Identifying Common Contraindications for BFR Training (BFRT)

Blood Flow Restriction Training (BFRT) has gained popularity as an effective method to accelerate recovery, enhance muscle strength and hypertrophy with lower loads. However, like any specialized training technique, it carries certain risks that must be understood before incorporating it into a fitness routine. Identifying common contraindications for BFRT is essential to ensure safety and maximize benefits.

Understanding BFRT Risks

BFRT involves applying a cuff or strap to partially fully occlude venous flow from the limb while allowing partial arterial flow to the limb to remain. This occlusion creates a hypoxic environment that stimulates muscle growth and strength gains even with lighter weights. Despite its advantages, improper use or ignoring individual health conditions can lead to complications.

Some of the primary BFRT risks include:

• Nerve damage from using a cuff or strap that is too narrow (<2" for arms, >3" for legs) or one that requires initial cuff pressure in excess of 185mmHg.

• Fiber crusing injury aka Rhabdomyolysis when the cuff is over tightened, requires a high initial pressure >210mmHg or is left tightened for excessive periods which depend on the type of cuff used.

• Tissue damage if the cuff is overtightened or used for prolonged periods.

  
  

Understanding these risks helps trainers and trainees make informed decisions about who should avoid or modify BFRT.

BFR cuff placement on arm during training

Who Should Avoid BFRT?

While BFRT is generally safe for healthy individuals, certain populations should avoid it or seek medical advice before starting. These include:

• People with cardiovascular diseases: Conditions such as untreated hypertension, atherosclerosis, or history of heart attack, and CVD increase the risk of adverse events during BFRT.

• Individuals with existing blood clotting disorders: Deep vein thrombosis (DVT), pulmonary embolism, or existing clotting abnormalities.

• Pregnant women: The safety of BFR during pregnancy has not been established although there are a few new studies that show BFRT can be safe..

• Those with varicose veins or vascular insufficiency: Restricting blood flow can worsen these conditions.

• Individuals with skin infections, wounds, or recent surgery near the cuff site: Risk of infection, delayed wound healing, and nerve damage if close to the tournquet site used during surgery.

If you fall into any of these categories, consult a healthcare professional before attempting BFRT.

What are the contraindications for BFRT?

BFRT, like any other type of exercise, requires careful consideration of contraindications to prevent harm. Contraindications are specific conditions or factors that make a particular treatment or exercise inadvisable.

Common contraindications for blood pressure exercise include:

1. Untreated hypertension (high blood pressure): Elevated blood pressure with a systolic measurement abover 135 mmHg can be worsened by the increased vascular resistance during BFR.

2. Cardiac arrhythmias: Irregular heartbeats may be triggered or aggravated by the stress of exercise.

3. Peripheral artery disease: Narrowed arteries reduce blood flow, and further restriction can cause ischemia.

4. Recent surgery or trauma: Healing tissues may be compromised by altered circulation.

5. Severe obesity: Excess adipose tissue requires higher cuff pressures and can affect cuff pressure accuracy and increase risk.

6. Neurological disorders: Conditions like multiple sclerosis or neuropathies may be aggravated.

   
   

Understanding these contraindications helps prevent complications and ensures that blood pressure exercises are performed safely.

Gym environment prepared for BFR training

How to Safely Implement BFR Training

To minimize BFRT risks and avoid contraindications, follow these practical recommendations:

• Get medical clearance: Especially if you are not currently exercising or have any chronic health conditions or concerns.

• Use proper equipment: Choose cuffs designed for BFRT that require the lowest initial pressure and have calibrated adjustable pressure settings.

• Learn correct cuff placement: Position the cuff high in the armpit, proximal to the Humeral Head or high in the groin, proximal to the Femoral Head. Cuffs should not be placed anywhere else.

• Monitor pressure carefully: Pay attention to how you feel during use and avoid excessive cuff tightness. If you experience numbness of tingling, stop and loosen your cuffs.

  Limit session duration: Keep restriction periods short (typically under 24 minutes). Follow cuff provider recommendations.

• Start with low loads: Use light weights (20-30% of 1RM or 25% to 35% of your normal resistance load) to reduce strain. For aerobic exercise, start with occlusion duration of 5 to 7 minutes followed by loosening the cuffs for 1-2 minutes. Follow the instruction of the cuff provider.

• Watch for warning signs: Pain, numbness, excessive swelling, bruising, or discoloration signal excessive risk. Like all exercise, if you experience signs of a heart attack which can include: sharp chest pain, excessive sweating, pain radiating down the arm or leg, stop, remove the cuffs and call 911 immediately.

• Stay hydrated and warm up: Drink at least 16 ounces of water before starting, and avoid caffeine use for 60-minutes before you exercise. Proper preparation reduces injury risk.

  
  

Following these guidelines helps ensure BFR training is both effective and safe.

Recognizing Symptoms That Require Immediate Attention

Even with precautions, some symptoms during or after BFRTindicate serious problems. Stop training and seek medical help if you experience:

• Severe pain or burning sensation under the cuff.

• Numbness or tingling that does not resolve quickly.

• Swelling or discoloration of the limb.

• Shortness of breath, chest pain, or dizziness.

• Sudden weakness or loss of function in the limb.

  
  

Early recognition and response to these symptoms can prevent long-term damage.

Resources for Learning More About BFR Contraindications

For those interested in exploring the topic further, we provide detailed information on safety and contraindications on the website.

We also provide the premier BFRT Certificate the UT-BFRT Certificate Course. The UT-BFRT Certifiacte Course is the only BFRT course created in partnership with a major university, the University of Tennessee and featuring an expert faculty. The program is evidence-based, and equipment-agnostic teaching the science of BFRT and avoiding a "product centric" approach. Educating yourself and consulting professionals, you can make informed decisions about incorporating BFR into your clinical or fitness routine.

BFR training offers exciting benefits but requires respect for its risks and contraindications. By understanding who should avoid it, recognizing warning signs, and following safety protocols, you can harness its power while protecting your health. Always prioritize safety and consult experts when in doubt to enjoy the full potential of BFR training.