Effectiveness of blood flow restriction exercise on pain and disability in patients with low back pain: A systematic review

Objective To systematically evaluate the effectiveness of blood flow restriction exercise (BFRE) on disability and pain in individuals with chronic non-specific low back pain CNSLBP. Methods A systematic review of randomized controlled trials was conducted following PRISMA 2020 guidelines. PubMed, Scopus, and Web of Science were searched up to September 2025. Eligible studies compared therapeutic exercise programs incorporating BFRE with identical or conventional exercise interventions without BFRE. Oswestry Disability Index or its modified version was the primary outcome. Risk of bias was evaluated using the Cochrane RoB 2 tool. The study protocol was registered in PROSPERO with the identification code CRD420261283862. Results Three randomized controlled trials involving 104 participants were included. All studies reported significant within-group improvements in disability following BFRE-based interventions. In two trials, reductions in disability were significantly greater in the BFRE groups compared with control interventions, despite the use of lower external loads. In the remaining trial, between-group differences did not reach statistical significance, although absolute improvements favored BFRE. Pain intensity generally improved to a greater extent in BFRE groups. Nevertheless, overall risk of bias was low, with some concerns related to missing outcome data in one study. Conclusions BFRE may represent a potential adjunct to exercise-based rehabilitation for CNSLBP; however, current evidence remains preliminary, heterogeneous, and insufficient to establish clear superiority over standard exercise interventions. Further adequately powered randomized controlled trials with standardized protocols are needed to clarify its effectiveness, safety, and optimal application parameters.