Investigation of the efficacy of blood flow restricted training in lateral elbow tendinopathy

The blood flow restriction (BFR) method, which has gained attention in the literature for its potential effects, is an emerging approach increasingly used in musculoskeletal disorders. This study aimed to examine the effects of BFR combined with a multimodal treatment approach on pain, function, and quality of life in patients with LET and to compare the outcomes with those of a standard multimodal treatment program. A total of 69 participants diagnosed with LET and referred for physiotherapy, meeting the inclusion criteria, were enrolled in the study and randomly assigned into two groups. While the control group received a multimodal treatment program, the experimental group underwent an additional BFR intervention alongside multimodal therapy. The treatment program was administered twice per week for 8 weeks. Assessments were conducted at baseline, the 4th week of treatment, post-treatment, and at a 4th week follow-up. Outcome measures included demographic data, patient habits, joint range of motion (ROM), Visual Analog Scale (VAS), Pain-Free Grip Strength, the Patient-Rated Tennis Elbow Evaluation (PRTEE), the Short Form-12 Health Survey (SF-12), and the Global Rating of Change (GRC) scale. Data analysis was performed using SPSS, and a significance level of p<0.05 was considered statistically significant. After 8 weeks of treatment, pain significantly decreased in both the control group receiving multimodal therapy and the experimental group undergoing additional BFR treatment (p<0.05). Moreover, significant improvements were observed in pressure pain threshold, joint ROM, pain-free grip strength, quality of life, and patient satisfaction in both groups (p<0.05). Compared to the control group, the experimental group showed significantly greater improvement in the VAS activity score (p=0.010; partial η2=0.064), elbow flexion ROM (p=0.043; partial η2=0.047), and the physical component of quality of life (p=0.003; partial η2=0.075). However, no significant difference was found between the groups in terms of pain-free grip strength, PRTEE score, pressure pain threshold, or patient satisfaction (p>0.05). Our findings suggest that both multimodal therapy and the addition of BFR to multimodal therapy are effective in reducing pain and symptom severity, improving pressure pain threshold, joint ROM, pain-free grip strength, and quality of life in patients with LET. Based on these results, we propose that the BFR method could serve as an alternative therapeutic approach for patients who are unable to tolerate the mechanical load of strengthening exercises while still providing comparable mechanical stress. Keywords: Lateral elbow tendinopathy, blood flow restriction, multimodal therapy, exercise