Occlusion Training

Blood flow restriction (or occlusion) training – new research for knee pain, strength training and cycling performance

Aidan Rich, APA sports and exercise physiotherapist

It’s been a while since our previous look at the mechanisms and benefits of blood flow restriction (or occlusion) training. Since then there has been some more research evaluating the effect of blood flow restriction for both knee pain and quadricep strength. Today we will have a look through these recent publications.

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First we will take a look back at what blood flow restriction is, and how it is proposed to work. Blood flow restriction involves using a very tight elastic bandage (or blood pressure cuff). The muscles downstream from the compression receive less blood flow as a result. While the blood flow restriction is in place, strength training (or other training) can be performed. This places a higher load on the muscles without placing a high load on the joint (the knee joint in this example).  So someone with a knee injury can safely undertake strength exercises for their quadriceps without causing a high load (or any damage) to their knee. For more detail on the mechanisms underlying blood flow restriction, check out my previous blog on this topic, or an excellent overview by Lachlan Giles here

Up first we have an article by Vasileios Korakakis, undertaking some research in Doha, Qatar

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This was an interesting study that showed use of blood flow restriction effectively blocked anterior knee pain (patellofemoral pain, kneecap pain) when undertaken during exercise. In practice, this could mean that someone with anterior knee pain could undertake some blood flow restriction training as a warm up for a gym program, before continuing their program in a normal manner. Practical and simple to implement!

The second study is by the same author

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This study showed that low load (so not very heavy weight) training with blood flow restriction was more effective at reducing anterior knee pain compared to low load strength training alone. The take home here would be that if someone is struggling to be able to undertake strength training due to knee pain (and traditional approaches such as tape, manual therapy, quadricep timing drills) do not work, then use of blood flow restriction may be a good option.

These findings were supported using another study, which this time utilised ‘sham’ (placebo) blood flow restriction. 

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These findings add to those from a previous randomised controlled trial by Lachlan Giles which supported the use of blood flow restriction for anterior knee pain. Myself, along with other Advance Healthcare practitioners, were involved in treatment in this trial.

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Finally a look at blood flow restriction training in a completely different setting – cycling! For some reason this has been heavily researched over the last 12-18 months and we will look at some of these papers now.

This study from Brazil, showed that there were considerable strength gains (comparable to gym training), by using blood flow restriction while cycling! The cycling wasn’t particularly intense; 4 times per week for 8 weeks, with each session lasting 30 minutes and at just 40% VO2 max (quite easy!).  Perhaps something to consider for those cyclists or triathletes looking for strength improvement but who are struggling to get to the gym.

A study from Murdoch University in Australia investigated the metabolic responses to low intensity cycling with blood flow restriction in place. The study showed that heart rate and cardiac output were higher while using the blood flow restriction. This paper also cautioned that care should be taken when using blood flow restriction in people with vascular compromise as there was a higher load on the heart during this activity.  It’s probably time to mention here that blood flow restriction is generally very safe, however some populations have a higher risk and consultation with a practitioner who understands precautions and contraindications of blood flow restriction training will help to reduce any risk


Aidan Rich is an APA Sports Physiotherapist at Advance Healthcare in Boronia. Aidan has a special interest in running related injuries, and is a keen runner and triathlete himself. He is available for consulting at the Boronia clinic, bookings can be made via the clinic website or by phoning our friendly reception team on 03 9839 3322. The Boronia clinic is located close to Ferntree Gully, Croydon and Rowville.