What Can BFR Teach Us About Pain? - Active Health and Restoration
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What Can BFR Teach Us About Pain?


Former Chief Editor of the number one orthopedic technique journal, Dr. Brian Day, MD, specifically mentions the Delphi device in his editorial. Dr. Robert LaPrade, formerly of the Steadmon Philipon clinic in Vail, Colorado, the expert on knee multi-ligament repair, also mentions the same Delphi device used in our Carol Stream clinic.

"I still have knee pain and my ACL surgery was two years ago." -AHR past patient

Since 2000, when researchers Cook and Koltyn coined the term, “exercise induced hypoalgesia”, doctors and physical therapists have pushed exercise as an effective method for reducing a patient’s pain.

More recently, additional information came to light, which should get your attention if you are currently experiencing any pain or discomfort.

The research has shown that the addition of BFR to resistance training for the lower leg produced a significant reduction in pain levels, when compared to low intensity exercise alone for the lower leg.

We see this effect every day in our office with patients who can’t physically play soccer, basketball, or football to their specific needs.

One such collegiate football player came to our office with a nagging ankle issue. He wasn’t able to run an “out route” from the backfield and, on a dime, cut when he reached the sideline and sprint upfield. Due to his ankle mobility issue, he was rounding his runs and ran out of bounds each time. Frustrated, he came to our office to work on his ankle, but what we ended up figuring out along the way shocked us both.

Two years prior, this athlete suffered a torn anterior cruciate ligament (ACL) on the same leg. Even two years after the surgical procedure, he still reported tenderness and the occasional pain episode in the knee. Not convinced that the affected leg had healed fully, we investigated further to find out significant discrepancies between the left and right leg on this athlete. He had still not yet gotten his affected leg back up to 100% his pre-ACL strength baseline. And yet he was cleared to play.

With some moderate amount of swelling in his ankle joint, we decided to pursue a rigorous course of manual therapy, soft-tissue work and BFR to minimize any muscle deficits, since he was unable to continue to perform his team’s usual in-season weight lifting program. 

Enter BFR and the rest of the story….

We began using BFR three times a week at a consistency of 3-4 exercises per session. The athlete reported that he had never experienced such rigorous exercises previously and greatly appreciated the intensity, as it felt like he was getting “back to where” he needed to be to play again.

About the fourth session in, this athlete reported that his anterior knee pain, the ache and tenderness was gone. Not just reduced, but gone, completely. He had a grin on his face from ear to ear and was ecstatic at the current state of his knee. 

After a few more sessions, he was back on the field, cutting and helping his team make it all the way to the quarterfinals of the National tournament. His contribution to the team was immense and we are extremely proud of his mentality and his ability to work hard for his team. 

So what’s the take home message here? BFR is an effective strategy to reduce pain even in areas outside of the targeted tissue. As mentioned in our case study, our athlete eliminated his knee pain when he came to us for an ankle mobility issue.

Now, there is no doubt that a heavy resistance and strengthening program would have gotten him to his desired state at some point, but unfortunately, athletes and clients fall into the “Doom Loop” all too often.

The Doom Loop goes like this: A region or part of the body hurts, so you don’t use it (so as to not hurt it further), and since you don’t use it very often, then when you do go to use it, it hurts and doesn’t feel normal - so you don’t use it anymore! And the cycle goes on and on and on…

When BFR enters the picture, it offers a safe, effective method of interrupting the “Doom Loop” by getting you moving again safely. Simple range of motion exercises with BFR is a great place to start, and also slowly starts to reverse the effects of a lack of mobility on that problematic area. Once tolerance has been built up, we slowly add bands and weights to the exercises to really create an amplified effect on muscle.

Since our office utilizes the Gold Standard BFR device, called the Delphi Personalized Tourniquet System, you can be rest assured that the device is safe and extremely effective. In fact, nearly 90% of all the research studies conducted on BFR use the same Delphi device we use right here at our Carol Stream clinic.

In fact, some of the world leaders in surgical procedures have authored editorial papers specifically mentioning and encouraging outpatient use of the Delphi device for post-operative conditions such as ACL, meniscus, labral repair, rotator cuff surgery, and many others.

If you, or someone you know, has previously had a surgical procedure done BUT still is experiencing tenderness and discomfort, like our football stud was, then please call our office today to see if BFR is right for you.  Call (630) 480-0113 now!


  1. Cook, D. B. and Koltyn, K. F. (2000) ‘Pain and exercise.’, International Journal of Sport Psychology, 31, pp. 256–277.
  2. Hughes, L. et al. (2019) ‘Comparing the Effectiveness of Blood Flow Restriction and Traditional Heavy Load Resistance Training in the Post-Surgery Rehabilitation of Anterior Cruciate Ligament Reconstruction Patients: A UK National Health Service Randomised Controlled Trial’, Sports Medicine, 49(11), pp. 1787–1805. doi: 10.1007/s40279-019-01137-2.
  3. Vaegter, H. B., Handberg, G. and Graven-Nielsen, T. (2014) ‘Similarities between exercise-induced hypoalgesia and conditioned pain modulation in humans’, Pain. International Association for the Study of Pain, 155(1), pp. 158–167. doi: 10.1016/j.pain.2013.09.023.

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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