Blood flow restriction for chronic ankle instability: A meta-analysis of clinical and patient-reported outcomes

Blood flow restriction (BFR) has demonstrated beneficial effects by enabling muscle growth and strength with lighter weights, thereby reducing joint stress. BFR training has been studied in various joints such as after reconstruction of the anterior cruciate ligament, but its application in chronic ankle instability (CAI) remains underexplored. This systematic review aims to fill this gap by investigating the effects of BFR training on balance, ankle strength, and patient-reported outcomes in individuals with CAI.

A systematic search was conducted in PubMed, Scopus, CINAHL, and SPORTDiscus for randomized controlled trials published in English from 2000 onward. Studies were included if they examined BFR interventions in individuals with CAI. Methodological quality was assessed using the Physiotherapy Evidence Database scale.

Two independent reviewers screened studies and extracted data. A random-effects meta-analysis synthesized outcomes related to balance, ankle strength, and self-reported instability.

Nine trials met inclusion criteria. Meta-analysis revealed significant improvements in balance (standardized mean difference [SMD] = 0.33-2.72), patient-reported outcomes (SMD = 0.04-2.84), and ankle strength (foot abduction SMD = 0.01-1.13; adduction SMD = 1.12-1.92). Substantial heterogeneity was observed, and most studies reported short-term effects.

BFR training may improve balance, ankle strength, and perceived stability in individuals with CAI. These findings support its potential as a rehabilitation adjunct, but high-quality trials are needed to confirm long-term efficacy and guide clinical implementation.

PROSPERO CRD42025638559.