Does blood flow restriction result in skeletal muscle damage? A critical review of available evidence

Blood flow restriction (BFR) alone or in combination with exercise has been shown to result in muscle hypertrophy and strength gain across a variety of populations. Although there are numerous studies in the literature showing beneficial muscular effects following the application of BFR, questions have been raised over whether BFR may lead to or even increase the incidence of muscle damage. The purpose of this review is to examine the proposed mechanisms behind muscle damage and critically review the available BFR literature. The available evidence does not support the hypothesis that BFR in combination with low-intensity exercise increases the incidence of muscle damage. Instead, the available literature suggests that minimal to no muscle damage is occurring with this type of exercise. This conclusion is drawn from the following observations: (a) no prolonged decrements in muscle function; (b) no prolonged muscle swelling; (c) muscle soreness ratings similar to a submaximal low load control; and (d) no elevation in blood biomarkers of muscle damage.