BFR Contraindications

While Blood Flow Restriction Rehabilitation (BFR) can be a positive and extremely effective form of rehabilitation for many types of injuries and across all age groups, there are precautions and contraindications that should be taken into consideration prior to using this type of training.

Individuals with poor circulatory systems, such as the presence of varicose veins, shiny or scaly skin, brittle or dry nails, and extreme hair loss pose a higher risk of side effects from the training and should seek their physician’s approval. Others who struggle from obesity or loose limb tissue, arterial calcification, diabetes, sickle cell anemia, or hypertension also should take precautionary measures before proceeding with BFR rehabilitation.

Some contraindications for tourniquet use include the following:

• Venous thromboembolism
• Impaired circulation or peripheral vascular compromise
• Previous revascularization of the extremity
• Extremities with dialysis access
• Acidosis
• Extremity infection
• Tumor distal to the tourniquet
• Medications and supplements known to increase clotting risk
• Open fracture
• Increased intracranial pressure
• Open soft tissue injuries
• Post-traumatic lengthy hand reconstructions
• Severe crushing injuries
• Severe hypertension
• Elbow surgery (where there is concomitant excess swelling)
• Skin grafts in which all bleeding points must be readily distinguished
• Secondary or delayed procedures after immobilization
• Vascular grafting
• Lymphectomies
• Cancer

Research suggests that BFR rehabilitation training is safe for healthy individuals, those with varying comorbidities, and training athletes. However, taking the necessary precautions to determine potential eligibility is highly recommended.