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February 14, 2026Applied Physiology Nutrition and Metabolism0 citations

Comparison of neuromuscular responses to blood flow restriction and ice application during maximal effort knee extension and flexion: a randomized, controlled, crossover trial

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CHClifton J. HolmesBHBjoern HornikelAFAbby Fleming

Key Result

Blood flow restriction during maximal leg contractions caused similar muscle activation but significantly decreased mechanical output compared to control and ice conditions.

Key Points

  • The research aims to evaluate the effects of blood flow restriction and ice application on muscle performance and activation during knee exercises.
  • Fifteen resistance-trained individuals participated in controlled, crossover trials.
  • Subjects performed maximal effort knee extensions and flexions using an isokinetic dynamometer under three conditions: control, ice application, and blood flow restriction.
  • Electromyography was used to measure neuromuscular recruitment during the exercises and results were analyzed using repeated measures ANOVA.
  • No significant differences in muscle recruitment between ice and blood flow restriction conditions.
  • Control condition showed the lowest muscle recruitment as measured by root mean square values in both legs.
  • Blood flow restriction condition produced lower mechanical outputs with significant differences observed in peak torque, work per rep, and average power per rep for knee extensions.
  • Significant differences for peak torque, work, and power per rep were observed in right and left knee flexions under different conditions.

Structured PICO

Does blood flow restriction or ice application alter muscular performance and neuromuscular recruitment during maximal effort knee extension and flexion in resistance trained individuals?

P
Population
15 resistance trained individuals (mean age: 23.9±4.8 yrs., weight: 79±12.6 kg, height: 175.7±10.4 cm)
I
Intervention
Blood flow restriction (80% personal occlusion pressure) and ice application during 5 sets of 5 maximal effort knee extensions and flexions on an isokinetic dynamometer
C
Comparator
Control condition (CON) performing the same exercise protocol without blood flow restriction or ice
O
Outcome
Muscular performance and neuromuscular recruitment assessed via peak torque (PT), work per rep (WK), average power per rep (PWR), and root mean square (RMS) muscle recruitment values using electromyography (EMG)surrogate

Blood flow restriction during maximal leg contractions decreases mechanical output but maintains similar muscle activation compared to control and ice application conditions.

Abstract

The purpose of this study was to determine the acute effects of blood flow restriction (BFR) and ice application on muscular performance and neuromuscular recruitment during sets of maximal effort leg extension and flexion on an isokinetic dynamometer. Fifteen resistance trained individuals (age: 23.9±4.8 yrs., wt: 79±12.6 kg, ht: 175.7±10.4 cm) performed 5 sets of 5 maximal effort knee extensions and flexions with both legs on an isokinetic dynamometer with electromyography (EMG) under three conditions: control (CON), ice application (ICE), and BFR (80% personal occlusion pressure). Repeated measures ANOVA was used to assess between conditions and sets for peak torque (PT), work per rep (WK), average power per rep (PWR), and root mean square (RMS) muscle recruitment values. No differences were detected between conditions, however, CON produced the lowest muscle recruitment with differences being observed between set averages for RMS values in the right (p<0.001) and left (p=0.005) legs and in condition × set interaction for RMS values in the right (p=0.006) and left (p=0.11). BFR produced the lowest mechanical outputs with both leg extensions displaying differences in the condition × set interaction for PT, WK, and PWR (p<0.05). Right flexion differences were observed for condition, set, and the condition × set interaction for PT, WK, and PWR (p<0.05). Left flexion displayed differences in the condition × set interaction for PT, WK, and PWR (p<0.05). The application of BFR during maximal leg contractions results in similar muscle activation and decreased mechanical output compared to CON and ICE conditions.

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Cite This Study

Holmes et al. (2026) studied this question. Blood flow restriction during maximal leg contractions caused similar muscle activation but significantly decreased mechanical output compared to control and ice conditions.

synapsesocial.com/papers/699011932ccff479cfe58605https://doi.org/10.1139/apnm-2025-0168
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