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Synopsis Restoration of skeletal muscle mass and strength are critical to successful outcomes following orthopedic surgery. Blood flow restricted resistance exercise (BFR) has emerged as an attractive candidate to augment traditional low intensity physical rehabilitation exercise, and has yielded successful outcomes over a wide variety of applications. BFR is well tolerated and safe for the majority of individuals, though the post-surgical orthopedic patient has additional considerations due to their heightened risk for venous thromboembolism (VTE). While the pathogenesis of VTE is multifactorial and individual specific, it is commonly described as a combination of blood stasis, endothelial injury, and alterations in the constituents of the blood leading to hypercoagulability. The collective literature suggests that, given the pathogenic mechanisms of VTE, the finite use of a wide, partially occluding cuff during resistance exercise should be low risk and that the likelihood of BFR directly causing a VTE event is remote. Alternatively, it is plausible that BFR may enhance blood flow and promote fibrinolysis. Of greater concern would be the individual with preexisting asymptomatic VTE, which could be dislodged during BFR. Though, it is unknown if the direct risk associated with BFR is greater than the risk associated with traditional exercise alone. Presently, there are no universally agreed upon standards indicating which post-surgical orthopedic patients may perform BFR safely. While excluding all post-surgical orthopedic patients from performing BFR may be overly precautious, clinicians need to thoroughly screen for VTE signs and symptoms, be cognizant of each patient's risk factors, and use proper equipment and prescriptions methods prior to initiating BFR. J Orthop Sports Phys Ther, Epub 12 Sep 2018. doi:10.2519/jospt.2019.8375.

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