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Peer-reviewedCC BYMedicine

Effects of blood flow restriction training in adult upper-limb musculoskeletal rehabilitation: A systematic review.

  • Lama Saif Khan1
  • Abdulelah K Alqawlaq2
  • Majd Hussain Almech2
  • Abdulaziz Khalid Alaryani3
  • Yousef I Alhusaini4
  • Adnan Alaa Sultan2
  • Fouad Turki Alnajjar2
  • Abdullah Mohammed Falqi2
  • Wahib Shehab Alshaibani5
  • Mohamed Ibrahim Hassan5
  • Ramy Samargandi6
  • Maan Jamjoom4,7,8
8 affiliations
  1. 1Emergency Medical Services, Medical Fakeeh, Jeddah, Saudi Arabia.
  2. 2General Medicine Practice Program, Batterjee Medical College, Jeddah, Saudi Arabia.
  3. 3Critical Care in Emergency Medical Service, Johns Hopkins Aramco Healthcare, Abqaiq, Saudi Arabia.
  4. 4College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
  5. 5Department of Orthopedic Surgery, International Medical Center, Jeddah, Saudi Arabia.
  6. 6Department of Orthopedic Surgery, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia.
  7. 7Department of Emergency Medicine, Ministry of the National Guard Health Affairs, Jeddah, Saudi Arabia.
  8. 8King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{khan2026effects,
  title = {{Effects of blood flow restriction training in adult upper-limb musculoskeletal rehabilitation: A systematic review.}},
  author = {Lama Saif Khan and Abdulelah K Alqawlaq and Majd Hussain Almech and Abdulaziz Khalid Alaryani and Yousef I Alhusaini and Adnan Alaa Sultan and Fouad Turki Alnajjar and Abdullah Mohammed Falqi and Wahib Shehab Alshaibani and Mohamed Ibrahim Hassan and Ramy Samargandi and Maan Jamjoom},
  journal = {Medicine},
  year = {2026},
  month = oct,
  doi = {10.1097/md.0000000000051205},
  url = {https://europepmc.org/article/MED/42888637},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Effects of blood flow restriction training in adult upper-limb musculoskeletal rehabilitation: A systematic review.
AU  - Lama Saif Khan
AU  - Abdulelah K Alqawlaq
AU  - Majd Hussain Almech
AU  - Abdulaziz Khalid Alaryani
AU  - Yousef I Alhusaini
AU  - Adnan Alaa Sultan
AU  - Fouad Turki Alnajjar
AU  - Abdullah Mohammed Falqi
AU  - Wahib Shehab Alshaibani
AU  - Mohamed Ibrahim Hassan
AU  - Ramy Samargandi
AU  - Maan Jamjoom
PY  - 2026
DA  - 2026/10/01
JO  - Medicine
DO  - 10.1097/md.0000000000051205
UR  - https://europepmc.org/article/MED/42888637
AB  - 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.
SN  - 0304-5412
SN  - 1536-5964
ER  -