Blood Flow Restriction Training After ACL Surgery: Hype or Help for Your Quads?
“A new gold-standard study puts Blood Flow Restriction Training (BFRT) under the microscope. Does it really outperform traditional strength training in ACL rehab? Here’s what the evidence says.”
Rebuilding quad strength after ACL surgery is one of the toughest and most crucial parts of recovery. It dictates confidence, function, and return to sport — and many patients and clinicians are always on the lookout for ways to fast-track this process.
Enter Blood Flow Restriction Training (BFRT) — a technique that uses inflated cuffs to restrict blood flow while performing low-load exercises, promising big strength gains without heavy lifting. Sounds ideal, right?
But does it really outperform traditional progressive strengthening in a good rehab programme?
A gold-standard study by Erickson et al. (2025), published in Medicine & Science in Sports & Exercise, set out to answer exactly that.
What Did the Study Investigate?
48 individuals aged 15–40 undergoing ACL reconstruction were recruited. All followed a comprehensive, standardised physiotherapy program before and after surgery — including strength, gait, ROM, NMES, and balance training — under the care of research physiotherapists.
Then came the difference:
Group A did low-load quad exercises (20–30% 1RM) with active BFRT (cuffs inflated to 60% limb occlusion).
Group B did the same exercises with heavier loads (60–70% 1RM) and sham BFRT (low pressure cuffs with no physiological effect).
Outcomes were measured at baseline and again at 4–5 months post-surgery, including:
Quad strength (isometric, isokinetic, RTD)
Walking biomechanics
Muscle size & fibrosis (via MRI)
Muscle physiology (via biopsy)
What Did the Study Find?
There were no significant differences between the groups in:
Quadriceps strength gains
Gait mechanics
Muscle size or fibrosis
Muscle cell structure or recovery
That’s right — the addition of BFRT didn’t offer any measurable advantage over heavier-load training within a well-designed rehab program.
What Does This Mean for Patients?
If you’re rehabbing after ACL surgery, you don’t necessarily need BFRT to make strong progress. The key is consistency and quality. A well-structured, evidence-based programme with progressive strengthening will likely serve you just as well — or better — than relying on any one tool.
What Does This Mean for Health Professionals?
This study challenges the idea that low-load BFRT is superior to traditional strengthening. Instead, it reinforces the importance of:
High-quality, guideline-based care
Progressive loading principles
Early quad activation (with NMES if needed)
Objective strength and function monitoring
BFRT may still have value — especially in cases where patients can’t tolerate higher loads — but it shouldn’t be viewed as an upgrade to already robust care.
Takeaway Message
BFRT isn’t a magic bullet — it’s a tool, not a replacement for good rehab.
This study reminds us that when it comes to quad recovery, the basics done well still reign supreme. So whether you’re a patient or clinician, invest your time and energy into building a solid, progressive, evidence-based programme.
Have questions about your ACL rehab? Our team at Carlingford Active Health can help you navigate the process with proven, personalised strategies.
This article was inspired by Mick Hughes’ review of Erickson et al. (2025) and their study published in Medicine & Science in Sports & Exercise. We thank Mick for his ongoing work in translating complex research into practical insights for clinicians and patients alike.