Effect of Supervised Rehabilitation Program Combined with Blood Flow Restriction Training on Muscle Activation and Postural Control in Athletes with Chronic Ankle Instability: A Randomized Controlled Trial

Abstract

Blood flow restriction (BFR) training has been advocated as an alternative approach for improving clinical outcomes in patients undergoing musculoskeletal conditions. This study compared effects of a supervised rehabilitation program (R) with and without blood flow restriction training on muscle activation and postural control in athletes with chronic ankle instability (CAI). Twenty-four collegiate athletes with CAI, aged between 18-23 years, participated in this study. They were randomly allocated to the BFR+R (n = 12) and R (n = 12) groups. Both groups underwent similar rehabilitation three days/week for 6 weeks. BFR+R group wore a cuff around the thigh at 80% arterial occlusion pressure, while the R group received no inflation. Pre-and post-intervention electromyography (EMG) activity of the gluteus maximus, gluteus medius, fibularis longus, and tibialis anterior, and reach distances and center of pressure (COP) movement and excursion during the Y-balance test (YBT) were measured at baseline, 4-and 6-week of intervention. The results demonstrated that both groups showed significantly increased normalized EMG amplitudes for all muscles examined during the YBT in all directions compared with baseline, of which the BFR+R group showed greater improvement (all P < 0.05). These results were concomitant with the improvement of reach distances, sway velocity, 95% confidence ellipse area, and path length during the YBT, although no statistical differences were detected between the groups. These findings indicated that despite greater activations of hip and ankle muscles over 6-week intervention, including BFR training in traditional rehabilitation has no additional effect on dynamic postural control compared with the traditional one.