Blood Flow Restriction Training Reduces Anterior Knee Pain to Allow for Therapeutic Loading

This 2018 study looked at 30 individuals with anterior knee pain and sought to determine if blood flow restriction training could induce hypoalgesia (pain relief). Participants in this study performed a shallow single leg squat, a deep single leg squat, and a 20cm step-down, all of which are common functional assessments in musculoskeletal rehabilitation as well as common treatment options to build resiliency and strength in patients with anterior knee pain. Participants were then asked to rate their pain (0-10).

Participants then performed 4 sets of knee extensions with BFR at 80% arterial occlusion. The knee extensions were performed from 0-90 degrees of knee flexion and at a tempo of 2 seconds for the concentric and 2 seconds for the eccentric, monitored by a metronome. The set/rep scheme was failure, 15, 15, 15 with 30 seconds rest in between. After the BFR protocol, participants repeated the above-mentioned functional tests and results showed a clinically significant median 60% reduction in reported pain. This decrease in pain was found to last 45 min after the intervention.

While it is difficult to draw conclusions from a single study, this evidence has extremely important implications for rehabilitation professionals working with patients with anterior knee pain. Aside from the plethora of other potential benefits of BFR training, this study suggests BFR MAY allow for heavier loading to be performed with less pain.


“The clinical implications are that low-load BFR exercise may be used to reduce pain and provide a window of opportunity for clinicians to optimally load otherwise painful tissues and joints.”

Like we always say, BFR training can be a bridge to optimal loading!

Further research and questions raised:
– The outcome measurement of pain is a subjective perception.
– There was no control group, which opens the door to possible placebo effect.
– No long-term data.
– All subjects were recreationally active males with anterior knee pain. Would these findings be repeatable with other subgroups (youth, elderly, females, high level athletes, untrained individuals, etc.?) and other diagnoses? – Was it BFR that made the difference or was it simply because the tissues were warmed up?

Source: Korakakis V, Whiteley R, Epameinontidis K. Blood Flow Restriction induces
hypoalgesia in recreationally active adult male anterior knee pain patients allowing
therapeutic exercise loading. Phys Ther Sport. 2018 Jul;32:235-243. doi:
10.1016/j.ptsp.2018.05.021. Epub 2018 May 31. PMID: 29879638.

****Remember, the decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice. Are you ready to meet the growing demand as a Confident BFR Provider?
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