Blood Flow Restriction Training in Tennis Elbow

Lateral epicondylitis (LE) is a common musculoskeletal disorder caused by repetitive overuse of the forearm extensor muscles. It is characterized by pain over the lateral epicondyle of the humerus, which may radiate to the surrounding tissues at the origin of the wrist extensor tendons. LE is one of the most frequent causes of lateral elbow pain, with a reported prevalence of approximately 1-3% in the general population. Among conservative interventions, exercise-based rehabilitation is considered a cornerstone of management. In particular, exercise programs incorporating eccentric contractions have demonstrated superior clinical outcomes compared with several other exercise approaches and are therefore widely recommended. Blood flow restriction training (BFRT) has recently emerged as an alternative rehabilitation strategy that promotes neuromuscular adaptations while using low mechanical loads. BFRT involves the application of a pneumatic cuff, tourniquet, or elastic band around the proximal portion of an extremity to partially restrict arterial inflow while substantially reducing venous return, thereby creating localized metabolic and hemodynamic stress during exercise. The primary aim of this randomized controlled trial was to investigate the effects of BFRT on pain, functional status, pain-free grip strength, health-related quality of life, and ultrasonographic characteristics of the common extensor tendon in patients with lateral epicondylitis.

Inclusion Criteria: * age between 18 and 75 years; * clinical diagnosis of lateral epicondylitis based on medical history and physical examination; * pain intensity of ≥4 on a 10-cm Visual Analog Scale (VAS) during daily activities; * provision of written informed consent. Exclusion Criteria: * hypertension, diabetes mellitus, cardiovascular disease, peripheral vascular disease, previous deep vein thrombosis, or lymphedema; * orthopedic, rheumatologic, or neurological disorders affecting the upper extremity; * fibromyalgia; * congenital or acquired elbow deformity; * previous trauma, fracture, or surgery involving the affected upper extremity; * cervical radiculopathy or peripheral neuropathy affecting the involved limb; * receipt of any treatment for lateral epicondylitis within the preceding 3 months; * skin lesions, infection, or open wounds at the cuff application site; * bleeding disorders or current anticoagulant therapy; * pregnancy; * active malignancy or a history of malignancy; * cognitive impairment or neurological or psychiatric disorders that could interfere with comprehension of study procedures or completion of outcome assessments.