Using Blood Flow Restriction Training in Physical Therapy to recover from a Climbing Injury in Seattle or Via Telehealth

Using Blood Flow Restriction Training in Physical Therapy to recover from a Climbing Injury in Seattle or Via Telehealth

What Is Blood Flow Restriction (BFR)?

Blood flow restriction training involves the use of straps or bands placed at the upper arm or thigh. These bands are tightened to partially limit blood flow, and are worn during a set of exercises. By using BFR clients are able to see strength gains at just 20% of 1-rep max and in less than half the time when compared to traditional resistance exercise. For more detailed information, please see a previous blog post I wrote about BFR. 

Beyond Strengthening

Some recent studies have shown that BFR training using light loads is able to elicit a similar tendon response to performing exercises at heavy loads.  This means the development of strong, stiff (in a good way), and more robust connective tissue by using lighter weights. Not only has BFR been shown to strengthen muscles and tendons but it has also been shown to increase one’s VO2 Max and local oxidative capacity for improved endurance sport performance (see: alpine, sport & trad climbers). 

A Climber’s Application

As climbers we always want to be performing.  We want to be hitting that next V-grade, clip the chains on the 5.___, reach a new peak.  Navigating the stresses that we place on our bodies in that search means continuous maintenance- antagonist exercises, core work, hang boarding, weights, periodization, massage, stretching, and nutrition.  Unfortunately injuries do happen and the gains from weeks, months, or years of hard work can feel like they are wiped out.

Blood flow restriction training is a tool for us to minimize those losses and even come back stronger.  Usually to see strength and hypertrophic gains we need to follow the Overload Principle.  We have to be hitting 70-80% of our 1-rep max in resistance training but with BFR we can achieve strengthening at as low as 20% of 1-rep max.  That means that injured pulleys can be rehabbed safely without losing finger strength.  It means the creaky knee (aka: Squamish knee) can be addressed without flaring it up.  The tendon response to BFR means that chronic elbow pain just might finally go away.  The mechanism by which BFR works  limits the amount of available oxygen for muscles meaning that they are forced to rely on the anaerobic system (see: type IIb, fast twitch muscle fibers). From a sheer performance perspective this means increased strength and power.


Specific applications

As climbers many of us are constantly dealing with nagging elbows, finger pain that is lingering just beneath the surface- and lurking around the corner, an acute knee injury. 

Here are just a few possible applications for BFR training:

  • Climber’s elbow,  (medial & lateral epicondylosis)
  • Meniscus injury
  • Fracture recovery
  • Finger injury (ie: A2 pulley sprain)
  • Post-operative rehab
  • In-season training
  • Endurance athletes
  • Sprain & strain rehab
  • Achilles tendinitis
  • Patellofemoral syndrome
  • “Pre-hab”

What Should I Expect?

Using blood flow restriction often feels like performing a very strenuous workout.  As the cuff inflates you will naturally feel some pressure at the site.  Below the cuff you may find that your skin turns a bit reddish or even a little purple and your veins may pop out a bit more too: don’t worry, this is totally normal.  As with any hard exercise, you may find that you are a bit sore the following day or even the day after that.  When performing exercises with the inflated cuff it is often described as  getting especially pumped like at the end of a long route.

We at Union follow two well established protocols when performing BFR training.  Most commonly we will be following the resistive exercise plan where four sets of 30, 15, 15, 15 reps will be performed with a timed short rest in between.  Commonly there will be a number of exercises that are performed with a change for the pressure at the cuff to be released. Exercises will be chosen to target tissue and to address specific strengthening goals. In some cases we may have the client perform an aerobic activity such as cycling to an established level of their heart rate reserve.  This form of training technique has also been shown to elicit strength and hypertrophy gains while also improving local oxidative capacity and even a person’s VO2 max. 

More Info

For a bit more background and to learn more about how BFR works please follow this link to my  previous blog post.  

BFR at Union PT

At Union PT we are outdoor athletes ourselves. We understand the unique challenges faced in climbing. Beyond BFR we are trained in manual therapy and movement analysis, making sure you will get the most out of each visit.  Not only will we address the immediate issue but we’ll also look “upstream” to see WHY you are here with that problem.  While there are other clinics out there that offer BFR, at Union PT we provide individualized, one-on-one care for your sport and wellness goals.  


To ensure a thorough diagnosis and see if BFR might be right for you, schedule an appointment at our Seattle-based physical therapy office.

About the author:

Jon Sparks, PT, DPT, CSCS is a physical therapist at Union PT in Seattle. He is experienced in treating acute and chronic industrial injuries, postoperative rehabilitation and orthopedic injuries. He enjoys staying up-to-date with evidence-based treatments.  Outside the clinic Jon is thoroughly obsessed with rock climbing.  When not climbing, he enjoys traveling, exploring new restaurants and snowboarding.