Blood Flow Restriction in Upper‐Extremity Rehabilitation: A Systematic Review of Clinical Studies
Mitchell J. Christiansen, Sundas Shaikh, Mary K. MulcaheyPurpose
To evaluate the effects of blood flow restriction (BFR) therapy on upper‐extremity strength, pain, range of motion, and functional outcomes.
Methods
This systematic review followed the 2009 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. PubMed, Embase, and Scopus were searched from January 2000 through August 2025 for studies evaluating upper‐extremity BFR during resistance or therapeutic exercise. Studies were included if they were randomized controlled trials or prospective studies published in English that reported pre‐ and postintervention outcomes of strength, pain, range of motion, muscle morphology, or validated functional scores.
Results
A total of 492 studies were identified, 5 of which met inclusion criteria, encompassing 128 participants. Four studies (80%) were randomized controlled trials, and 1 study (20%) was a prospective cohort study. Clinical indications for the use of BFR included rotator cuff tendinopathy, lateral epicondylitis, distal radius fracture rehabilitation, and postoperative shoulder rehabilitation. Four of 5 studies (80%) showed statistically significant BFR‐related improvements in strength, with the remaining study reporting within‐group improvements that did not reach between‐group significance. Three of 4 studies (75%) that assessed pain reported significant reductions favoring BFR, with the fourth showing clinically within‐group pain reductions in both BFR and control. Notable findings included a significant between‐group improvement in internal rotation strength at 60°/s favoring BFR in rotator cuff tendinopathy ( P = .04) and significant pain reduction in distal radius fracture rehabilitation (visual analog scale: 5.5 → 1.5, P = .03).
Conclusions
In this systematic review, 4 of 5 studies (80%) reported statistically significant strength improvements favoring BFR, and 3 of 4 studies (75%) assessing pain showed significant reductions favoring BFR, with no serious adverse events reported. These findings support BFR as a promising adjunct in upper‐extremity rehabilitation; however, heterogeneity in study design and intervention parameters limits definitive conclusions.
Level of Evidence
Level IV, systematic review of Level I and IV studies.