Blood flow restriction resistance exercise as a rehabilitation modality following orthopaedic surgery: A review of venous thromboembolism risk

Colin W. Bond, Kyle J. Hackney, Scott L. Brown, Benjamin C. Noonan

Research output: Contribution to journalReview article

2 Scopus citations


Restoration of skeletal muscle mass and strength is critical to successful outcomes following orthopaedic surgery. Blood flow restriction (BFR) resistance exercise has emerged as a promising means of augmenting traditional lowintensity physical rehabilitation exercise and has yielded successful outcomes in a wide range of applications. Though BFR is well tolerated and safe for most individuals, patients who have undergone orthopaedic surgery may be an exception, due to their heightened risk for venous thromboembolism (VTE). While the pathogenesis of VTE is multifactorial and specific to the individual, it is commonly described as a combination of blood stasis, endothelial injury, and alterations in the constituents of the blood leading to hypercoagulability. The collective literature suggests that, given the pathogenic mechanisms of VTE, limited use of a wide, partially occluding cuff during resistance exercise should be low risk, and the likelihood that BFR would directly cause a VTE event is remote. Alternatively, it is plausible that BFR may enhance blood flow and promote fibrinolysis. Of greater concern is the individual with pre-existing asymptomatic VTE, which could be dislodged during BFR. However, it is unknown whether the direct risk associated with BFR is greater than the risk accompanying traditional exercise alone. Presently, there are no universally agreed-upon standards indicating which postsurgical orthopaedic patients may perform BFR safely. While excluding all these patients from BFR may be overly cautious, clinicians need to thoroughly screen for VTE signs and symptoms, be cognizant of each patient's risk factors, and use proper equipment and prescription methods prior to initiating BFR.

Original languageEnglish (US)
Pages (from-to)17-27
Number of pages11
JournalJournal of Orthopaedic and Sports Physical Therapy
Issue number1
StatePublished - Jan 1 2019



  • Blood stasis
  • Endothelial injury
  • Hypercoagulability
  • Occlusion
  • Tourniquet

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation

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