Blood Flow Restriction Consent to Treat
Blood Flow Restriction (BFR) training is a new and innovative way to safely and quickly improve your strength and muscle size. During Blood Flow Restriction, a tourniquet cuff is placed around the arm or leg in order to partially (up to 80%) occlude the blood flow to the limb. This restricts the amount of oxygen being delivered to the muscles and creates a physiological environment where a lighter weight induces the same muscular response as a heavy one. When Blood Flow Restriction is utilized with strength training exercises, it allows for a more rapid increase in muscle size and strength to occur, which can decrease the length of recovery time and after an injury or improve muscle strength, even outside of injury recovery.
Risks/Side-Effects: Muscle soreness is the most common side-effect of Blood Flow Restriction. Mild bruising at or near the tourniquet site is another possible complication. While the soreness and/ or mild bruising can last up to a couple days, neither should have any significant detriment to your activities. While rare, more significant risks with Blood Flow Restriction include dizziness, fainting, muscle damage, nerve injury, or skin injury.
Alternatives: If you do not wish to receive Blood Flow Restriction, this does not exclude you from participating in Physical/ Occupational Therapy. Your therapist will be able to discuss other therapy treatment options, as well as expectations for improvement with treatment.
Patient Consent: My therapist has discussed with me, and I understand, both the probability of success of this procedure, as well as the potential side-effects. I understand multiple treatment sessions may be required/needed, as such, this consent will cover this treatment as well as all subsequent treatments at Spooner Physical Therapy. I understand that I have the right to withdraw consent for this procedure at any time before it is performed, both for the current session and any future sessions.
I also understand and acknowledge that I am fully responsible to release all information regarding my health status, medical conditions, and previous experiences of unusual instances with physical effort which may affect the safety and value of a Blood Flow Restriction session. I am also aware that I am required to report these and any other unusual symptoms before, during, and/or after the Blood Flow Restriction training sessions to the professional staff at Spooner Physical Therapy.
Minors: If patient is under the age of 18, the signature of a parent or legal guardian is required to receive Blood Flow Restriction Training. While this individual is welcome to be present for any treatments, their presence is not a requirement for the provision of this procedure.
I have read and fully understand this consent form. I understand that I should not sign this form until all items, including my questions, have been answered to my satisfaction. With my signature, I hereby consent to the performance of this procedure.
Submitting the information below serves as my legal signature and consent to the performance of this procedure.