The Blood Flow Restriction Screening Process


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The Blood Flow Restriction Screening Process
Nicholas M. Licameli, PT,DPT




There have been many attempts to provide adequate pre-BFR training screening to rule out potentially inappropriate candidates for this modality.  A recent paper by The BFR Pros’ very own Nick Rolnick proposed a funnel-based thought process algorithm that gives BFR trained providers some guidelines and encourages relevant thought processes when making the decision to include BFR into the plan of care.  The funnel can be seen in Figure 1.


At the top of the funnel, you’ll see “loading problem” and “pain problem.” This is the most important because those with a loading problem (either from post-injury/surgery or medically unsafe to lift heavy weights) or a pain problem (particularly in the lower extremity – the knee) can and likely should be initial candidates for BFR. 


After meeting these criteria, there is a need to screen for clotting risk.  This is shown in Figure 2 and includes recommendations based on the current evidence as well as clinical expertise.  While we know that BFR training does not increase risk of developing blood clots, it is important to properly screen for underlying conditions that would make an individual more susceptible to clot development. 


Once this is cleared, the BFR provider should consider hemodynamics/cardiovascular baselines to determine if BFR exercise is appropriate, knowing that there are likely exaggerated responses with at-risk populations.  Intermittent BFR and using lower pressures may be options to work around acute changes in hemodynamics for those at risk, while maintaining a training effect, however MD clearance is key.


The next gradation is physical activity considerations. We should be asking ourselves “What does the patient do exercise-wise?” because it can impact their tolerance to BFR and initial programming considerations.  Is this person a high-level athlete or a weekend warrior?  Are they a manual laborer or a desk worker?  Do they like the feeling of “pushing it” in the gym or do they call it quits at the first sign of a muscle burn?


Then we have to check out their medical history and if anything co-exists that may impact the response to BFR exercise (relevant issues are likely related to exercise pressor reflex sympathetic tone) or other conditions such as pregnancy that may just not be appropriate (although pregnancy is not an absolute contraindication in my book but likely should be avoided if the individual has not previously performed BFR). Last, if the provider is still unsure, check with experts/MDs!


What do you think?  Do you have your own screening tools that you use?  Share below!

Adapted from:

****Remember, the decision to use BFR, or any treatment for that matter, should be based on the pillars of evidence-based practice.

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