Effects of blood flow restriction training in adult upper-limb musculoskeletal rehabilitation: A systematic review.
Lama Saif Khan, Abdulelah K Alqawlaq, Majd Hussain Almech et al.
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In 30 seconds
This systematic review assessed the clinical effects, tolerability, and prescription of blood flow restriction training (BFRT) in adults undergoing rehabilitation for upper-limb musculoskeletal conditions. It included 20 reports—9 parallel-group randomized trials, 1 randomized crossover trial, 2 case series, and 8 case-report publications—with 340 participants enrolled or randomized. Findings were synthesized narratively because of heterogeneity. Some trials reported better pain or functional outcomes with BFRT, including a sham-controlled lateral elbow tendinopathy trial showing a 12-week between-group pain difference of -1.54 (95% CI -2.89 to -0.18; P = .026). Overall, BFRT was not consistently superior to active rehabilitation.
Key findings
- In sham-controlled lateral elbow tendinopathy, 12-week pain favored BFRT: between-group difference -1.54 (95% CI -2.89 to -0.18; P = .026).
- For chronic lateral epicondylitis, BFRT plus conventional therapy produced greater PRTEE and quick disabilities of the arm, shoulder and hand reductions; pain and strength changes did not differ significantly.
- 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).
- Across included reports, results varied by condition and outcome, with some benefits in distal-radius-fracture activity pain and rotator-cuff tendinopathy measures.
Why it matters
BFRT is proposed as a low-load rehabilitation option, and the review identifies potential benefits across several upper-limb conditions. However, results differ across trials and outcomes, so clinicians should distinguish promising condition-specific findings from evidence of consistent superiority. The review also highlights uncertainty about tolerability because adverse-event ascertainment was incomplete.
What to keep in mind
Confidence is limited by small samples, heterogeneous BFRT prescriptions and co-interventions, uncontrolled designs, and incomplete adverse-event ascertainment. Heterogeneity required narrative rather than pooled synthesis.