Why Are Automatic Personalized Blood Flow Restriction Systems Best?

Automatic Personalized BFR systems help the health care practitioner ensure that the best reported patient outcomes can be achieved safely and consistently. 

Other equipment and efforts that promise to approximate the success of automatic personalized BFR systems cannot do that, for the following 7 reasons.

Reason 1: Personalized BFR tourniquet cuffs are surgical-grade tourniquet cuffs that have proven safety.

These specialized and patented tourniquet cuffs are used safely thousands of times each day in hospitals and surgery centers throughout the US and around the world, for patients having a wide range of limb shapes, sizes and tissue compositions.

Many offering alternative cuffs have no independent proof of their safety for BFR.

Reason 2: Personalized BFR tourniquet cuffs have proven effectiveness.

The cuff design allows pressures to be applied effectively, safely and consistently to a wide range of limb sizes, shapes and tissue compositions for sustained, repeated periods as required for BFR. The lowest effective pressures and the lowest pressure gradients are applied when these cuffs are used with automatic personalized BFR tourniquet systems [1-3].  This is supported by ample evidence published during the past 30 years.

Those offering alternative cuffs have no proof of effectiveness.  Also, none can be used with automatic personalized BFR instruments.

In contrast, research has shown that many seemingly similar imitations require hazardously high cuff pressures to reach Limb Occlusion Pressure (LOP) [1]. Even if LOP and blood flow restriction can be achieved at high cuff pressures, these high pressures are unnecessary and are hazardous for patients, as clearly proven in medical literature during the past 30+ years.

Reason 3: Automatic personalized BFR tourniquet systems use cuffs for two purposes: to measure Limb Occlusion Pressure, and to deliver specified pressure to limbs safely, accurately and reliably.

In contrast, alternative cuffs cannot do so safely or effectively, and seemingly similar alternative cuffs cannot be used with automatic personalized BFR tourniquet instruments.

Reason 4: Automatic personalized BFR tourniquet systems allow Limb Occlusion Pressure to be measured automatically, quickly, accurately and consistently.

The errors associated with manual efforts to estimate LOP by Doppler ultrasound in a clinic setting by those who are not experts in ultrasound are substantial.  Published evidence shows that, even among experts in Doppler ultrasonography, operator-to-operator variances are only moderately reliable [4, 5]. In BFR, these errors and variances directly impair attempts to follow proven treatment protocols.

Combinations of different types of equipment (including Doppler ultrasound, gels, elapsed time clocks, manual recording, pumps and valves and gauges to monitor and control pressures, etc) that have been proposed to attempt to manually estimate LOP are slow and time-consuming in a busy clinic, and the resulting estimates of LOP can be inaccurate and variable, even if meticulous attention is paid to technique and training. Use of hand-held Doppler ultrasound requires an average of 3 minutes of dedicated time to locate a sufficient pulse and attempt an LOP measurement, with an experienced operator in a controlled setting [6]. This time required increases substantially in the hands of an inexperienced operator in a busy clinic type setting, and will more than double if repeat or bilateral measurements are needed.

Expensive, high-quality equipment is needed to attempt manual measurements, and even that equipment can produce erroneous and highly variable results without extensive training, meticulous technique, and without taking the considerable dedicated time required for proper manual measurement – all of which are difficult or impossible in clinical settings.

Reason 5: Automatic personalized BFR tourniquet systems allow personalized restriction pressures specified by BFR protocols to be achieved and regulated, accurately and safely.

Those offering alternative systems do not provide for automatic setting of restriction pressures according to proven protocols, and do not provide for regulation of restriction pressures during time periods specified by protocols [7].   Many studies have shown that BFR pressures vary substantially from prescribed pressures without automatic pressure regulation [7, 8].

Reason 6: Automatic personalized BFR tourniquet systems improve consistency of therapy, and allow patient outcomes to be better matched to treatments actually delivered.

Substantial variations between expected and delivered treatments has been suggested as an unrecognized source of variability in reported patient outcomes [3, 9].

Reason 7: Automatic personalized BFR tourniquet systems have proven BFR protocols embedded in them, to automatically help achieve optimal patient outcomes.

The use of alternative equipment not having embedded protocols makes compliance with prescribed BFR therapy more difficult, time-consuming, and variable [3, 7]. This makes achieving optimal patient outcomes more uncertain.


[1] Younger AS, McEwen JA, Inkpen K. Wide contoured thigh cuffs and automated limb occlusion measurement allow lower tourniquet pressures. Clinical orthopaedics and related research. 2004 Nov 1;428:286-93.

[2] Noordin S, McEwen JA, Kragh Jr CJ, Eisen A, Masri BA. Surgical tourniquets in orthopaedics. JBJS. 2009 Dec 1;91(12):2958-67.

[3] Day B. Personalized Blood Flow Restriction Therapy: How, When and Where Can It Accelerate Rehabilitation After Surgery?. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018 Aug 1;34(8):2511-3.

[4] Stekelenburg CM, Sonneveld PMDG, Bouman M-B, et al. The hand held Doppler device for the detection of perforators in reconstructive surgery: What you hear is not always what you get. Burns. 2014;40(8):1702-1706.

[5] Yu P, Youssef A. Efficacy of the Handheld Doppler in Preoperative Identification of the Cutaneous Perforators in the Anterolateral Thigh Flap: Plastic and Reconstructive Surgery. 2006;118(4):928-933.

[6] Tuncali B, Boya H, Kayhan Z, Arac S. Tourniquet pressure settings based on limb occlusion pressure determination or arterial occlusion pressure estimation in total knee arthroplasty? A prospective, randomized, double blind trial. Acta Orthop Traumatol Turc. 2018;52(4):256-260.

[7] Brandner CR, May AK, Clarkson MJ, Warmington SA. Reported Side-effects and Safety Considerations for the Use of Blood Flow Restriction During Exercise in Practice and Research: Techniques in Orthopaedics. 2018;33(2):114-121.

[8] Hughes L, Rosenblatt B, Gissane C, Paton B, Patterson SD. Interface pressure, perceptual, and mean arterial pressure responses to different blood flow restriction systems. Scandinavian Journal of Medicine & Science in Sports. 2018;28(7):1757-1765.

[9] DePhillipo NN, Kennedy MI, Aman ZS, Bernhardson AS, O’Brien LT, LaPrade RF. The role of blood flow restriction therapy following knee surgery: Expert opinion. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2018 Aug 1;34(8):2506-10.