Utility of Blood Flow Restriction Training to Improve Ankle Strength in Patients With Chronic Ankle Instability: A Critically Appraised Topic.

Abstract

Clinical scenario: Lateral ankle sprains are common musculoskeletal injuries, especially in active individuals, with up to 70% cases leading to chronic ankle instability (CAI). CAI is characterized by recurrent ankle sprains, persistent dysfunction, and an increased risk of long-term joint degeneration. Strength deficits at the ankle are one of the hallmark symptoms of CAI, directly impacting joint stability and functional performance.

Clinical question: Does incorporating blood flow restriction (BFR) training, either applied passively without concurrent exercise or combined with rehabilitation exercises, enhance ankle strength in individuals with CAI compared with traditional rehabilitation methods?

Summary of key findings: (1) Three studies were reviewed to evaluate the effects of BFR training on ankle strength in individuals with CAI. (2) Results showed that although BFR alone did not result in consistent improvements in ankle strength, significant improvements in ankle strength across all 4 directions (plantarflexion, dorsiflexion, eversion, and inversion) were found when combined with rehabilitation or other therapeutic modalities.

Clinical bottom line: BFR training might be most effective when incorporated into a comprehensive rehabilitation plan aimed at improving ankle strength. Although passive BFR (applied without concurrent exercises) demonstrates limited effectiveness, combining BFR with traditional rehabilitation or therapeutic exercises significantly enhances muscle strength at the ankle joint in individuals with CAI.

Strength of recommendation: Grade B evidence supports the inclusion of BFR in rehabilitation programs for individuals with CAI to enhance muscle strength.