Background/Purpose: Knee osteoarthritis (OA) is one of the most prevalent musculoskeletal disorders in the world. Current guidelines for the non-surgical management of knee OA include the recommendation of quadriceps strength training. Current recommendations for strength training include high load resistance training at 60-80% 1RM, which is often not feasible in patients with OA due to the pain associated with the high compressive forces in the joint from the high loads. Low-load blood flow resistance training (LL-BFRT) is an emerging area of interest in research as a means that may provide similar results without eliciting pain. The purpose of this analysis is to determine if LL-BFRT is as effective as high-load resistance training at increasing knee extensor strength in patients with knee OA.

Case Description: The patient is a 62-year-old male referred to an outpatient orthopedic physical therapy clinic for the evaluation and treatment of symptomatic left knee OA. The patient is otherwise healthy and continues to be active. The patient’s chief complaint is knee pain during occupational and recreational activities. The patient’s goal is to reduce his pain and to delay or avoid a total knee arthroplasty (TKA).

Outcomes: All 8 studies showed an increase in knee extensor strength with the intervention, although some only minimally. The studies included subjects with either radiographic knee OA, symptomatic knee OA, anterior knee pain, or post TKA secondary to knee OA.

Discussion: LL-BFRT has been shown to be effective at increasing knee extensor strength with less associated pain than high-load resistance training. However, protocols and higher quality studies are needed as well as studies including individuals with co-morbidities to determine the true safety and efficacy of this intervention.

Document Type


Degree Name

Doctor of Physical Therapy (DPT)

Level of Degree


First Advisor

Ron Andrews, PT, Ph.D., OCS


Blood flow restriction training, Kaatsu training, knee extensor strength, knee osteoarthritis