Effects of blood-flow restriction training on dynamic postural control and ankle function in individuals with chronic ankle instability: a systematic review and meta-analysis of randomized controlled trials

BACKGROUND: Decreased ankle-muscle strength and activation can lead to postural control disorders in individuals with chronic ankle instability (CAI). Blood-flow restriction training (BFRT) promotes muscle growth and function at low loads, representing a safe and efficient rehabilitation strategy. However, previous small-scale studies have shown inconsistent results. This review conducted a meta-analysis of existing randomized controlled trials (RCTs) to investigate the influence of BFRT on the dynamic postural control and ankle function of CAI individuals. METHODS: PubMed, Embase, Cochrane Library, Web of Science, and EBSCO were searched until November 16, 2025. The primary outcomes included Y-balance test (YBT) distance, ankle-muscle strength, and ankle-muscle activation, whereas the secondary outcome was Cumberland ankle instability tool (CAIT) score. Methodological quality was assessed using Cochrane Risk-of-Bias tool (version 2) and PEDro scale. We conducted a meta-analysis using a random-effects model via the metafor package in R software. RESULTS: A total of nine RCTs involving 252 participants were included in this work. Results showed that compared with the control group, BFRT may improve the YBT anterior distance (standardized mean difference [SMD] = 0.57, 95% confidence interval [CI] 0.18 to 0.96; low-certainty evidence) and comprehensive score (SMD = 0.31, 95% CI 0.16 to 0.45; very low-certainty evidence), dorsiflexion muscle strength (SMD = 1.12, 95% CI 0.09 to 2.15; very low-certainty evidence), tibialis anterior muscle activation (SMD = 0.92, 95% CI 0.41 to 1.43; very low-certainty evidence), and CAIT score (MD = 2.30, 95% CI 0.89 to 3.71; very low-certainty evidence). CONCLUSION: BFRT may improve the dynamic postural control, ankle-muscle strength, muscle activation, and function score of CAI individual. However, further high-quality RCTs are warranted to confirm these findings.