Can we help reduce muscle loss after an acute injury or operations with passive BFR?

BFR training can help muscle recovery from injury and operations

The positive benefits of Blood Flow Restriction (BFR) training using low external loads on muscle strength and function has been well documented. In my experiences I am seeing the majority of BFR users utilizing this training methodology in early stage rehab for restorative muscle size, strength and function. There is however evidence in using BFR passively post-operatively (or injury) as a method to attenuate muscle loss (1–3,5). Immobilisation typically results in disuse atrophy of the muscles due to the lack of mechanical stress that is typical with muscle use. For example, knee surgery (or injury) is perhaps the most common area of note where the attenuation of thigh muscle atrophy is important since the rehabilitation process takes a prolonged period of time in order to regain the original muscular size and strength.

 A couple of studies in particular have investigated how the inclusion of passive BFR can assist with preventing the loss of muscle size and strength caused by immobilisation and unloading (1-3,5). In post-ACL operative patients, passive occlusion was applied twice daily for 10 days to see whether it attenuated muscular atrophy compared to a control group of no intervention (4). The BFR stimulus consisted of 5 x 5minutes of occlusion pressure with a 3 minutes rest between stimuli (Table 1).


Occlusion stimulus resulted in a significant attenuation of muscle CSA compared to the control group (Table 2). The relative decrease in CSA of knee extensors was also significantly larger in the control group than in the BFR group.


Kubota et al (2008) investigated the changes in muscle thigh CSA and strength in 15 healthy male subjects where their left ankle was immobilized for 2 weeks using a cast. During this period, the subjects walked using crutches and were instructed to keep their immobilized leg non-weight bearing. Using a similar protocol to that of Takarada et al (2000), immobilization/unloading resulted in significant decreases in muscle strength of knee extensors (p <.01) and flexors (p<.05) muscles in the control group whereas using a BFR stimulus resulted in significantly smaller decrements in strength measures than those in the control group. BFR also resulted in no changes in lower body muscle size, whereas immobilisation (control) resulted in significant decreases in thigh muscle CSA (Table 3).


 Lejkowski et al (2011) presented a case study on the inclusion of a BFR protocol for an accelerated post-operative knee rehabilitation program following ACL reconstructive surgery (Table 4). The protocol also included other therapies and techniques as per a program proposed by Wilk et al (6).

BFR protocol following ACL surgery 


Knee Injury and Osteoarthritis Outcome Score (KOOS), a Lower Extremity Functional Scale (LEFS) and thigh muscle girth measurement were taken pre and post surgery as assessment measures. Three months post surgery yielded LEFS scores similar to pre-operative values (66/80 to 65/80). Some improvements in KOOS scores were made when comparing the pain, symptoms, activities of daily living, sport and recreational function. Muscle girth was measured periodically (every 3 weeks) over the 3-month post-surgical period. When compared to the unaffected lower limb, the girth measurements of the thigh and leg remained identical and at no point did they decrease suggesting atrophy. In the discussion, the author highlights the inherent limitations of this paper. However from a practical stand this case study provides a pragmatic application of BFR training into rehabilitative setting.

The above examples highlights the role the BFR can play in the acute post-operative (injury) phase.

It anyone is currently using BFR in this manner it would be great to hear what you are doing and leave your comments below.

On the other hand, please comment below if you have any questions about how you can implement passive BFR into your own practice.

This article is also available for download in the resources page of this website.

Thank you. 


  1. Kubota, A., Sakuraba, K., Koh, S., Ogura, Y., and Tamura, Y. Blood flow restriction by low compressive force prevents disuse muscular weakness. Journal Of Science And Medicine In Sport. 14: 95–99, 2011.
  2. Kubota, A., Sakuraba, K., Sawaki, K., Sumide, T., and Tamura, Y. Prevention of disuse muscular weakness by restriction of blood flow. Medicine And Science In Sports And Exercise. 40: 529–534, 2008.
  3. Lejkowski, P.M. and Pajaczkowski, J. a. 30 - Utilization of Vascular Restriction Training in post-surgical knee rehabilitation: a case report and introduction to an under-reported training technique. The Journal Of The Canadian Chiropractic Association. 55: 280–7, 2011.
  4. Takarada, Y., Sato, Y., and Ishii, N. Effects of resistance exercise combined with vascular occlusion on muscle function in athletes. European Journal Of Applied Physiology. 86: 308–14, 2002.
  5. TAKARADA, Y., TAKAZAWA, H., and ISHII, N. Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Medicine And Science In Sports And Exercise. 32: 2035–2039, 2000.
  6. Wilk, K.E., Arrigo, C., Andrews, J.R., and Clancy, W.G. Rehabilitation After Anterior Cruciate Ligament Reconstruction in the Female Athlete. Journal Of Athletic Training. 34: 177–193, 1999.



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