Do not set a player’s blood flow restriction (BFR) pressure from a lying-down test if the exercise will be seated or standing. Test the same cuff, thigh position and body position the player will use in the drill.

A lying-down pressure test can give staff the wrong number for seated knee-extension work, standing calf raises or walking.

Alves et al.’s 2026 Frontiers in Physiology study tested fifty-one healthy adults with an 18 cm thigh cuff in lying, seated and standing positions. Leg fat related to the seated pressure reading, while lean and fat mass related to the standing reading.

Blood pressure and thigh size explained more of the pressure reading than body-composition labels. Systolic blood pressure carried the largest part of the pressure difference the model could explain, from 38.4% to 65.0% across positions. ¹

A player tested lying down may not get the same level of restriction when the cuff is used with the leg hanging down or loaded.

The record needs the body position, cuff width, cuff placement, pressure reading and chosen percentage for each BFR exercise.

Test in the exercise position

In Hughes and colleagues’ 50-person lower-limb study, the average pressure reading, in mmHg, was 187.00 ± 32.5 lying down, 204.00 ± 28.5 seated and 241.50 ± 49.3 standing.

At a 60% target, those averages become about 112 mmHg from the lying-down value and about 145 mmHg from the standing value. The example is illustrative; a lying-down reading can set standing cuff work too low. ²

The 2024 Frontiers body-position and cuff-size paper tested 51 healthy volunteers with 11 cm and 18 cm cuffs. The lower-limb pressure reading was lower lying down than seated or standing with both cuff sizes. ³

When the leg moves from lying flat to seated or standing, the pressure needed at the cuff changes too.

In Sieljacks et al.’s 24-subject study, the wide-cuff pressure reading rose from 148 ± 19 to 177 ± 20 mmHg when the person moved from lying down to seated.

With a narrow cuff, the reading rose from 348 ± 94 to 409 ± 101 mmHg. Staff need a new pressure test when lower-limb BFR changes from lying to seated or standing work. ⁴

Use the same cuff setup

Different cuff widths or models require different pressure readings before the player changes position.

In 116 subjects, Loenneke et al. found narrow cuffs required much higher pressure than wide cuffs to stop arterial blood flow, 235 ± 42 versus 144 ± 17 mmHg. The same paper found thigh size, body composition and blood pressure helped explain the pressure needed. ⁵

Australian Institute of Sport BFR guidelines define the key pressure reading as the pressure required to stop blood flow to a limb. The guidelines recommend individual measurement or calculation instead of a copied number.

The same guidelines list blood pressure, limb characteristics and cuff shape, width and length as factors that influence the full 100% pressure reading. They also say the athlete should use the same cuff in training as in assessment.

Limb position, cuff movement and body changes during exercise can alter the restriction. The pressure record needs the cuff model, cuff width, placement and position beside the reading. ⁶

A common target range is 40–80% of the player’s own pressure reading for resistance and aerobic work. Patterson et al.’s 2019 review describes the method as allowing some blood into the limb while limiting the outflow. ⁷

A fixed pressure number cannot cover every player, limb, cuff and position. Staff are trying to create the same level of restriction for that player, cuff and exercise position.

Fixed pressures miss the target

In one narrow-cuff dataset from Loenneke et al.’s 2013 opinion article, 200 mmHg would have placed 19 of 83 participants at or above the pressure that stopped arterial flow.

The authors argued pressure should be set for the individual and cuff width, not copied from previous studies or based only on arm blood pressure. ⁸

The 2023 review covered 23 studies and 1,335 participants on the things that change the pressure reading. Cuff characteristics, cuff placement, body position, time, sex and limb segment had all been studied.

Body position changed lower-limb readings more than upper-limb readings. The training record therefore needs the cuff, limb segment, body position and timing before staff set the pressure. ⁹

The pressure-position evidence mainly comes from healthy adults, not injured footballers in return-to-play blocks.

A 2024 ACL rehab review found only five studies and said the method seemed to help strength, muscle size and patient-reported outcomes after ACL injury, but more comparable trials were needed. ¹⁰

Staff can use the pressure-position studies to record and repeat cuff pressure. Clinical staff still decide whether BFR fits the player, injury and rehab stage.

Before a lower-limb set, match the planned exercise to the pressure test: same cuff width and model, same cuff position on the thigh, same body position, recorded pressure reading and chosen percentage.

The session record also needs numbness, dizziness, unusual pain or excessive discomfort during the set. If the player moves from a lying quad set to a seated knee extension, standing calf raise or walking, the pressure target should be rechecked in that position or estimated with a method validated for that cuff and posture.