Your first blood flow restriction session, step by step.

Bring a list of your medications and a summary of your health history, including any history of blood clots, heart or blood vessel conditions, and any surgery in the last year. The screen at the start of the session depends on it, and the conditions that matter are listed in the safety guide in this hub. If a surgeon has given you loading restrictions, bring those too, because they set the ceiling for what you will do under the cuff.

Wear shorts if the cuff is going on your leg, or a sleeveless top if it is going on your arm. The cuff sits at the top of the limb, against the skin or a thin layer of clothing, and needs to be positioned and checked. Bring your ICBC claim number or WorkSafeBC claim details if the injury is covered under either, and your extended health card if you plan to direct bill.

The New Westminster studio is inside Shops at New West, above New Westminster SkyTrain station. There is elevator access from the platform. If you are driving, Carnarvon Street parking and the mall parkade are a short walk away. The studio is open 7am to 8pm Monday to Friday and 9am to 5pm on weekends, as of the hours published on 22 September 2026.

Before the cuff comes out, your physiotherapist runs through the conditions that change the decision. Some rule BFR out for now: an untreated or recent blood clot, an active infection in the limb, certain heart and blood vessel conditions. Others call for a closer look or a word with your physician: a history of clots, blood pressure that is not well controlled, pregnancy, and a list of others covered in the safety guide.

This is standard practice, and the 2024 survey of allied health practitioners in the Journal of Strength and Conditioning Research found that 68.2 percent of those using BFR screen for contraindications before applying it. We screen at the first session and re-check at each visit, because a new medication, a surgical date or a new symptom can change the answer between appointments.

If something in the screen needs a physician's input, the session continues without the cuff. You still get a full physiotherapy assessment and a plan, and the cuff is added once the question is answered. Nothing is lost by asking.

The cuff is placed at the top of the thigh or the upper arm and inflated slowly while your physiotherapist checks the pulse below it, with a Doppler probe or the cuff system's own sensor. The pressure at which the pulse disappears is your arterial occlusion pressure, or AOP, for that limb on that day. The cuff is then deflated.

The working pressure is set as a percentage of that number, between 40 and 80 percent under the 2019 position stand, with the lower end common for the arms and for a first session. Because AOP depends on your limb size, your blood pressure and the cuff width, it is measured on you rather than looked up. This is the step that separates a clinical application from a strap pulled tight by feel, and it takes a minute or two.

You will feel the cuff go tight during the measurement and the limb may feel full or tingly for a moment at the top pressure. That passes as soon as the cuff deflates. The working pressure is lower and feels like a firm blood pressure cuff that stays on.

The exercise is one you can already do: a leg press, a knee extension, a calf raise, a sit-to-stand, a biceps curl, chosen for your injury and your stage. The load is light, 20 to 40 percent of your estimated maximum, which means a weight you could normally lift thirty times or more without trouble. Under the cuff you will not find it easy.

The standard protocol from the position stand is 30 repetitions, then 15, 15 and 15, with 30 to 60 seconds of rest between sets and the cuff kept inflated through the rest. By the end of the first set the muscle is burning and heavy. The shorter sets keep it there. If you cannot complete a set, that is information, and the load or pressure is adjusted rather than pushed through.

The cuff is released as soon as the four sets are done, and blood rushes back into the limb, which feels warm and full for a few minutes. If a second exercise is planned, the cuff is reinflated for that one. Time under the cuff for a single exercise is a few minutes, and the cuff is never left on through the rest of the appointment.

Expected: a tight cuff, a heavy and full limb, a burning muscle that tires far earlier than the weight would suggest, and a wish for the set to end. The position stand describes muscle swelling immediately after BFR as consistent, returning to baseline within 24 to 48 hours, and muscle soreness in the days after as consistently raised above baseline and short-lived. Bruising under the cuff is possible; the 2006 Japanese survey of 12,642 people reported it in 13.1 percent.

Not expected: numbness, pins and needles, or a cold or pale hand or foot below the cuff. The position stand links numbness to pressures applied outside the research guidelines, and the survey reported it in 1.297 percent of people. Any of these means the pressure comes down or the cuff comes off, and you should say so immediately rather than finishing the set.

Also not expected: chest pain, shortness of breath, faintness that does not pass with the cuff released, or pain in the calf or limb that feels different from muscle fatigue. These are stop-and-assess signs regardless of the cuff. Your physiotherapist watches for them and asks you to report anything that does not feel like ordinary exercise effort.

That evening the limb feels worked. The next day or two you will have muscle soreness of the ordinary kind, often more than the light weight would seem to justify. It settles. Swelling in the muscle settles within 24 to 48 hours according to the position stand. If soreness is severe, or the limb swells and stays swollen, or you notice a hot, red or painful area, contact the studio the same day, and treat a swollen, painful calf as a same-day medical question.

Between sessions you continue the rest of your program without the cuff. BFR sessions run 2 to 3 times a week in a standard block, or in a short daily block straight after surgery, and the cuff is used only under supervision. Do not buy a cuff to repeat the session at home; the pressure cannot be set properly and the screen cannot be repeated.

At the next visit your physiotherapist asks how the limb responded, re-checks the screen, and adjusts the load, the pressure or the exercise. Progress over a block is measured in the strength and size of the muscle and in how the joint tolerates loading, with the aim of moving to heavier, unrestricted loading as soon as the tissue allows.