Effects of Blood Flow Restriction on Muscle Activation During Dynamic Balance Exercises in Individuals With Chronic Ankle Instability

Abstract

Context: Dynamic balance exercises are commonly utilized during ankle sprain and chronic ankle instability (CAI) rehabilitation. Blood flow restriction (BFR) has been used to enhance muscle activity during exercise and improve outcomes of traditional rehabilitation exercises in clinical populations. Objective: Examine the effects of BFR on lower-extremity muscle activation during dynamic balance exercises in individuals with CAI. Design: Crossover study design. Setting: Laboratory. Patients or Other Participants: Twenty-five (N = 25) young adults with a history of CAI. Interventions: Participants performed dynamic balance reaching exercises during 2 randomized order conditions, BFR, and control. For each condition, participants performed 2 trials of balance exercises. Each trial included 4 sets (30 × 15 × 15 × 15) of reaches in anterior, posteromedial, and posterolateral directions. For the BFR condition, the authors placed a cuff around the proximal thigh at 80% of arterial occlusion pressure. For the control condition, no cuff was worn. Main Outcome Measure(s): The authors recorded normalized electromyography muscle activation of the vastus lateralis, soleus, tibialis anterior, and fibularis longus during balance exercise trials and recorded participants’ ratings of perceived postural instability and exertion after each trial of balance exercises. Results: The authors observed greater vastus lateralis (P < .001, d = 0.86 [0.28 to 1.44]) and soleus (P = .03, d = 0.32 [−0.24 to 0.87]) muscle activation during balance exercises with BFR than control. The authors observed no differences in tibialis anterior (P = .33, d = 0.09 [−0.46 to 0.65]) or fibularis longus (P = .13, d = 0.06 [−0.50 to 0.61]) muscle activation between the conditions. The authors observed greater ratings of perceived postural instability (P = .004) and exertion (P < .001) during balance exercises with BFR than control. Conclusions: Individuals with CAI demonstrated large increases in vastus lateralis and small increases in soleus muscle activation during dynamic balance exercises with BFR. The BFR had no effect on fibularis longus and tibialis anterior muscle activation. Individuals with CAI perceived greater postural instability and exertion during dynamic balance exercises with BFR.

Effect of supervised rehabilitation combined with blood flow restriction training in athletes with chronic ankle instability: a randomized placebo-controlled trial

“…Unexpectedly, we found no between-group difference in YBT reaching distances in all directions examined following a 4-week intervention. This result differs from the finding of a previous study that showed that dynamic balance exercise with BFR-induced large-to-small increases muscle activation of the ankle muscles and increased postural stability and exertion in individuals with CAI compared with the control ( Burkhardt et al, 2021 ). This discrepancy in results may be because of the differences in methodology (i.e., training protocols and outcome measures) and participant characteristics (athletes vs. sedentary) among studies.…”

“…At present, the precise mechanisms underlying BFR-induced strength gain in patients with CAI are unknown. However, most recent studies ( Burkhardt et al, 2021 ; Killinger et al, 2020 ) have demonstrated considerable muscle activations during acute resistance exercise or dynamic balance exercise with BFR in individuals with CAI compared with controls.…”

“…Most recent studies on individuals with CAI demonstrated great fibularis longus and tibialis anterior muscle activations during submaximal isometric resistance exercise with BFR compared with the control ( Killinger et al, 2020 ). Furthermore, Burkhardt et al (2021) have recently reported large-to-small increases in muscle activation of the vastus lateralis and soleus muscles and increases in postural instability and exertion during dynamic balance exercise combined with BFR in individuals with CAI.…”

“…Blood flow restriction (BFR) resistance exercise has emerged as a new rehabilitation for patients with postoperative surgery, such as knee arthroscopy, anterior cruciate ligament reconstruction, and Achilles’ tendon rupture, including patients with nonoperative musculoskeletal deficits, for example, knee osteoarthritis, patellofemoral pain syndrome, anterior knee pain, or CAI ( Burkhardt et al, 2021 ; Fujita et al, 2007 ; Killinger et al, 2020 ). This novel rehabilitation strategy involves the application of an inflatable cuff or tourniquet around the limb, which maintains arterial inflow while occluding venous return during exercise, resulting in local hypoxia ( Loenneke et al, 2012 ).…”

Can Blood Flow Restriction Training Benefit Post-Activation Potentiation? A Systematic Review of Controlled Trials

“…In addition, low external load demand in BFR training allows it to benefit both healthy people and load compromised populations in need of rehabilitation [17,18]. Furthermore, more recent research has documented that BFR training may increase muscle activation both in sports training [19,20] and sports rehabilitation [21,22]. Therefore, some recent studies have applied the BFR method to CAs (BFR-CAs) and found enhanced athletic performance as a result of greater PAP [6,23].…”