Date Approved


Graduate Degree Type


Degree Name

Athletic Training (M.A.T.)

Degree Program

Health Professions

First Advisor

Tonya Parker

Second Advisor

Matthew Feeback

Academic Year



Purpose: To determine if using Blood Flow Restriction (BFR) combined with low-load exercise can elicit an increase in strength and tendon size of the distal biceps tendon when compared to high-load exercise protocol. Methods: Twenty-one participants (11 M, 10 F; 2 Left-handed: 19 Right-handed; Age range 18-25yoa) were randomized to either the treatment group (BFR + low load exercise) or the control group (high load exercise). Participants were enrolled in a 7-week exercise protocol, with exercise sessions held twice weekly. The first week included measurements of each participant's 1 repetition maximum (1RM) and ultrasound measurements of the dominant distal bicep’s tendon. Participants in the experimental group performed seated biceps curls with the BFR cuff (Smart Tools) placed over the deltoid tuberosity, with the limb occlusion set to medium intensity. The Smart Tools device occluded the limb fully, then released down to 20% occlusion rate. BFR participants performed 4 sets of the exercise with 30 reps performed for the first set followed by 15 reps for sets 2 through 4 using a weight that was 40% of their predicted 1RM. Participants in the high-load group performed the same exercise for a duration of 4 sets with 10 reps for the first set followed by 8 for set 2 and 6 for sets 3 and 4, at 80% of their predicted 1RM. At the midpoint ultrasound measurements were taken. At the conclusion of the 7-week protocol final 1 repetition maximum and ultrasound imaging on the distal bicep’s tendon was performed. Results: There was a significant increase in muscle strength as measured by 1RM (p=.003). Within subject contrast revealed an increase in tendon size at each data point that was taken throughout the 7-week training period (p<.001). Conclusion: Both groups demonstrated increased tendon thickness over the 7-week protocol. However, exercise with the BFR cuff applied to the upper extremity did not elicit a greater increase in tendon thickness when compared to the control group. The data analysis does demonstrate that using low-load BFR can elicit similar effects as performing high-load training. Further data collection is ongoing, as more research is still needed on the topic.