Blood Flow Restriction (BFR) Therapy to Rehabilitate Muscle Injuries in Post-operative Knee Patient

  • Minakshi Jatav Department of Physiotherapy, Chandigarh University, Chandigarh, India.
Keywords: Blood Restriction, Vascular Obstruction, Geriatric, Sarcopenia, Muscle Atrophy, Strength Training, Exercise Training


KAATSU is a blood flow restriction training that was developed in Japan in the 1960s as a low-intensity strengthening exercise. It involves the wrapping of a tourniquet or pneumatic cuff over the muscle at a quick repetition rate during low-intensity muscle contractions. It is a muscle-strengthening technique used in physical therapy clinics to help patients regain muscle function following an injury or surgery. This is performed by temporarily cutting off blood flow to the muscles during the exercise.
There were no linguistic or regional limitations in the literature searches for this article. This review contains a total of 25 records. Other resources were used to define additional elements. 4 records were duplicated and removed from the database. A total of 21 documents were found, with two being ruled out based on the title and abstract. Only 19 full-text items were authorised, and among these, 7 were eliminated because they were urgent research, case studies, and in a few studies, physical characteristics were not examined. This review article finally contained a total of 12 papers.
Low-intensity exercise is used in blood flow restriction strengthening to achieve strength improvements similar to those seen in high-intensity training. BFR is a novel approach to physical therapy (PT). According to a preliminary study, this can result in adequate strength improvements during low-intensity exercise.

How to cite this article:
Jatav M. Blood Flow Restriction (BFR) Therapy to Rehabilitate Muscle Injuries in Post-operated Knee Patient. Chettinad Health City Med J. 2022;11(2):51-61.



Sato Y. The history and future of KAATSU training. Int J KAATSU Train Res. 2005;1(1):1-5. [Google Scholar]

Mattar MA, Gualano B, Perandini LA, Shinjo SK, Lima FR, Sá-Pinto AL, Roschel H. Safety and possible effects of low-intensity resistance training associated with partial blood flow restriction in polymyositis and dermatomyositis. Arthritis Res Ther. 2014 Oct;16(5):473. [PubMed] [Google Scholar]

Yokokawa Y, Hongo M, Urayama H, Nishimura T, Kai I. Effects of low-intensity resistance exercise with vascular occlusion on physical function in healthy elderly people. Biosci Trends. 2008 Jun;2(3):117-23. [PubMed] [Google Scholar]

Abe T, Sakamaki M, Fujita S, Ozaki H, Sugaya M, Sato Y, Nakajima T. Effects of low-intensity walk training with restricted leg blood flow on muscle strength and aerobic capacity in older adults. J Geriatr Phys Ther. 2010 Jan;33(1):34-40. [PubMed] [Google Scholar]

Ozaki H, Miyachi M, Nakajima T, Abe T. Effects of 10 weeks walk training with leg blood flow reduction on carotid arterial compliance and muscle size in the elderly adults. Angiology. 2011 Jan;62(1):81-6. [PubMed] [Google Scholar]

Segal N, Davis MD, Mikesky AE. Efficacy of blood flowrestricted low-load resistance training for quadriceps strengthening in men at risk of symptomatic knee osteoarthritis. Geriatr Orthop Surg Rehabil. 2015 Sep;6(3):160-7. [PubMed] [Google Scholar]

Bryk FF, Dos Reis AC, Fingerhut D, Araujo T, Schutzer M, Cury RP, Duarte Jr A, Fukuda TY. Exercises with partial vascular occlusion in patients with knee osteoarthritis: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2016 May;24(5):1580-6. [PubMed] [Google Scholar]

Karabulut M, Abe T, Sato Y, Bemben MG. The effects of low-intensity resistance training with vascular restriction on leg muscle strength in older men. Eur J Appl Physiol. 2010 Jan;108(1):147-55. [PubMed] [Google Scholar]

Shimizu R, Hotta K, Yamamoto S, Matsumoto T, Kamiya K, Kato M, Hamazaki N, Kamekawa D, Akiyama A, Kamada Y, Tanaka S, Masuda T. Low-intensity resistance training with blood flow restriction improves vascular endothelial function and peripheral blood circulation in healthy elderly people. Eur J Appl Physiol. 2016 Apr;116(4):749-57. [PubMed] [Google Scholar]

Yasuda T, Fukumura K, Tomaru T, Nakajima T. Thigh muscle size and vascular function after blood flow restricted elastic band training in older women. Oncotarget. 2016 Jun;7(23):33595. [PubMed] [Google Scholar]

Ozaki H, Yasuda T, Ogasawara R, Sakamaki-Sunaga M, Naito H, Abe T. Effects of high-intensity and blood flow-restricted low-intensity resistance training on carotid arterial compliance: role of blood pressure during training sessions. Eur J Appl Physiol. 2013 Jan;113(1):167-74. [PubMed] [Google Scholar]

Patterson SD, Ferguson RA. Enhancing strength and postocclusive calf blood flow in older people with training with blood-flow restriction. J Aging Phys Act. 2011 Jul;19(3):201-13. [PubMed] [Google Scholar]

Thiebaud RS, Loenneke JP, Fahs CA, Rossow LM, Kim D, Abe T, Anderson MA, Young KC, Bemben DA, Bemben MG. The effects of elastic band resistance training combined with blood flow restriction on strength, total boneâ€free lean body mass and muscle thickness in postmenopausal women. Clin Physiol Funct Imaging. 2013 Sep;33(5):344-52. [PubMed] [Google Scholar]

Jiji. Japan’s older population hits records high [Internet]. The Japan Times; 2021 [cited 2021 Sep 11]. Available from:

Staff R. Nordic combined-American Lodwick injures shoulder [Internet]. Reuters; 2014 [cited 2014 Jan 11]. Available from:

Lowery RP, Joy JM, Loenneke JP, de Souza EO, Machado M, Dudeck JE, Wilson JM. Practical blood flow restriction training increases muscle hypertrophy during a periodized resistance training programme. Clin Physiol Funct Imaging. 2014 Jul;34(4):317-21. [PubMed] [Google Scholar]

DePhillipo NN, Kennedy MI, Aman ZS, Bernhardson AS, O’Brien L, LaPrade RF. Blood flow restriction therapy after knee surgery: indications, safety considerations, and postoperative protocol. Arthrosc Tech. 2018;7(10):e1037-43. [PubMed] [Google Scholar]

Tennent DJ, Hylden CM, Johnson AE, Burns TC, Wilken JM, Owens JG. Blood flow restriction training after knee arthroscopy: a randomized controlled pilot study. Clin J Sport Med. 2017 May;27(3):245-52. [PubMed] [Google Scholar]

Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 2017 Jul;51(13):1003-11. [PubMed] [Google Scholar]

Centner C, Wiegel P, Gollhofer A, König D. Effects of blood flow restriction training on muscular strength and hypertrophy in older individuals: a systematic review and meta-analysis. Sports Med. 2019 Jan;49(1):95-108. [PubMed] [Google Scholar]