Physiother Theory Pract. 2026 Jan 4:1-15. doi: 10.1080/09593985.2025.2608879. Online ahead of print.
ABSTRACT
BACKGROUND: Chronic ankle instability (CAI) is often treated with strength and balance training, but pain and fear of re-injury can limit tolerance to high-intensity exercise. Blood flow restriction training (BFRT) allows strength gains under low loads and may serve as an alternative for these patients. However, current research lacks a systematic evaluation of BFRT in individuals with CAI, particularly comparing different training modalities.
OBJECTIVE: To systematically evaluate the effects of BFRT on individuals with CAI through meta-analysis.
METHODS: Relevant randomized controlled trials were identified by searching eight databases (CNKI, VIP, Wanfang, PubMed, Embase, Web of Science, Cochrane Library, and PEDro) from their inception to October 17, 2025. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Publication bias was assessed with Egger’s test.
RESULTS: A total of 3206 records were identified, and 11 studies were included. Compared with control groups, BFRT improved anterior Y balance score [MD = 2.08, 95%CI (0.37 to 3.79), p < .05], posterolateral Y balance score [MD = 2.88, 95%CI (0.64 to 5.11), p < .05], and CAIT score [MD = 2.39, 95%CI (1.28 to 3.51), p < .05]. There was no statistical difference between the BFRT and control groups in overall Y balance score [MD = 1.48, 95%CI (-0.18 to 3.13), p > .05] and posteromedial balance score [MD = 0.30, 95%CI (-1.85 to 2.44), p > .05]. Subgroup analysis was conducted based on pressure type. BFRT of relative pressure improved CAIT scores and most balance measures except posteromedial. BFRT of absolute pressure significantly improved CAIT scores but showed no effects on Y-balance in any direction or overall score. The probability ranking indicated that relative pressure BFRT was superior to absolute pressure BFRT.
CONCLUSION: Training under blood flow restriction can improve ankle balance and stability in individuals with CAI through neuromuscular adaptations. Relative pressure is more effective than absolute pressure, emphasizing the need for individualized training. Further high-quality studies are required to confirm long-term effects and refine protocols.
PMID:41485135 | DOI:10.1080/09593985.2025.2608879
