Efficacy of blood flow restriction training in chronic ankle conditions: a systematic review and meta-analysis

Chronic ankle conditions often lead to persistent functional limitations. Blood flow restriction (BFR) training is a potential adjunct to rehabilitation, but its specific efficacy for chronic ankle conditions remains to be synthesized.

To systematically evaluate the effects of BFR-assisted rehabilitation on primary outcomes (dynamic balance and patient-reported ankle stability) and secondary outcomes (ankle range of motion and muscle strength) in individuals with chronic ankle conditions (including chronic ankle instability, chronic ligamentous injury, and tendinopathy).

A systematic search of PubMed, Web of Science, Embase, CNKI, and Wanfang databases was conducted up to April 13, 2025. We included randomized controlled trials (RCTs) involving adults with chronic ankle instability (CAI) defined by a history of sprain and/or Cumberland Ankle Instability Tool (CAIT) score < 24. Grey literature was excluded. The protocol was registered on PROSPERO (CRD420251249207). Methodological quality was assessed using the Cochrane Risk of Bias (RoB) 1.0 tool. Data were pooled using random- or fixed-effects models.

Seven RCTs (n = 204) were included. The overall risk of bias across the included studies was generally low to moderate. Meta-analysis of post-intervention values indicated that BFR-assisted rehabilitation significantly improved the primary outcome of dynamic balance (MD = 5.75; 95% CI [2.10, 9.40]; P < 0.01; I² = 34%, P = 0.22) compared with conventional rehabilitation. Significant improvements in the other primary outcome, CAIT scores were also observed (MD = 3.68; 95% CI [0.26, 7.11]; P = 0.05). However, secondary outcomes for dorsiflexion and plantarflexion range of motion exhibited high heterogeneity and unstable pooled estimates, showing no significant benefit. Muscle strength data were insufficient for meta-analysis.

BFR-assisted rehabilitation appears to enhance dynamic balance and perceived ankle stability in patients with chronic ankle conditions. However, evidence regarding its effect on joint range of motion remains inconclusive because of data instability. Current evidence supports BFR as a functional intervention, though standardized protocols are needed to further validate its clinical utility.