Effect of blood flow restriction therapy in traumatic and non-traumatic ankle conditions – a systematic review and meta-analysis

Abstract Ankle injuries, both traumatic and non-traumatic, often result in persistent weakness and restricted mobility, where high-load resistance training may be contraindicated due to pain, instability, or surgical limitations. In such cases, blood flow restriction (BFR) therapy provides a low-load alternative capable of inducing strength and hypertrophic adaptations through localised hypoxia and metabolic stress. This systematic review and meta-analysis evaluated the effects of BFR therapy on strength, balance, functional outcomes, and morphological adaptations in ankle conditions. A comprehensive search of PubMed, Scopus, and PEDro, along with allied-health databases, identified ten studies involving 304 participants, of which seven were eligible for quantitative synthesis. When compared with conventional exercise, BFR combined with exercise significantly enhanced strength in adduction (MD = 12.24 N, 95% CI: 5.74–18.74), abduction (MD = 9.61 N, 95% CI: 1.17–18.05), dorsiflexion (MD = 0.08 Nm/kg, 95% CI: 0.05–0.10), and improved range of motion (MD = 5°–15°). Functional outcomes (CAIT) favoured BFR, whereas FAAM-ADL and FAAM-Sport showed positive but non-significant trends. Morphological adaptations were directionally favourable but heterogeneous. Collectively, BFR therapy represents a safe and promising adjunct, facilitating early-phase strength and mobility recovery under restricted loading conditions, warranting further standardised and long-term investigations.