Effects of blood flow restriction training on patients with chronic ankle instability: a systematic review and meta-analysis

OBJECTIVE: To systematically review the effects of blood flow restriction training (BFRT) on postural control and ankle function in patients with chronic ankle instability (CAI). METHODS: We systematically searched PubMed, Embase, The Cochrane Library, Web of Science, EBSCO, and Scopus databases up to February 2, 2025. This study was registered in PROSPERO (CRD42025642187). The search aimed to collect randomized controlled trials examining the effects of BFRT on patients with CAI. Four outcomes including Y balance test reach distance, Cumberland Ankle Instability Tool scores, ankle muscle strength, and ankle muscle activation were selected. Quality of the included studies was assessed using the Cochrane Risk of Bias Tool Version 1, and meta-analysis was performed with RevMan 5.3. RESULTS: A total of eight randomized controlled trials were included, involving 243 patients with CAI. Compared to the control group, BFRT significantly improved Y balance anterior reach distance (MD = 4.90, 95% CI: 1.73 to 8.08, P = 0.002), Cumberland Ankle Instability Tool scores (MD = 3.09, 95% CI: 1.59 to 4.59, P < 0.001), ankle dorsiflexor strength (SMD = 0.90, 95% CI: 0.03 to 1.77, P = 0.04), ankle plantar-flexor strength (SMD = 1.12, 95% CI: 0.20 to 2.04, P = 0.02), and tibialis anterior muscle activation (MD = 11.13, 95% CI: 4.12 to 18.14, P = 0.002). CONCLUSION: Current evidence showed that BFRT significantly improved Y-balance anterior reach distance, CAIT scores, ankle dorsiflexor and plantarflexor strength, and tibialis anterior activation. These findings supported its effectiveness in improving postural control and ankle function in patients with CAI. However, some included studies are of low quality, requiring larger, high-quality studies for validation.