My Story of Blood Flow Restriction Therapy

In April 2016, I was playing with my Salisbury Women’s Rugby team at Nationals in Davis, California. Twenty minutes into the game I went into a tackle, planted my left foot, twisted and heard “the pop.” I got ACL reconstructive surgery in August using a hamstring graft and my rehab started just a week after at True Sports Physical Therapy in Baltimore where I was introduced to blood flow restriction therapy (BRF).

How BFR was brought to my attention

At the beginning of my rehabilitation process my Physical Therapist, Yoni, stressed the importance of reducing quadriceps atrophy, since that tends to be the biggest challenge post ACL reconstruction. I know from PT school that the body is a chain of connections and if something isn’t working properly, it will cause secondary issues elsewhere. I experienced this first hand a few weeks post op when I found myself hip hiking on my surgical side to compensate during gait. This gait deviation happened not too long after my nonsurgical knee was starting to have pain from overuse. Yoni summed BFR up by saying muscles can be tricked into thinking they are lifting heavy loads as if you were in the last few reps of an exercise without actually loading and stressing the joints/ligaments post op. Muscles are able to work at the usual anaerobic state like they would be lifting by restricting blood flow to that specific muscle.

What sold me on BFR

It didn’t take much to sell me on BFR. Yoni had built a great rapport with me and had proven he had my best interests in mind. I was willing to do whatever he had suggested. However, as a DPT student I did have a healthy dose of skepticism and wanted to know on a physiological level how it worked and if it was safe to use. To me, occluding blood flow to my muscles to the point where my leg turned a dark red/purple, seemed slightly alarming and painful. I had seen people in the gym and online wrapping their arm or leg with a band to essentially do the same thing, and although it intrigued me, I had never considered doing it myself (and with good reason). Yoni explained to me that BFR is safe if done properly, AKA having a board certified DPT use a BFR machine. The reason being, is that the machine completely occludes blood flow so that it can get a base reading. It then sets a specific percentage so blood flow isn’t being completely cut off. Mine was typically set for about 70-80% occlusion. What I also liked about the machine was how portable it was and it could be applied to pretty much all major muscle groups. I was able to do many exercises in multiple positions including sitting, supine, and even squatting.

What it felt like

One of the first few exercises I did with the machine was LAQ. I could immediately tell the difference using the machine compared to not using it. My quads caught fire within the first 5 reps, which would never typically happen. As I progressed, I was able to use the machine while doing single leg (SL) and double leg (DL) wall squats, SLDL, glute bridges, weighted step ups, leg press, and BOSU back lunge into a deadlift. I found it hard sometimes to isolate my quadriceps as well as my hamstrings during exercises (since I got a hamstring graft, I felt extremely weak in this area) but the BFR machine helped with that. Using the BFR made my hamstrings, glutes, and quads feel way more fatigued compared to not using BFR. I even felt sore the following day after PT from using the machine. Usually, I would start with 30 repetitions, take a 30 second break, then continue with 15 reps and 30 seconds breaks until 5 minutes was up. Some exercises fatigued me to the point that I felt like I wouldn’t be able to finish the work out. Luckily, Yoni was extremely motivating and helped me push through the sweat and fatigue.


Changes I felt/saw.

Within days of my surgery, even with swelling, I noticed a significant decrease in my left quad muscle mass. When they were first measured, my left leg was about 2 cm smaller than my right (non-surgical) leg. Within a few weeks the girth of my legs were no more than .2-.3 cm apart, I was so surprised! I was attending PT twice a week and would only do a leg workout maybe one other time during the week. Because of this I knew that BFR was helping. I talked to a few classmates who also have had ACL repairs and they told me that they still felt like there was an imbalance between the two limbs, which had concerned me. However, although my strength in my hamstrings still felt a little off because of the tendon graft, as far as my quadriceps were concerned there was very little visible atrophy. By the end of my treatment my quads were equal in size and in strength.

Would I do it again?

If I knew more about BFR before starting physical therapy, I think it would have drawn me to True Sports even more. There a few places around the Baltimore area that utilize it and I think that that is one of the many reasons, along with the skilled therapists, that make True Sports such a good clinic. I truly believe it is a major contributor to my accelerated rehab process after my ACL surgery. I would, and have, recommended friends to True Sports because of the experience I had using BFR and the clinic in general. BFR is a great resource if paired with appropriate exercises, which was a great benefit to going where I did because of the sports specificity and the knowledge the therapists have there. While there are many theories and research on BFR, I can testify that it was a great experience and was what I needed as an athlete to regain my strength. Research is limited to certain populations at the moment such as younger individuals, athletes, however there is a recent body of research focusing on patients post CVA. I believe it is something that will continue to expand in the PT practice. Anybody interested should take the time to do research on it to see how we could potentially utilize BFR in a rehabilitative setting to optimize patient treatment and rehabilitation.

Jess Werth, SPT