• What is Personalized Blood Flow Restriction rehabilitation (PBFR) training?

    It is the application of a specialized tourniquet system to a proximal arm or leg, which is inflated, to a personalized and specific pressure to reduce blood flow to an exercising extremity. The application is brief and intermittent, typically about 6 minutes per exercise, but can last up to 30 minutes based on the specific protocol. With PBFR you can create significant strength and hypertrophy gains with loads as low as 20% 1RM.

    The exact mechanism behind the positive results seen with PBFR is still being extensively researched. Theories range from a significant build up of metabolites by anaerobic metabolism, a systemic anabolic response and cellular swelling. It is most likely a combination of multiple factors. It does appear that muscle protein synthesis plays a primary role as this has been consistently demonstrated in the literature.

  • Is there any research for personalized blood flow restriction? Does it work?

    Yes, there is a substantial amount of literature that has studied the effects of PBFR. In fact, a recent meta-analysis found a total of 820 articles pertaining to PBFR. The authors of the review concluded “Importantly, research suggests that low load resistance exercise (20–30% 1 RM) and low load aerobic exercise (<70 m/min walk training), which would not be expected to cause considerable increases in muscular quantity or quality under normal circumstances, when combined with PBFR produced an exaggerated response for maximizing muscle strength and hypertrophy.” http://www.jsams.org/article/S1440-2440(15)00182-6/abstract?cc=y=

    PBFR consistently demonstrates greater results compared to work matched controls exercising without PBFR. The positive results have been seen in patients after injury, in the elderly, and in athletes. It has also been applied extensively in a military rehabilitation setting on severely compromised patients. http://www.defense.gov/news/newsarticle.aspx?id=123685

    Upon completion of the certification course, the clinician will be very well versed in the PBFR literature, the scientific rational as well as how to apply it clinically.

  • How does PBFR work?

    The exact mechanism behind the positive results seen with PBFR is still being extensively researched. Theories range from a significant build up of metabolites by anaerobic metabolism, a systemic anabolic response and cellular swelling. It is most likely a combination of multiple factors. It does appear that muscle protein synthesis plays a primary role as this has been consistently demonstrated in the literature.

  • Is PBFR safe?

    PBFR has consistently demonstrated to be a safe modality in the literature. It has been performed on thousands of subjects in the peer-reviewed literature with little to no side effects.

  • Why would I want to do this in a clinical setting?

    After injury or surgery a patient is usually unable to lift loads or at an effort level known to induce skeletal muscle adaptation. PBFR allows the clinician to begin the strength and hypertrophy phases of rehabilitation much earlier. PBFR has demonstrated statistically significant improved patient outcomes after anterior cruciate ligament surgery both acutely and chronically. http://www.ncbi.nlm.nih.gov/pubmed/11128848http://www.ncbi.nlm.nih.gov/pubmed/12635796

    Very compromised patients suffering inflammatory muscle wasting diseases such as polymyositis and dermatomyositis have also demonstrated positive results without any potential safety risks. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232679/

    It has also demonstrated improved results in patients who have suffered severe musculoskeletal trauma https://www.jsomonline.org/Newsletter/140715.html and in women with risk factors for symptomatic knee osteoarthritis http://www.ncbi.nlm.nih.gov/pubmed/25289840.

    Clinically our providers have applied it to many diagnoses with very positive results including but not limited to total joint arthroplasties, Achilles repairs, fractures, rotator cuff repairs, muscle strains, nerve injuries, post-operative knee reconstructions and cartilage repairs, and tendinopathies.

  • Are there educational requirements to perform Blood Flow Restriction?

    There aren’t any strict requirements around education for Physical Therapists prior to using BFR. It’s up to the clinician to determine whether they are competent in the application. The wording from APTA is that BFR is within the scope of practice of physical therapists, but “Each PT should consider his or her personal scope of practice before engaging in BFRT.” The primary goal with our certification course is to make clinicians competent in the application of Blood Flow Restriction and proper tourniquet application and safety. We are committed to providing the most up to date, evidence-based information on BFR and being a resource beyond the course.


    The ORS certification course is the only CME that meets the educational requirement to purchase and use the Delfi PTS for BFR tourniquet system.

  • Why buy Delfi when there are cheaper options?

    We commonly get asked about how the Delfi device compares to others in the market.

    • Delfi has a proven track record of medical device manufacturing over the last 30 years making industry-standard surgical grade tourniquets.
    • Delfi has a proven track record of innovation and quality in the area of tourniquet design and manufacturing.
    • Delfi revolutionized tourniquet systems in 1980 with the invention of the microprocessor.
    • The Delfi microprocessor is credited with markedly reducing the incidence of nerve injury from surgical tourniquet application.
    • The Delfi PTS possesses patented limb occlusion pressure (LOP) detection technology.
    • The accuracy of Delfi’s LOP technology has been research validated against a trained doppler ultrasound technician. (https://link.springer.com/article/10.1007%2Fs40846-016-0173-5)
    • The Delfi system has research validation demonstrating it applies consistent pressure throughout the exercise (https://onlinelibrary.wiley.com/doi/10.1111/sms.13092).

    The Delfi PTS for BFR is the most objective and safe way to perform and personalize BFR. Ultimately it is the responsibility of the clinician to decide what device to use for BFR. We prefer the objectivity of the Delfi device as it ensures a uniform application regardless of individual patient characteristics. Additionally, this objectivity allows a clinician to substantiate their choice in a BFR device.

    The Delfi PTS for BFR is the trusted BFR system used by the Department of Defense, the largest healthcare systems, US Olympic teams and professional and collegiate sports. In fact, the Delfi PTS for BFR is the only BFR device available on professional sports workers compensation in every league.

    For more information on Delfi and the Delfi PTS, including certificates of use, visit: http://www.delfimedical.com/personalized-bfr/

  • Is the Delfi PTS for BFR FDA Approved?

    Medical devices such as tourniquets are not given FDA approval like drugs. Medical devices are listed within the FDA registry. For access to the Delfi PTS for BFR listing click here: (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/rl.cfm?lid=62061&lpcd=KCY). Technically no BFR device is listed as such with the FDA. Rather, BFR devices fall under the FDA listing for surgical-grade pneumatic tourniquet systems; not for a Blood Flow Restriction device. The FDA does not differentiate between the two, both are intended to limit blood flow into a limb.


    ORS also must register with the FDA to legally distribute a medical device. Here is a link to our listing (https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfRL/rl.cfm?rid=186481)

  • Who can purchase a Delfi PTS for PBFR system?

    At this time, only those licensed medical healthcare providers that have completed an Owens Recovery Science PBFR certification training may purchase a Delfi PTS for PBFR system. This includes the following providers: Medical Doctors, Physical Therapists, Athletic Trainers, Chiropractors and Occupational Therapists.

  • Can I bill for PBFR Rehabilitation in the clinic?

    At this time, there is no specific billing code for PBFR. However, you perform exercise while performing PBFR which allows the clinician to bill therapeutic exercise (97110) while doing PBFR. In todays outcome driven healthcare system the ability to potentially improve exercise results with the addition of PBFR can be very beneficial to the clinician.

  • Does PBFR fall within My Practice Act?

    The American Physical Therapy Association recently performed a 10 state review spread geographically across the United States to determine if PBFR falls within those states practice acts. The APTA determined that PBFR does fall within each of those states practice acts for Physical Therapists.

    See review here: https://www.apta.org/PatientCare/BloodFlowRestrictionTraining/

    Similarly the Board of Certification for Athletic Trainers in its Spring 2018 AP Update provided some guidance for ATC’s and whether or not their license allows them to perform PBFR.

    See article here: http://www.boc-digital.org/bocatc/summer_2018/MobilePagedArticle.action?articleId=1404065#articleId1404065

  • I am planning on taking a PBFR certification course; can I pre-purchase my unit(s)?

    Yes. We are able to process your order at anytime. The unit will be shipped to your physical address after your course completion.

  • How large is the unit? Is it portable?

    The unit is very light and portable. The exact dimensions of the tourniquet pump are:

    Height: 180 mm (7.0 inches)

    Width: 120 mm (4.7 inches)

    Depth: 110 mm (4.3 inches)

    Weight: 1.08 kg (38.0 oz)

    In the clinical setting using a rolling stand makes it very easy to move the system.