perform BFR up to 2-3x per week per muscle group for best

About the Author

Tim is an exercise science
graduate and CSCS who has been training in Baltimore MD since 2004.
While his specialty is body composition, he has extensive
experience working with clients from young athletes to cardiac
rehabilitation patients. Tim has been published in a variety of
fitness publications and writes for his blog when he isn’t
helping clients get stronger, leaner, and generally more awesome in

Earlier this year, Tim published his first book
“Ignition Protocol”, available on

Being a former fat boy, Tim developed a deep seeded passion for
training and nutrition in his teenage years after a major body
transformation. This passion is what drives him to seek the best
results for his clients and readers. Tim combines a knowledge base
earned from years of practice in the field, research, and time
spent under the bar with practical advice to help his clients
accomplish their goals.

You can find Tim on Instagram HERE
or his blog HERE.

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Blood Flow Restriction: The Holy Grail of Gimmicks?
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Source: FS – All-FitnessBlogs
Blood Flow Restriction: The Holy Grail of Gimmicks?