Occlusion therapy (blood flow restriction training) for knee pain

Occlusion therapy

Occlusion therapy, also known as ‘Blood Flow Restriction’ training, or “Kaatsu” training in Japan, is a method of exercise where the blood flow is restricted to the muscles using a tight band or tourniquet.

We use occlusion therapy as an adjunct treatment when there are restrictions on lifting heavier weights as part of a normal gym program.

The science behind occlusion therapy is that the muscles are exposed to a low oxygen environment when the blood flow is restricted. This stimulus allows easier fatigue to the muscle, which, along with some hormonal changes, results in greater strength and hypertrophy (muscle growth) gains than would otherwise occur.

Here are two examples:

-          Jessica has had patellofemoral (knee cap) pain for 6 months.  Over this time she has lost a lot of the strength in her quadriceps.  We know from previous research that if her quadriceps strength is improved, this should help reduce Jessica’s pain.  However when we get Jessica to lift moderately heavy weights (e.g leg press, knee extension exercise) – she gets knee cap pain which stops her from being able to complete the exercise.  With using occlusion therapy, we can reduce the weight by 60-70% AND still get significant quadriceps fatigue from the exercise, which will result in strength gains

-          Andrew has had recent ACL (Anterior Cruciate Ligament) reconstructive surgery. Because the strength of the graft is quite low for the first 6 weeks, Andrew should avoid lift very heavy weights.  Using occlusion therapy, Andrew can lift quite light weights, still get a lot of fatigue in his muscles, and minimise the loss of strength that occurs after this surgery.

There is a lot of evidence supporting this treatment

-          Lachlan Giles, a Melbourne based physiotherapist, is completing his PhD on this topic.  Lachlan looked at occlusion therapy for knee cap pain and I was involved as a treating physiotherapist in his randomised controlled trial.  The results are not published yet so I can’t say too much yet, however Lachlan has shared some of the data and it’s very exciting for occlusion therapy!  (Edit: I've found this video  where Lachlan gives a great explanation of why to use occlusion training).


-          Other articles have looked at the muscle growth and strength gains with occlusion therapy

-          This article provides a good summary of the basis and practical application for occlusion therapy.

-          Many elite sporting clubs (AFL, A-League soccer) use this therapy as part of their rehabilitation or strength training program

Occlusion therapy is not without risk, so a detailed and individual explanation of how to perform occlusion training is important.  Serious side effects are generally VERY rare but have included blood clot and rhabdomyolysis (breakdown of muscle causing kidney damage).

It’s worth mentioning that occlusion therapy is a treatment option, but rarely makes up the entire treatment.  In the example of Jessica above with her knee cap pain, other treatment may involve hip strength exercises, jumping and landing drills, taping, as well as several other things.  If you think you’d benefit from occlusion therapy, come into the clinic and we can provide an individualised treatment approach for you. 

Aidan Rich is an APA Sports Physiotherapist based in Melbourne, Victoria. He works at Advance Healthcare in Boronia, and Lifecare Ashburton Sports Medicine.  Aidan's interests include hip, knee and tendon pain, as well as bike fit and bike setup.  More on Aidan on LinkedIn,  & Twitter.

photos courtesy Owens Recovery Science (cover photo), Sportsrehab.com.au (torniquet), campusrush.com (lower photo)