Low‐Load Blood Flow Restriction Exercise Training Prior to a Physiotherapy Session Is Associated With Reductions in Anterior Knee Pain During Functional Tasks: A Blinded Randomized Sham‐Controlled Crossover Trial

Objective: Evaluate the effect of low‐load resistance training with blood flow restriction (BFR) or sham‐BFR on pain perception and pressure pain thresholds in patients with anterior knee pain immediately after application and following a subsequent physiotherapy session. Design: Blinded randomized sham‐controlled crossover trial. Patients: 40 adult males with anterior knee pain. Intervention: Patients completed four sets of open kinetic chain knee extensions (90°–0°): one set of 30 repetitions followed by three sets of 15. They were randomized to receive 80% occlusion pressure or 10% (sham) in the first session and the alternate condition in the next session of this crossover trial. Outcomes: Primary outcomes included pain (0–10) during three functional tests, global rating of change, percentage improvement, pressure pain thresholds, and perceived effort, assessed immediately post‐BFR (80% or sham) and immediately after a 45‐min physiotherapy session. Results: Pain ratings and global/percentage change significantly improved after 80% BFR ( p < 0.001), with increased knee pressure pain thresholds. Pressure pain thresholds were unchanged at tibialis anterior or elbow. 80% of BFR exercises were perceived as significantly higher effort ( p < 0.001). Conclusion: In contrast to 10% sham occlusion, 80% occlusion improves pain reduction and functional ratings during three functional (step‐down) tests, with effects immediately persisting postrehabilitation. Pressure pain thresholds increased locally; and exercise effort was higher in the 80% occlusion condition. Trial Registration: ClinicalTrials.gov identifier: NCXT04989023