Medicine · 2026
Effects of blood flow restriction training in adult upper-limb musculoskeletal rehabilitation: A systematic review.
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Khan Lama Saif, Alqawlaq Abdulelah K, Almech Majd Hussain, Alaryani Abdulaziz Khalid, Alhusaini Yousef I, Sultan Adnan Alaa, Alnajjar Fouad Turki, Falqi Abdullah Mohammed, Alshaibani Wahib Shehab, Hassan Mohamed Ibrahim, Samargandi Ramy, Jamjoom Maan
Аннотация
BACKGROUND: Blood flow restriction training (BFRT) has been proposed as a low-load rehabilitation strategy for symptomatic and postoperative upper-limb musculoskeletal conditions. This review evaluated the clinical effects, tolerability, and prescription characteristics of BFRT in adult upper-limb musculoskeletal rehabilitation.
METHODS: This systematic review was registered in International Prospective Register of Systematic Reviews (CRD420261299726) and reported with reference to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. CENTRAL/Cochrane Library, Embase via Ovid, MEDLINE/PubMed, Science Citation Index/Web of Science, and Scopus were searched without a start-date restriction before February 18, 2026; backward reference-list/citation checking was also used. Randomized trials, case series, and case reports were eligible. Findings were synthesized narratively because of heterogeneity, and studies were appraised using risk of bias 2 or design-appropriate Joanna Briggs Institute checklists.
RESULTS: Twenty reports were included: 9 parallel-group randomized trials, 1 randomized crossover trial, 2 case series, and 8 case-report publications. Across the reports, 340 participants were enrolled or randomized and 326 contributed to the analyzed/treated clinical samples; 158 were men (48.5%) and 168 were women (51.5%). In a sham-controlled lateral elbow tendinopathy trial, BFRT resulted in a significantly greater reduction in 12-week pain (between-group difference -1.54, 95% confidence interval [CI] -2.89 to -0.18; P = .026) and patient-rated tennis elbow evaluation (PRTEE) (-15.23, 95% CI -23.57 to -6.90; P < .001). In patients with chronic lateral epicondylitis, PRTEE reduction (-24.20 ± 4.02 vs -15.60 ± 3.71; P = .001) and quick disabilities of the arm, shoulder and hand reduction (-12.83 ± 4.97 vs -7.51 ± 4.72; P = .025) were significantly greater with BFRT plus conventional therapy, whereas between-group pain and strength changes were not significant. In nonoperative distal-radius-fracture rehabilitation, mean activity-pain reduction was 4.0 versus 2.3 points (P = .03). In rotator-cuff tendinopathy, BFRT resulted in significantly greater biceps thickness (P = .002) and internal-rotation strength (P = .040). Conversely, a pragmatic elbow trial found no significant between-group difference in 12-month PRTEE (adjusted contrast + 4.32, 95% CI -9.17 to 17.81; P = .53).
CONCLUSION: BFRT may be considered a low-load adjunct in adult upper-limb musculoskeletal rehabilitation settings, but it is not consistently superior to active rehabilitation for pain, strength, or function. Confidence remains limited by small samples, heterogeneous prescriptions and co-interventions, uncontrolled designs, and incomplete adverse-event ascertainment.
METHODS: This systematic review was registered in International Prospective Register of Systematic Reviews (CRD420261299726) and reported with reference to Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020. CENTRAL/Cochrane Library, Embase via Ovid, MEDLINE/PubMed, Science Citation Index/Web of Science, and Scopus were searched without a start-date restriction before February 18, 2026; backward reference-list/citation checking was also used. Randomized trials, case series, and case reports were eligible. Findings were synthesized narratively because of heterogeneity, and studies were appraised using risk of bias 2 or design-appropriate Joanna Briggs Institute checklists.
RESULTS: Twenty reports were included: 9 parallel-group randomized trials, 1 randomized crossover trial, 2 case series, and 8 case-report publications. Across the reports, 340 participants were enrolled or randomized and 326 contributed to the analyzed/treated clinical samples; 158 were men (48.5%) and 168 were women (51.5%). In a sham-controlled lateral elbow tendinopathy trial, BFRT resulted in a significantly greater reduction in 12-week pain (between-group difference -1.54, 95% confidence interval [CI] -2.89 to -0.18; P = .026) and patient-rated tennis elbow evaluation (PRTEE) (-15.23, 95% CI -23.57 to -6.90; P < .001). In patients with chronic lateral epicondylitis, PRTEE reduction (-24.20 ± 4.02 vs -15.60 ± 3.71; P = .001) and quick disabilities of the arm, shoulder and hand reduction (-12.83 ± 4.97 vs -7.51 ± 4.72; P = .025) were significantly greater with BFRT plus conventional therapy, whereas between-group pain and strength changes were not significant. In nonoperative distal-radius-fracture rehabilitation, mean activity-pain reduction was 4.0 versus 2.3 points (P = .03). In rotator-cuff tendinopathy, BFRT resulted in significantly greater biceps thickness (P = .002) and internal-rotation strength (P = .040). Conversely, a pragmatic elbow trial found no significant between-group difference in 12-month PRTEE (adjusted contrast + 4.32, 95% CI -9.17 to 17.81; P = .53).
CONCLUSION: BFRT may be considered a low-load adjunct in adult upper-limb musculoskeletal rehabilitation settings, but it is not consistently superior to active rehabilitation for pain, strength, or function. Confidence remains limited by small samples, heterogeneous prescriptions and co-interventions, uncontrolled designs, and incomplete adverse-event ascertainment.