History of Blood Flow Restriction Training: Where Did it Come From?

Given the practice itself seems relatively odd when you first hear it (we’re purposely going to restrict blood flow? Isn’t that counterproductive?), we think it’s important to cover a brief history of blood flow restriction training.

In this article, we’ll discuss who thought of the concept to begin with (and why), when research began to emerge, and how we got to where we’re at today in the scientific landscape of BFR training.

BFR Origins

If you’ve had at least some exposure to BFR, you’ve likely heard the word KAATSU. You may think of that as the brand KAATSU that sells BFR cuffs.

While it’s true there is a BFR brand called KAATSU, the term dates back much further than the brand.

The legend goes a bit like this. 

In 1966, a man named Yoshiaki Sato was attending a memorial service. In traditional Japanese posture, he was sitting on his knees (see the image below for a reference).

After some time in that position, he noticed a fairly significant discomfort in his legs and postulated that this was due to the circulation to his calves being cut off, or at least impacted.

He recalled the sensation as similar to what you’d feel from resistance training (I.E. calf raises).

He had experience in bodybuilding at the time, so he was well acquainted with the feeling.

This caused him to ponder whether restricting blood flow has any correlating benefits to resistance training - the curiosity led him on a 6-7 year journey of exploration and testing, where he ultimately developed the methodology behind “KAATSU” or the Japanese word for pressure.

Later, he developed and commercialized BFR cuffs under the name KAATSU, but the origins came from his early experimentation of BFR generally, which is why people to this day often tend to conflate the two terms.

Blood Flow Restriction Early Research 

It wasn’t until about 3 decades later that blood flow restriction began to emerge in the literature, at least at scale.

There’s a bit of deliberation within the scientific community when the first bit of BFR research was published. Technically, people will point out that there are published studies from the 1930s where cuffs were applied for some form of limb occlusion, but this was not for the purpose of increasing muscle function, so we’re going to put those aside for now.

Many will regard a study published in 1998 by Shinohara as the catalyst for modern day blood flow restriction research - at least in the way that we view BFR today.

Quick caveat: of course, a search on pubmed will reveal earlier studies - for example, we were able to find one out of Sweden from early 1994.

Largely though, Shinoharra’s 1998 paper is referenced as the precipice of BFR literature.

The researchers used a within-subject unilateral design, which allowed for the subjects to serve as their own control. This method is very effective with BFR research and has been replicated (rightly so) many times.

Put simply, this just means that they had the subjects undergo a specific protocol (in this case, single leg isometric knee extension training) where only one leg had a BFR cuff applied. This makes the design relatively straightforward - just observe differences in specific outcomes between limbs.

They looked only at strength, where they observed a 26% increase in strength in the BFR leg, with no significant strength increase in the other leg.

Evolution of BFR Research

Fast-forward nearly 25 years and there are now hundreds of peer-reviewed papers highlighting the benefits of blood flow restriction training.

The scientific community has studied BFR’s application in multiple verticals now, including:

• Rehabilitation
• Muscle endurance and aerobic capacity
• Hypertrophy
• Strength
• Pain management

So far, blood flow restriction has withstood the test of time and rigorous scientific scrutiny. We still have much to learn about the practice - in fact, some of its mechanisms are still unknown. In other words, we know it works, but can’t fully explain why.

As new research emerges, you’ll be able to find succinct and sophisticated breakdowns right here at SAGA.

We’ll also be delivering methodical breakdowns of meta-analyses and systematic reviews around different BFR topics - from athlete performance, to rehabilitation, systemic effects, to safety and much more.

For now, we hope this gave you a clear picture of the origins of blood flow restriction and how we got to where we are today.

We’ll see you on the next article in our educational series.