How to Use Blood Flow Restriction (BFR) to Accelerate Your Recovery After Achilles Repair

Zarah Anvery, DPT, OCS, MPH.

If you've recently undergone Achilles tendon repair, you’re probably wondering how to regain strength, mobility, and confidence in your leg. Blood Flow Restriction (BFR) training has become a powerful adjunct to rehab — especially in the early stages when traditional strengthening isn’t safe yet.

In this post, we’ll walk through a phase-by-phase guide to using BFR after Achilles surgery, based on the protocols used by physical therapists treating high-level athletes.

What is BFR?

Blood Flow Restriction (BFR) uses a specialized cuff to partially restrict blood flow to a limb during low-load exercises. This creates a metabolic environment that mimics heavy resistance training, allowing patients to build strength safely during the early healing process.

BFR can be especially beneficial after Achilles tendon repair, where early weight-bearing and high-load exercises are typically restricted.

PHASE I: Immediate Post-Op (Weeks 1–3)

Goals:

• Protect surgical site

• Minimize muscle atrophy

• Promote circulation and healing

BFR Protocol:

• Frequency: 1–2x/day

• Exercises:

  • Supine quad sets

  • Glute sets

  • Straight leg raises (with brace if needed)

  • Ankle pumps (unloaded, within precautions)

BFR Parameters:

• 80% limb occlusion pressure

• 5 sets of 30/15/15/15/15 reps

• 30 seconds rest between sets

• Keep total BFR time under 10–15 minutes

Note: All exercises are performed without load and with brace or boot in place as directed by your surgeon.

PHASE II: Protected Mobilization (Weeks 4–6)

Goals:

• Begin gentle ROM

• Continue preventing atrophy

• Initiate neuromuscular re-education

BFR Protocol:

• Frequency: 3x/week (under supervision)

• Exercises:

  • Seated heel slides

  • Straight leg raises

  • Mini bridge holds

  • Seated BFR bike (if cleared)

BFR Parameters:

• Same 5-set protocol: 30/15/15/15/15

• Slowly begin isometric gastroc/soleus contractions (in protected position)

Note: ROM still restricted — avoid excessive dorsiflexion!

PHASE III: Strength & Functional Loading (Weeks 7–12)

Goals:

• Restore strength

• Begin functional activities

• Improve balance and proprioception

BFR Protocol:

• Frequency: 2–3x/week

• Exercises:

  • Seated or standing calf raises (double leg initially)

  • Step-ups

  • Terminal knee extensions

  • Balance work with BFR (optional)

BFR Parameters:

• Still low-load (<30% 1RM)

• Gradually increase load as tolerated

• Reduce cuff pressure and frequency over time

Note: Most patients will wean off BFR by week 12, transitioning to full resistance training.

Key Takeaways

• BFR offers a safe and effective method to maintain strength and accelerate healing after Achilles tendon repair.

• Following a structured, phase-based protocol helps minimize risk and maximize benefit.

• Always perform BFR under supervision of a licensed professional trained in its use, especially in the early stages of recovery.

Final Thoughts

If you're recovering from surgery, you don’t have to wait months to rebuild strength. With BFR and smart rehab, you can take proactive steps—starting now.

Want help implementing a BFR program tailored to your recovery? Reach out to learn more!

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