What is BFR?

BFR utilizes a tourniquet system similar to a blood pressure cuff to reduce blood flow to a limb while the patient is performing low load strengthening exercises. Typically, to grow muscle and strength, a person needs to work at a load of 70% 1 repetition max weight. However, people recovering from injury or with arthritic joints are not able to perform this load due to pain and safety. Patients using BFR have demonstrated improved muscle strength and hypertrophy with only 20-30% loads of 1 rep max (1RM). This technique allows patients to work muscles without placing an excessive load on the joint and should be performed under the supervision of a licensed physical therapist. The gains are similar to High-Intensity training at heavy weight. Research has demonstrated improved post-exercise muscle protein synthesis, higher growth hormone elevations, and cellular swelling with BFR compared to resistance training at low loads and no BFR and similar to High-Intensity Training.

When is BFR used?

BFR is indicated in patients with muscle atrophy and weakness that are unable to train at high loads.  Post-operative knees benefit greatly from BFR training. One example of this is a post-op ACL reconstruction that is unable to perform high resistance exercise, particularly in the early stages of rehabilitation.  BFR allows rapid improvement in muscle strength and hypertrophy during these early stages.  BFR is also used commonly in the geriatric community who struggle to gain strength, with arthritic joints to decrease stress and improve strength around the joint, in athletes wanting to improve performance, and in recovery from intense exercise.

Is BFR Safe?

Like any other intervention, BFR is not indicated for all patients and should be performed under the supervision of a licensed physical therapist.  Hundreds of studies have been conducted on BFR and there have been minimal issues. It is also important to perform BFR with an FDA approved device that is self-regulating. These devices are manufactured by Delphi Incorporated through Owens Recovery Science. There are very few certified clinicians with FDA accredited units for BFR in Arizona and one can be located at Foothills Sports Medicine Gilbert-Mesa location. Please contact the office for scheduling to help with strength gains, post-surgical progress, and performance.


In short BFR training allows our patients and athletes to increase strength and improve muscle size and tone under a low load that is safe for patients and their joints. The research in the literature is vast and expansive. The majority of professional sports teams in the United States and Europe are already incorporating it with their athletes. There are large grants with NASA and the military for more research and implementation. The national orthopedic community is already implementing this treatment with their post-operative patients. This is a treatment modality that we feel is such a blessing for our patients and are excited to provide.

If you are interested in learning more about implementing BFR into your physical therapy plan, we currently offer this service at our Arrowhead, North Central Phoenix and Gilbert-Mesa clinics.

With the onset of school comes fall sports, which for Arizonians, means exercising in 100-degree temperatures during their training programs. During this time, it is especially important for athletes and physical therapy patients to stay hydrated for performance and safety.

Water regulates your body temperature as well as lubricates your joints. It helps transport nutrients to give you energy and keep you healthy. In athletes, severe cases of dehydration can cause post-extreme endurance syndrome or PEES. Symptoms of PEES include decreased body temperature, nausea, vomiting, diarrhea, dizziness, headaches, muscle cramps, and an inability to keep fluids down. In order to avoid dehydration, it is crucial that athletes drink plenty of fluids before, during, and after their training.

During every healthy work out an athlete loses body weight due to water loss through sweating. However, when certain thresholds are met and passed, the loss of water weight begins to have a negative impact on your work out.

When athletes experience a loss of two percent body weight during exercise they will begin to demonstrate decreased performance. At three percent, athletes will be at an increased risk of developing heat exhaustion and injuries. Because of these negative consequences, the goal is to keep dehydration below two percent.

To help aid an athlete in these efforts, athletes can calculate their sweat rate, or the amount of fluid lost during workouts. Typical sweat rate ranges from one to three liters per hour.

How to calculate sweat rate:

  1. Weigh yourself before exercise (nude is best)
  2. Workout for one hour
  3. Drink a measured amount of fluid during workout
  4. Do not urinate during workout
  5. Weigh yourself again following workout (nude is best)

Once you have the data, it’s time for some simple math:

  1. Pre-exercise body weight – post exercise body weight = Change in body weight (one pound of fluid loss is equal to 16 ounces)
  2. Change in body weight (one pound of body weight is equal to 16 ounces) + volume of fluid consumed = sweat rate for one hour of exercise

Knowing your sweat rate is a fantastic tool to avoid dehydration, especially in this heat. Contact us at Foothills Sports Medicine Physical Therapy and schedule an appointment at a location near you for all your physical therapy needs.

Chronic pain affects at least 100 million American adults, more people than diabetes, heart disease, and cancer combined. A common treatment of chronic pain has been prescription medications such as opioids codeine, morphine, oxycodone, hydrocodone, and tramadol, to name a short list. However, the number of opioid prescriptions has been on the rise, to the point where some states in the U.S. that have more prescriptions written than people living in the state.

According to the Centers for Disease Control and Prevention, since 1999 the sales of prescription opioids in the U.S. have nearly quadrupled. Consequentially, the cost of pain management on the healthcare system is staggering, burdening the U.S. with $560 to $635 billion dollars annually.

Low back pain is one of the most common conditions needing a costly course of treatment. Medicare has seen a 629% increase in expenditures in epidural steroid injections and a 423% increase in expenditures for low back pain over the last five years. In spite of this, the rate of pain is increasing, not decreasing.

Physical therapists are key members of the pain management healthcare team that can provide effective treatment to patients with chronic pain. Physical therapy provides an alternative to prescription opioid use, providing a variety of treatment techniques that have proven effective against chronic pain. Therapists utilize therapeutic dry needling, joint mobilizations, myofascial release, and exercise, providing a safe environment for patients on the path of rehabilitation.

The differentiating factor that separates physical therapy from other types of health care providers is the amount of time spent with patients during treatment visits. During this time physical therapists are also able to educate patients about management of their pain. A goal of patient education is to help the patient understand that pain is a healthy biological response, and that pain and injury are not synonymous.

If you’re experiencing pain, or would like help with your pain management, please contact your Arizona physical therapy experts at Foothills Sports Medicine for more information.



  1. Louw A., & Puentedura E. (2013). Therapeutic neuroscience education: Teaching patients about pain: A guide for clinicians. Story City, IA: International Spine and Pain Institute.
  1. Centers for Disease Control and Prevention
    • Retrieved 2016, from http://www.cdc.gov/drugoverdose/data/analysis.html
    • Retrieved 2016, from http://www.cdc.gov/drugoverdose/epidemic/index.html

Foothills Sports Medicine Physical Therapy is a Gilbert physical therapy provider that offers a wide range of services to patients across the Valley. We create a customized plan for each patient that is tailored to your specific needs to ensure success. To schedule a free assessment with one of our amazing staff members, simply go online here today. For more information about Gilbert physical therapy and what we can offer, follow our blog!

Gabe Lucas, PT, CSCS, and owner of our Gilbert-Mesa location, has been practicing physical therapy for over 15 years. He has extensive experience in outpatient orthopedics and treating sports injuries, including tendonitis and tendinosis. He explains what causes these conditions and how to prevent them.

The posterior tibialis is an important muscle that runs from the lower leg down to the ankle, then fans out into different bones of the foot. It absorbs shock when a person is running or walking, making it a common source of injury for runners, soccer players, and other athletes. It is typical for individuals to experience a gradual onset of pain across the inner part of the lower leg and/or ankle with increases with activity. When this increase in activity occurs, the muscle may become irritated due to overuse, which can result in posterior tibialis tendonitis. If not treated early and properly, the tendonitis may develop into a more chronic issue called tendinosis—the formation of scar tissue in the muscle’s tendon.

Physical therapists can treat posterior tibialis tendonitis as well as tendinosis. If patients seek treatment early enough, physical therapy can help prevent fibrosis from occurring with exercise prescription, manual therapy, and the use of modalities such as ultrasound and e-stim.

These methods are used to help decrease irritation and inflammation within the tissue. It is most common for physical therapists to see patients when the issue has unfortunately progressed to a chronic and fibrotic state. In this case, treatment techniques such as instrument assisted soft tissue mobilization and trigger point dry needling are very effective in stimulating blood flow to the area. This stimulation will help commence the healing process and is the first step in assisting the patient with returning to their prior level of function.

Finally, the most vital component of physical therapy is to determine the cause of posterior tibialis tendonitis/tendinosis. There are several possible causes including flat feet, improper footwear, altered lower extremity biomechanics, recent injury, or a dramatic fluctuation in activity. The therapists at Foothills are trained to analyze the causes of tendonitis, and can help you with any issues you may have. If you are experiencing inner ankle pain, inner lower leg pain, or pain with walking or running, please contact your Foothills physical therapist for a free consultation