Effects of blood flow restriction training on the function of chronic ankle instability: a systematic review and network meta-analysis

BACKGROUND: Chronic ankle instability (CAI) is often treated with strength and balance training, but pain and fear of re-injury can limit tolerance to high-intensity exercise. Blood flow restriction training (BFRT) allows strength gains under low loads and may serve as an alternative for these patients. However, current research lacks a systematic evaluation of BFRT in individuals with CAI, particularly comparing different training modalities. OBJECTIVE: To systematically evaluate the effects of BFRT on individuals with CAI through meta-analysis. METHODS: Relevant randomized controlled trials were identified by searching eight databases (CNKI, VIP, Wanfang, PubMed, Embase, Web of Science, Cochrane Library, and PEDro) from their inception to October 17, 2025. Methodological quality was evaluated using the Cochrane Risk of Bias tool. Publication bias was assessed with Egger's test. RESULTS: > .05]. Subgroup analysis was conducted based on pressure type. BFRT of relative pressure improved CAIT scores and most balance measures except posteromedial. BFRT of absolute pressure significantly improved CAIT scores but showed no effects on Y-balance in any direction or overall score. The probability ranking indicated that relative pressure BFRT was superior to absolute pressure BFRT. CONCLUSION: Training under blood flow restriction can improve ankle balance and stability in individuals with CAI through neuromuscular adaptations. Relative pressure is more effective than absolute pressure, emphasizing the need for individualized training. Further high-quality studies are required to confirm long-term effects and refine protocols.