Effectiveness of Blood Flow Restriction Training on Pain, Physical Function, and Muscle Strength in Patients with Tendinopathy: A Systematic Review and Meta-Analysis

Abstract

Background: Blood flow restriction (BFR) training enables resistance exercise at low external loads and may benefit individuals with painful tendons that cannot tolerate conventional heavy-load exercise. Objective: To synthesize the effects of BFR-assisted exercise on pain, physical function, and muscle strength in adults with tendinopathy. Methods: Comparative and uncontrolled clinical studies evaluating BFR for clinically diagnosed tendinopathy were synthesized according to PRISMA 2020 principles. Random-effects meta-analyses using restricted maximum likelihood were performed when outcomes, measurement scales, and follow-up periods were sufficiently comparable. Results: Ten studies were included in the qualitative synthesis; six were comparative, and five contributed to the quantitative synthesis. Three short-term studies (102 participants) showed no significant pooled effect on pain (0–10 scale; mean difference [MD] = −0.44, 95% confidence interval [CI] −1.27 to 0.40; I² = 46%). Two studies of lateral elbow tendinopathy (66 participants) demonstrated improved short-term physical function on the Patient-Rated Tennis Elbow Evaluation (MD = −10.78, 95% CI −16.88 to −4.67; I² = 52%), although sensitivity analysis was imprecise. Strength outcomes were inconsistent because of heterogeneous measures and follow-up periods and were not pooled. Overall, BFR produced outcomes comparable to heavy-load resistance training and showed selective advantages over sham or non-BFR low-load exercise. Conclusion: BFR-assisted low-load exercise may improve short-term diagnosis-specific function and selected strength outcomes but does not consistently reduce pain or outperform well-designed heavy-load rehabilitation. Larger, high-quality trials with standardized BFR protocols and core outcome measures are needed.