Document Type

Conference Proceeding

Publication Date



Background and purpose

The high load and intensity of traditional strength training may not always be appropriate or beneficial for certain patient populations such as the elderly or those with orthopedic injuries. In these cases blood flow restriction training with light resistance has been shown to be effective method of increasing strength and hypertrophy. However, what if traditional strength training is tolerated but not effective for an individual? The purpose of this case report is to describe the use of blood flow restriction training in a recreationally active male who was fully functional but continued with chronic unilateral quadriceps weakness and atrophy.

Case Description

A 37 year old male who participated in frequent physical activity and was functional for daily activities and hobbies presented with decreased quadriceps strength and atrophy 25 years post a well healed femur fracture. A 15% deficit was noted on initial evaluation during isokinetic testing along with a two centimeter difference in quadriceps girth. Light resistance, isotonic, single leg quadriceps strengthening was performed on the involved lower extremity with blood flow restriction. These exercises included straight leg raises, long arc knee extension and single leg press on the shuttle. A blood flow restriction device was used with the settings applied according to the instructions from the manufacturer. The cuff was placed as proximal as possible on the patient’s thigh. The unit continuously adjusted the pressure to maintain 80% occlusion throughout the exercise program. The exercises were performed two times a week for 6 weeks in addition to the patient’s normal exercise routine of high intensity interval training and weight lifting 2 times weekly.


Isokinetic testing was performed at initial evaluation, 3 weeks into the training program and upon completion at 6 weeks. Results indicated that at the end of the 6 week program the 15% deficit had improved to an 8% advantage over the uninvolved leg for a total percentage change of 27%. Girth measurement also increased by 1.5 centimeters.


Blood flow restriction training has been used to improve quadriceps strength and muscle size. It has been used for increasing strength post injury or surgery, during immobilization and in the elderly. It has been used to augment traditional strength training in athletes. The patient in this case had been active with sports and normal exercise routines that included traditional strength training, college football and high intensity interval training since the time of injury. Despite remaining active and fully recovering range of motion and normal strength, as graded with a manual muscle test, atrophy remained 25 years later. Upon completion of 6 weeks of blood flow restricted training, hypertrophy and improved strength were noted; these changes were not able to be achieved in the past with traditional strength training at higher intensities and resistances.


Baldwin T, Baldwin F. Blood Flow Restriction Training for Chronic Quadriceps Weakness and Atrophy: A Case Report. Poster presentation.

American Physical Therapy Association (APTA) Combined Sections Meeting

February 2018 – New Orleans, LA