Blood flow restriction training (BFRT) is increasing in popularity in the rehabilitation setting due to its believed impact on mitigating muscle atrophy, maintaining muscle mass and improving muscle function after musculoskeletal injury. This intervention has shown to be an effective option for addressing muscle strength and atrophy during earlier phases of rehabilitation when higher loads are not tolerated after injury. Although this intervention appears to be a safe and effective approach in sports medicine environments, there is limited information on the young athlete population. The purpose of this study is to provide a detailed overview of mechanisms, safety considerations, and clinical applications specific to the young athlete after musculoskeletal injury.
AndersonABPattersonJGDickensSDLeClereJFLeClereLE.Blood flow restriction therapy from development to applications. Sports Med Arthrosc Rev. 2019;27(3):119–123.
2.
AsakuraABellamyLMJoanisseS, et al. The acute satellite cell response and skeletal muscle hypertrophy following resistance training. PLoS ONE. 2014;9(10):e109739.
3.
BittarSTPfeifferPSSantosHHCirilo-SousaMS.Effects of blood flow restriction exercises on bone metabolism: a systematic review [published online ahead of print March 2, 2018]. Clin Physiol Funct Imaging. doi:10.1111/cpf.12512.
4.
BrandnerCRKidgellDJWarmingtonSA.Unilateral bicep curl hemodynamics: low-pressure continuous vs high-pressure intermittent blood flow restriction. Scand J Med Sci Sports. 2015;25(6):770–777.
5.
CeroniDMartinXEFarpour-LambertNJDelhumeauCKaelinA.Assessment of muscular performance in teenagers after a lower extremity fracture. J Pediatr Orthop. 2010;30(8):807–812.
6.
ClarkBCManiniTMHoffmanRL, et al. Relative safety of 4 weeks of blood flow-restricted resistance exercise in young, healthy adults. Scand J Med Sci Sports. 2011;21(5):653–662.
7.
CognettiDJSheeanAJOwensJG.Blood flow restriction therapy and its use for rehabilitation and return to sport: physiology, application, and guidelines for implementation. Arthrosc Sports Med Rehabil. 2022;4(1):e71–e76.
8.
CountsBRDankelSJBarnettBE, et al. Influence of relative blood flow restriction pressure on muscle activation and muscle adaptation. Muscle Nerve. 2016;53(3):438–445.
9.
Del VecchioACasoloANegroF, et al. The increase in muscle force after 4 weeks of strength training is mediated by adaptations in motor unit recruitment and rate coding. J Physiol. 2019;597(7):1873–1887.
10.
EstebeJPLe NaouresAChemalyLEcoffeyC.Tourniquet pain in a volunteer study: effect of changes in cuff width and pressure. Anaesthesia. 2000;55(1):21–26.
11.
FaigenbaumADKraemerWJBlimkieCJR, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res. 2009;23:S60–S79.
12.
FergusonRAHuntJEALewisMP, et al. The acute angiogenic signalling response to low-load resistance exercise with blood flow restriction. Eur J Sport Sci. 2018;18(3):397–406.
13.
FormigaMFFayRHutchinsonS, et al. Effect of aerobic exercise training with and without blood flow restriction on aerobic capacity in healthy young adults: a systematic review with meta-analysis. Int J Sports Phys Ther. 2020;15(2):175–187.
14.
FryCSGlynnELDrummondMJ, et al. Blood flow restriction exercise stimulates mtorc1 signaling and muscle protein synthesis in older men. J Appl Physiol. 2010;108(5):1199–1209.
15.
FujitaSAbeTDrummondMJ, et al. Blood flow restriction during low-intensity resistance exercise increases s6k1 phosphorylation and muscle protein synthesis. J Appl Physiol. 2007;103(3):903–910.
16.
GearhartRFJrLagallyKMRiechmanSEAndrewsRDRobertsonRJ.Safety of using the adult OMNI resistance exercise scale to determine 1-rm in older men and women. Percept Mot Skills. 2011;113(2):671–676.
17.
GieddJNBlumenthalJJeffriesNO, et al. Brain development during childhood and adolescence: a longitudinal MRI study. Nat Neurosci. 1999;2(10):861–863.
18.
GrahamBBreaultMJMcEwenJAMcGrawRW.Occlusion of arterial flow in the extremities at subsystolic pressures through the use of wide tourniquet cuffs. Clin Orthop Relat Res. 1993;286:257–261.
19.
GronfeldtBMLindberg NielsenJMieritzRMLundHAagaardP.Effect of blood-flow restricted vs heavy-load strength training on muscle strength: systematic review and meta-analysis. Scand J Med Sci Sports. 2020;30(5):837–848.
20.
HoutmanCJStegemanDFVan DijkJPZwartsMJ.Changes in muscle fiber conduction velocity indicate recruitment of distinct motor unit populations. J Appl Physiol. 2003;95(3):1045–1054.
21.
HughesLPatonBRosenblattBGissaneCPattersonSD.Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 2017;51(13):1003–1011.
22.
IlettMJRantalainenTKeskeMAMayAKWarmingtonSA.The effects of restriction pressures on the acute responses to blood flow restriction exercise. Front Physiol. 2019;10:1018.
23.
JackRALambertBSHedtCADelgadoDGobleHMcCullochPC.Blood flow restriction therapy preserves lower extremity bone and muscle mass after ACL reconstruction. Sports Health. 2023;15:361–371.
24.
KakehiSTamuraYKubotaA, et al. Effects of blood flow restriction on muscle size and gene expression in muscle during immobilization: a pilot study. Physiol Rep. 2020;8(14):e14516.
25.
KeebleARBrightwellCRLathamCM, et al. Depressed protein synthesis and anabolic signaling potentiate ACL tear-resultant quadriceps atrophy. Am J Sports Med. 2023;51(1):81–96.
26.
KellerMFO. Can we make blood flow restriction training more accessible? validity of a low-cost blood flow restriction device to estimate arterial occlusion pressure. J Strength Cond Res. 2023;37:1581–1587.
27.
LambertBHedtCDaumJ, et al. Blood flow restriction training for the shoulder: a case for proximal benefit. Am J Sports Med. 2021;49(10):2716–2728.
28.
LaurentinoGCUgrinowitschCRoschelH, et al. Strength training with blood flow restriction diminishes myostatin gene expression. Med Sci Sports Exerc. 2012;44(3):406–412.
29.
LepleyLK.Deficits in quadriceps strength and patient-oriented outcomes at return to activity after ACL reconstruction: a review of the current literature. Sports Health. 2015;7(3):231–238.
30.
LloydRSFaigenbaumADStoneMH, et al. Position statement on youth resistance training: the 2014 international consensus. Br J Sports Med. 2014;48(7):498–505.
31.
LoennekeJPWilsonJMWilsonGJPujolTJBembenMG.Potential safety issues with blood flow restriction training. Scand J Med Sci Sports. 2011;21(4):510–518.
32.
LuYPatelBHKymC, et al. Perioperative blood flow restriction rehabilitation in patients undergoing ACL reconstruction: a systematic review. Orthop J Sports Med. 2020;8(3): 1–7.
33.
MadarameHKuranoMTakanoH, et al. Effects of low-intensity resistance exercise with blood flow restriction on coagulation system in healthy subjects. Clin Physiol Funct Imaging. 2010;30(3):210–213.
34.
MortonRWOikawaSYWavellCG, et al. Neither load nor systemic hormones determine resistance training-mediated hypertrophy or strength gains in resistance-trained young men. J Appl Physiol. 2016;121(1):129–138.
35.
NakajimaTKM. Use and safety of Kaatsu training: results of a national survey. Int J KAATSU Train Res. 2006;2:5–13.
36.
NielsenJLAagaardPBechRD, et al. Proliferation of myogenic stem cells in human skeletal muscle in response to low-load resistance training with blood flow restriction. J Physiol. 2012;590(17):4351–4361.
37.
NyakayiruJFuchsCJTrommelenJ, et al. Blood flow restriction only increases myofibrillar protein synthesis with exercise. Med Sci Sports Exerc. 2019;51(6):1137–1145.
38.
PattersonSDBrandnerCR.The role of blood flow restriction training for applied practitioners: a questionnaire-based survey. J Sports Sci. 2018;36(2):123–130.
39.
PattersonSDHughesLWarmingtonS, et al. Blood flow restriction exercise: considerations of methodology, application, and safety. Front Physiol. 2019;10:533.
40.
PrueJRomanDPGiampetruzziNG, et al. Side effects and patient tolerance with the use of blood flow restriction training after ACL reconstruction in adolescents: a pilot study. Int J Sports Phys Ther. 2022;17(3):347–354.
41.
ReggianiCSchiaffinoS.Muscle hypertrophy and muscle strength: dependent or independent variables? a provocative review. Eur J Transl Myol. 2020;30(3):9311.
42.
RoehlTLambertBSAnkersenJHernandezKMcCullochPCHedtC.Optimal blood flow restriction occlusion pressure for shoulder muscle recruitment with upper extremity exercise. Am J Sports Med. 2023;51(7):1859–1871.
43.
RomanDPBurlandJPFredericksA, et al. Early- and late-stage benefits of blood flow restriction training on knee strength in adolescents after anterior cruciate ligament reconstruction. Orthop J Sports Med. 2023;11(11):1–6.
44.
Sánchez PastorAGarcía-SánchezCMarquina NietoMde la RubiaA.Influence of strength training variables on neuromuscular and morphological adaptations in prepubertal children: a systematic review. Int J Environ Res Public Health. 2023;20(6):4833.
45.
SaperMGFantozziPBompadreVRacicotMSchmaleGA.Return-to-sport testing after medial patellofemoral ligament reconstruction in adolescent athletes. Orthop J Sports Med. 2019;7(3): 1–7.
46.
SieljacksPWangJGroennebaekT, et al. Six weeks of low-load blood flow restricted and high-load resistance exercise training produce similar increases in cumulative myofibrillar protein synthesis and ribosomal biogenesis in healthy males. Front Physiol. 2019;10:649.
47.
SlyszJTBostonMKingRPignanelliCPowerGABurrJF.Blood flow restriction combined with electrical stimulation attenuates thigh muscle disuse atrophy. Med Sci Sports Exerc. 2021;53(5):1033–1040.
48.
SlyszJTBurrJF.The effects of blood flow restricted electrostimulation on strength and hypertrophy. J Sport Rehabil. 2018;27(3):257–262.
49.
SongJSSpitzRWYamadaY, et al. Exercise-induced hypoalgesia and pain reduction following blood flow restriction: a brief review. Phys Ther Sport. 2021;50:89–96.
50.
StrickerPRFaigenbaumADMcCambridgeTM.Resistance training for children and adolescents. Pediatrics. 2020;145(6):e20201011.
51.
TakaradaYTakazawaHIshiiN.Applications of vascular occlusion diminish disuse atrophy of knee extensor muscles. Med Sci Sports Exerc. 2000;32(12):2035–2039.
52.
VanwyeWRWeatherholtAMMikeskyAE.Blood flow restriction training: implementation into clinical practice. Int J Exerc Sci. 2017;10(5):649–654.
53.
WebbDR.Strength training in children and adolescents. Pediatr Clin North Am. 1990;37(5):1187–1210.
54.
WengleLMiglioriniFLerouxTChahalJTheodoropoulosJBetschM.The effects of blood flow restriction in patients undergoing knee surgery: a systematic review and meta-analysis. Am J Sports Med. 2022;50:2824–2833.
55.
WilsonKWPopchakALiRTKaneGLinA.Return to sport testing at 6 months after arthroscopic shoulder stabilization reveals residual strength and functional deficits. J Shoulder Elbow Surg. 2020;29(7S):S107–S114.
56.
YasudaTFukumuraKUchidaY, et al. Effects of low-load, elastic band resistance training combined with blood flow restriction on muscle size and arterial stiffness in older adults. J Gerontol A Biol Sci Med Sci. 2015;70(8):950–958.
57.
YasudaTMeguroMSatoYNakajimaT.Use and safety of KAATSU training: results of a national survey in 2016. Int J KAATSU Train Res. 2017;13(1):1–9.
58.
ZwolskiCQuatman-YatesCPaternoMV.Resistance training in youth: laying the foundation for injury prevention and physical literacy. Sports Health. 2017;9(5):436–443.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
