No, taking a course is not a requirement, but it is the recommended best practice. A BFR course will give you the most up-to-date information on how to apply BFR to meet your population. The course also walks through the safety considerations of BFR and how to determine who is appropriate.

If you feel like you already have all of the information you need to use BFR in your practice and you fall into one of the approved categories for purchase, then you can purchase the device without attending a course.

We strongly recommend taking a course if:

• You are new to  Controlled Blood Flow Training (BFR)
• You want to ensure optimal patient outcomes
• You want hands-on training with the equipment

Yes. When performed with appropriate equipment, personalized pressures, and trained supervision, Controlled Blood Flow Training (BFR) has been shown to be as safe as—or safer than—traditional high-load resistance exercise.

Across thousands of participants studied in peer-reviewed clinical and performance research, the incidence of adverse events with BFR is extremely low, comparable to that of other standard exercise interventions. Reported side effects are generally mild and transient—such as temporary skin redness, mild discomfort, or lightheadedness—and resolve quickly with cuff deflation.

The Delfi BFR Pro system (previously known as the Delfi Personalized Tourniquet System, PTS), used in hospitals, rehabilitation centers, and research settings worldwide, has been featured in over 145 published studies demonstrating its excellent safety, accuracy, and pressure control.

The papers on our Research & Literature page provide a comprehensive safety profile of Controlled Blood Flow Training (BFR) as observed in the literature.

Additional topics and resources that relate to the safety discussion:

VTE/DVT; Venous Thromboembolism/Deep Vein Thrombosis

Podcast with the folks who wrote the Clinical Practice Guidelines

Blog from ORS, Owens Recovery Science, on Controlled Blood Flow Training, BFR, and VTE

Hemodynamics

Podcast with Jamie Burr, PhD from ORS

Blog on hemodynamics from ORS

Yes. Controlled Blood Flow Training, also commonly referred to as Blood Flow Restriction (BFR) training, is one of the most extensively researched rehabilitation interventions in recent decades.
Hundreds of peer-reviewed studies have examined its physiological mechanisms, safety profile, and clinical effectiveness across diverse populations and applications—from post-operative and orthopedic recovery to neurologic and geriatric rehabilitation, cardiovascular conditioning, and athletic performance enhancement.

Within this broad body of literature, the Delfi BFR Pro (Delfi Personalized Tourniquet System) has been used and validated in over 145 peer-reviewed publications, establishing its accuracy, reproducibility, and safety as the clinical standard for personalized BFR.

This research spans:

• Mechanistic studies exploring muscle physiology, cellular signaling, and endocrine responses
• Safety and hemodynamic investigations confirming tolerance in both healthy and clinical populations
• Clinical trials and meta-analyses demonstrating improved strength, hypertrophy, and functional recovery
• Orthopedic, neurological , and geriatric applications , including post-surgical , chronic pain, and mobility-limited populations
• Performance and return-to-play studies in elite and tactical athletes

For complete details on the contraindications and precautions, please refer to the Information for Use ( IFU) available at delfimedical.com/ifu

Almost any patient that is cleared to participate in exercise but can’t perform exercise at a high enough intensity to cause adaptation could benefit from Controlled Blood Flow Training. Nothing about BFR is diagnosis-specific. Common applications include:

Post-Surgical Rehabilitation:

• ACL reconstruction
• Meniscus repair
• Rotator cuff repair
• Total joint replacement
• Achilles tendon repair

Injury Management:

• Muscle strains
• Tendinopathies
• Stress fractures (during non-weight bearing phases)
• Chronic pain conditions

Special Populations:

• Elderly individuals with sarcopenia
• Osteoarthritis patients
• Cardiac rehabilitation (with appropriate screening)
• Neurological conditions (MS, stroke, Parkinson’s)
• Athletes during in-season load management

For specific examples and protocols, see Owens Recovery Science (ORS) blogs on:

• Managing ACLs with PBFR
• Managing Muscle Strains
• BFR for the Older Individual

Controlled Blood Flow Training (BFR)— commonly referred to as BFR training and sometimes called occlusion training —involves placing a specialized pneumatic cuff around the upper portion of the arm or leg during exercise. The cuff safely limits venous return while maintaining partial arterial inflow, creating a controlled environment of reduced oxygen availability within the muscle.

This unique physiological state allows individuals to achieve muscle strength, size, and endurance gains typically associated with heavy-load training—but while performing low-intensity exercise that’s joint-friendly and ideal for rehabilitation or deload phases .

To ensure both safety and efficacy, the pressure applied should be personalized to each individual’s Limb Occlusion Pressure (LOP)—the minimum pressure required to fully occlude arterial flow in the limb.  We refer to this evidence-based approach as Controlled Blood Flow Training (BFR).

Typical target pressures are:

• Upper extremity: 40–50% of individual LOP
• Lower extremity: 60–80% of individual LOP

The Delfi BFR Pro system uses patented and proprietary technologies to automatically determine LOP and autoregulate, ensuring precise, repeatable, and individualized pressure control for every limb, every session.

If you want to dive deeper into BFR, you can find some of the key papers on our Research & Literature Page or a more thorough explanation on the page  About Controlled Blood Flow Training.

To find a certified educator, please contact Owens Recovery Science or our distributors if you are outside the USA.

If you can’t find a distributor in your region, send us an inquiry, and we’ll happily assist you in finding the right certification course to start your career as a Controlled Blood Flow Training Professional.

40 Years of Tourniquet Technology: Delfi has been making devices to Control Blood Flow into limbs for forty years. We modernized surgical tourniquet systems with the invention of the microprocessor in 1980, dramatically improving accuracy and decreasing risk. Prior to that, tourniquet systems were more likely to cause nerve injuries due to excessive pressure. All tourniquet systems used in surgical suites today are based on the Delfi microprocessor design.

Only Patented LOP Technology: Delfi holds the only patent on Limb Occlusion Pressure (LOP) measurement technology. Despite the BFR industry being nearly a decade old, this remains the gold standard for personalized pressure application.

Independent Research Validation: The Delfi BFR Pro system has independent research validation showing that it does what it claims to do:

• LOP Assessment Accuracy
• Consistent Pressure During Exercise
• Over 90 peer-reviewed publications using the Delfi system; see some of them on our Research & Literature page.

Surgical-Grade Patented Autoregulation: Research shows the Delfi system maintains target pressure within ±15 mmHg during dynamic exercise, even with muscle contractions. This level of accuracy and responsiveness is unmatched in the BFR market.

No Recurring Costs: Unlike some competitors, there are no subscription fees or ongoing costs beyond the initial device purchase and replacement cuffs as needed.

Clinical and Research Acceptance: Used in major research institutions, military rehabilitation centers, and professional sports organizations worldwide.

It’s really up to you as the clinician to decide what you feel is necessary to apply BFR clinically and how objective that application needs to be. We typically recommend that whatever device you choose to use, be able to defend why you chose it.

Controlled Blood Flow Training, BFR, can be used as a strategy to make exercises stressful enough to induce an adaptive response. Almost any patient who is cleared to participate in exercise but can’t perform it at a high enough intensity to cause adaptation could benefit from Blood Flow Restriction Training.

Key Clinical Advantages:

• Achieve muscle hypertrophy with loads as low as 20-30% of 1RM
• Reduce joint stress and compression forces
• Start resistance training earlier post-surgery (as early as day one post-op)
• Maintain muscle mass during immobilization or restricted weight-bearing
• Add training volume without excessive mechanical load
• Reduce pain during rehabilitation
• Accelerate return to function timeline

If you want to dive deeper or see examples of how BFR has been used, see blogs and podcasts from Owens Recovery Science:

Blogs:

• BFR After Anterior Cruciate Ligament Reconstruction
  • Managing ACLs with PBFR
  • More than Just Muscle
• Managing Muscle Strains
• BFR for the Older Individual
• BFR and Pain

Podcasts:

• Heart Failure and BFR?
• The Chanda Plan Podcast
• BFR in Persons with Multiple Sclerosis with Mark Mañago, PT, DPT, PhD, NCS
• BFR in Neuro Rehab with Nicole Walter, PT

Yes, you can. Send a message with your information as a Service Request here. 

Be prepared to include the serial number and a description of any issues you’re experiencing when you reach out.

Yes. Delfi offers both reusable and sterile single-use cuffs, as well as a hybrid option:

• Reusable cuffs: Easi-Fit, Petite-Fit, Vari-Fit.
• Sterile single-use cuffs: Easi-Fit, Pedi-Fit, Vari-Fit.
• Hybrid cuff (Adaptive): Supplied sterile for initial use and may be reused up to five times following appropriate cleaning between uses.

Delfi Pediatric Cuffs are specifically designed with appropriate width and application ranges for pediatric limbs. This helps maintain proper cuff-width-to-limb-size relationships, which are associated with achieving occlusion at lower pressures.

The PTSii performs automatic self-calibration. Annual calibration is recommended as part of routine maintenance or following any unscheduled service.

Delfi offers a dedicated calibration service. Contact: service@delfimedical.com

The PTSii inflates a 34-inch cuff on a 30-inch thigh to 350 mmHg in less than 5 seconds.

Yes. The PTSii can be configured as a twin system, where each unit operates independently. This supports use during simultaneous bilateral limb procedures and IVRA (Bier Block).

The twin configuration also allows the units to be separated and used independently in different operating rooms when needed.

The PTSii incorporates multiple safety mechanisms, including:

• Automatic system self-checks
• Continuous pressure regulation
• Integrated cuff leak detection
• Continuous self-monitoring
• Positive Locking Connector (PLC)

Wider cuffs generally require lower pressure to achieve arterial occlusion compared to narrower cuffs. Clinical guidance recommends selecting cuff width and length based on limb size and circumference to support safe and effective use.