What Can Blood Flow Restriction Teach Us About Pain? - Active Health and Restoration
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What Can Blood Flow Restriction Teach Us About Pain?

What can blood flow restriction teach us about pain?


This week on the Health Restoration Blog, we are highlighting Blood Flow Restriction. We wanted to provide helpful information regarding one of the fastest growing trends in physical therapy, physical medicine, strength training and overall longevity. 

Today’s article focuses primarily on how Dr. Alex Earl uses an important (and effective) treatment method to overcome nagging aches and pains that the traditional medical system is not sufficient at resolving. The reason for this is quite simple, blood flow restriction focuses on identifying and rectifying the ROOT PROBLEM (and not masking underlying symptoms…)

What is Blood Flow Restriction Therapy? 

Blood Flow Restriction (BFR) training offers patients the opportunity to achieve significant strength training gains using lighter loads, effectively minimizing stress on the limb. By applying targeted external pressure to an extremity, Blood Flow Restriction allows for the maintenance of arterial inflow while temporarily restricting venous outflow beyond the restricted site.

This technique maximizes the efficiency of strength training exercises, offering a promising avenue for enhancing rehabilitation outcomes with reduced mechanical strain.

Experienced health care providers, like chiropractors and physical therapists, employing blood flow restriction will recognize the method as a crucial aspect of patient care. Specifically, some individuals have reported greater reductions in pain with Blood Flow Restriction when compared to various other passive care modalities, such as electric stim, massage or acupuncture. 

How does Blood Flow Restriction Work? 

Blood Flow Restriction training involves the strategic application of a specialized tourniquet or pressure cuff to partially restrict blood flow to the muscles during exercise. This restriction creates a temporary state of hypoxia (low oxygen levels) within the working muscles, stimulating a cascade of physiological responses.

Despite the reduced oxygen supply, blood flow restriction allows arterial blood to continue entering the muscles while impeding venous return, leading to a buildup of metabolites like lactate and hydrogen ions. These metabolites trigger an adaptive response, prompting the body to release growth factors and activate satellite cells, ultimately promoting muscle growth and strength gains.

Additionally, Blood Flow Restriction may enhance endurance, improve metabolic efficiency, and expedite recovery. This innovative training modality enables individuals to achieve significant muscular adaptations using lighter loads, making it particularly beneficial for rehabilitation, athletic performance enhancement, and overall fitness goals.

How does Blood Flow Restriction Affect Pain Levels in Patients?

There have been thousands of research articles, papers and editorials published in the last few years regarding the effects of Blood Flow Restriction, but very few studies have looked at the actual effects on the pain experience. 

After all, patients, not test subjects, are the ones who enter our private practices, hospitals and athletic departments all over the world in pain. 

But what can we learn from Blood Flow Restriction about the pain experience? For starters, it’s important to note that the individual experiences pain in a unique and multidimensional way. It cannot be overstated how complex the pain mechanism is within the human body. 

So why do an overwhelming number of patients in outpatient rehabilitation centers and clinics all over the world experience such dramatic reduction in their pain?

In the realm of rehabilitative and therapeutic interventions, Blood Flow Restriction training stands as both an enigma and a beacon of hope. While traditionally hailed for its profound impact on muscular hypertrophy and strength gains, Blood Flow Restriction has often been met with skepticism due to concerns surrounding its potential adverse effects, particularly in individuals with existing cardiovascular conditions. 

However, recent scientific inquiries have unveiled a promising facet of Blood Flow Restriction that extends beyond mere muscle-building prowess—its remarkable efficacy in alleviating pain associated with various orthopedic and musculoskeletal conditions. This paradigm shift not only challenges the conventional understanding of Blood Flow Restriction but also underscores its potential as a non-pharmacological adjunct in pain management protocols.

One of the theories as to how blood flow restriction works on patients is via what is called the Gate Control Theory.

The Gate Control Theory states that there is a window of opportunity (a “gate”) to perform other tasks now that pain has been subsided enough. In essence, you are suppression the pain experience because the brain is focusing on the challenge of dealing with less than normal oxygen levels in the limb with the blood flow restriction tourniquet applied. 

As pain levels reduce, functional improvements can then be achieved.

As clinicians navigate the complex landscape of rehabilitative medicine, it becomes imperative to discern the nuanced interplay between the limitations and the untapped therapeutic potential of Blood Flow Restriction in clinical practice.

As we stand at the precipice of innovation in rehabilitative medicine, it is paramount that clinical practices embrace the transformative potential of Blood Flow Restriction therapy for managing musculoskeletal conditions.

In contrast to conventional modalities such as heat/ice therapy, ultrasound, electric stimulation, and laser treatment, which primarily offer symptomatic relief without addressing underlying physiological mechanisms, Blood Flow Restriction stands out as a dynamic, evidence-based intervention capable of eliciting profound improvements in pain reduction and functional outcomes.

Recent comparative studies have underscored the superiority of Blood Flow Restriction over traditional passive modalities in terms of pain management, highlighting its efficacy in enhancing tissue healing, promoting muscle strength and hypertrophy, and optimizing rehabilitation outcomes.

As we navigate the complexities of modern healthcare, it behooves us to prioritize the adoption of BFR-type treatments, not merely as a replacement for antiquated methods, but as a paradigm shift towards personalized, efficacious care tailored to the unique needs of each patient.

Real Life Case Study: “That was VERY challenging – I like it!” 

Recently, a local CrossFit athlete came to our Carol Stream chiropractic and physical medicine office with shoulder pain. As part of our initial assessment, we put him through our complete movement assessment, which revealed simple movements to be very painful for his shoulder, especially anything overhead. 

Most chiropractic and physical therapy offices do the bare-minimum assessments for painful shoulders. In fact, most providers only do range of motion (ROM) tests! They rarely, if ever, load the shoulder and see how it responds. Blood flow restriction is, in my humble opinion, the best strategy to load the shoulder without the risk of further damaging tissue. It also allows the shoulder to be loaded with very low weights compared to heavy resistance training (HRT). 

In our office, we refer to it as a “Doom Loop”…

  • It hurts to move the shoulder 
  • So you don’t move the shoulder.
  • So when you load the shoulder at the gym, it hurts. 
  • And when it hurts (again), you stop moving the shoulder… 
  • And again, and again the cycle continues.

In our comprehensive movement assessment, we evaluate every muscle, bone, tendon and ligament in the body. We look at how each segment moves in isolated functions and in dynamic functions as a whole.

After the assessments, we put forth a specific plan of action for our guy to….

  1. Return to CrossFit without any fears, worries, or concerns to do any shoulder motions.
  2. Have a specific plan of action to reduce the likelihood of the pain coming back.

This particular patient stated this was the most complete assessment he’d ever gone through, which gave him the confidence to begin his treatment plan towards a full recovery.  

During his first session, he was blown away at challenging and aggressive our approach. Afer all, he went to 8+ weeks of traditional physical therapy, had been seen by a chiropractor for adjustments over 20 times and had gone to a sports massage therapist nearly a dozen times. 

And, yet, none of them actually identified the root cause of his shoulder ailment because time spent on the assessment reduces time spend on treatment. 

An incomplete assessment leads to incomplete recovery. 

An incomplete assessment leads to an over-treatment by providers who are just guessing. 

If you’re an athlete or an active individual who is also experiencing shoulder pain, then don’t wait any longer. Give us a call or text us at (630) 765-0575 to get started on your own complete recovery today!

Do this next!

  1. Share this Article with a Friend or Family member who has been dealing with shoulder or knee pain. Blood Flow Restriction could help!
  2. Call our office TODAY at (630) 765-0575 to book your BFR Taster Session today OR click here to book online. 
  3. Keep an eye out for next week’s article!


  • Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: A systematic review and meta-analysis. British Journal of Sports Medicine. 2017;51(13):1003-1011. doi:10.1136/bjsports-2016-097071
  • Lauver JD, Cayot TE, Rotarius T, et al. Blood flow restriction training as a prehabilitation concept in total knee arthroplasty patients: A blinded randomized controlled trial. American Journal of Sports Medicine. 2018;46(4):837-845. doi:10.1177/0363546517745565
  • Loenneke JP, Fahs CA, Rossow LM, et al. Blood flow restriction pressure recommendations: A tale of two cuffs. Frontiers in Physiology. 2013;4:249. doi:10.3389/fphys.2013.00249
  • Yasuda T, Loenneke JP, Ogasawara R, et al. Muscular adaptations following 21 consecutive days of strength training with vascular occlusion. European Journal of Applied Physiology. 2012;112(5):1821-1832. doi:10.1007/s00421-011-2161-x
  • 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 Medicine. 2019;49(1):95-108. doi:10.1007/s40279-018-0994-y
  • Laurentino GC, Loenneke JP, Teixeira EL, et al. The effects of strength training with blood flow restriction on muscle strength, endurance and hypertrophy in patients with Parkinson’s disease. Disability and Rehabilitation. 2019;41(13):1569-1573. doi:10.1080/09638288.2018.1455996
Alex Earl

Alex Earl

Alex Earl, DC - Chiropractic Physician - Dr. Earl helps people of all ages remain active, strong and able to participate in the activities they love. Aside from Active Health & Restoration, Alex is a clinical instructor for Midwest Rehabilitation Institute, along with a few other professional educational organizations across the country. He is a Diplomate in Clinical Rehabilitation through the American Chiropractic Board of Rehabilitation (ACRB). Dr. Earl earned his Doctor of Chiropractic (DC) degree from National University of Health Sciences in 2015. He is currently a resident in West Chicago, IL with his beautiful wife, and four (perfect) children. In his spare time, Alex coaches high school soccer.
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