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The effects of high-pressure versus low-pressure blood flow restriction resistance exercise in individuals with lower limb musculoskeletal injuries and persistent pain: a randomised controlled trial

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Compare the efficacy and acceptability of low load blood flow restriction (BFR) using two different limb occlusion pressures (LOP) on pain and function in individuals with lower-limb musculoskeletal injury (MSKI) and associated persistent pain. Randomised controlled trial within a military residential rehabilitation setting. Twenty-eight individuals (N=21 male; N=7 female) with lower-limb MSKI were randomly allocated into: 1) BFR-RE with 80% LOP (BFR80), or 2) BFR-RE with 40% LOP (BFR40). Both groups completed 7x BFR-RE sessions during 5-days of residential rehabilitation at 20% 1-repetition maximum. The primary outcome measure was the Brief Pain Inventory (BPI). Secondary outcomes include injury-specific outcomes, pain pressure threshold (PPT) and lower-limb muscle strength assessment. All reported outcomes reflect changes in scores. BPI ‘worst’ displayed a time x group interaction ( p =.013), driven by higher pain in BFR80 from pre- to post-intervention (standardised mean difference [SMD]=1.532, p =.006). There was a significant time x group interaction for BPI ‘severity’ ( p =.022), driven by significant between-group differences at T3 (BFR80-BFR40: SMD=1.305, p =.015). PPTs improved within-session and over time. Both pressures demonstrated cumulative exercise-induced hypoalgesia via rising PPTs. BFR80 reported increased ‘worst’ pain score. Lower LOP may better preserve training volume and exercise tolerability. • High-pressure BFR may exacerbate injury-specific pain during rehabilitation. • Low-pressure BFR preserves training volume in those with MSKI and persistent pain. • A cumulative exercise-induced hypoalgesia effect (i.e., sustained increase in pressure pain threshold values) was present following repeated BFR sessions and at short-term (4 day) follow up. • High pressure may suit low-pain presentations or late-stage rehabilitation.

Source: Physical Therapy in Sport

DOI: 10.1016/j.ptsp.2026.101920