Blood Flow Restriction Training in Rehabilitation: A Narrative Review of Musculoskeletal and Neurological Applications, Mechanisms, and Safety

Abstract

Background. Blood flow restriction (BFR) training combines low-load exercise with a proximal cuff that partially restricts arterial inflow and more substantially impedes venous outflow. Because it produces strength- and hypertrophy-related adaptations at loads too low to threaten healing tissue, BFR has become a prominent rehabilitation adjunct. Aim. To synthesise, from a clinically oriented and critical perspective, the physiological rationale, methodology of application, condition-specific efficacy, systemic effects, and safety of BFR across musculoskeletal and neurological rehabilitation. Material and methods. Narrative review of peer-reviewed English-language systematic reviews, meta-analyses, randomised controlled trials, scoping reviews, and clinically oriented reviews addressing BFR in rehabilitation, with emphasis on medical applications and safety. Results. Low-load BFR consistently outperforms load-matched exercise without occlusion and approaches, without reliably surpassing, high-load training for hypertrophy; maximal-strength gains remain smaller. Evidence is most developed after anterior cruciate ligament reconstruction, in knee osteoarthritis, after knee arthroplasty, in tendon rehabilitation, and increasingly in upper-limb and neurological populations. Benefits for muscle mass, strength, and patient-reported function are frequent; effects on pain and balance are inconsistent. Protocol heterogeneity, small samples, and incomplete adverse-event reporting limit the evidence. Conclusions. With individualised occlusion pressure, screening, and monitoring, the short-term safety profile is favourable. BFR is a low-risk adjunct for load-compromised patients when higher loads are temporarily contraindicated, to be integrated into progressive rehabilitation rather than used as a universal substitute for conventional training.