Immediate Effects of Blood Flow Restriction-Augmented Active Joint Mobilization on Dynamic Postural Control, Proprioception, and Self-Reported Instability in Individuals with Chronic Ankle Instability: A Randomized Controlled Trial

Objective: To compare the immediate effects of blood flow restriction-augmented active joint mobilization (BFR-AJM) versus active joint mobilization (AJM)alone in individuals with chronic ankle instability (CAI).The outcomes were dynamic postural control, ankle joint position sense, static balance, and self-reported instability.Design: Single-blind (assessor-blinded) randomized controlled trial.Methods: Forty individuals with CAI (Cumberland Ankle Instability Tool [CAIT] score ≤24; mean age 21.7±2.5 years) were randomized 1:1 to the BFR-AJM group (n=20) or the AJM group (n=20).Both groups received a single session of AJM involving Maitland Grade III anterior-to-posterior talar and distal tibiofibular glides paired with voluntary dorsiflexion.The BFR-AJM group additionally wore a pneumatic cuff around the proximal lower leg of the affected limb, inflated to 140-150 mmHg throughout the intervention.The primary outcome was overall dynamic postural control,measured using the Biodex Limits of Stability (LOS) test.Secondary outcomes included directional dynamic control, static stability indices, joint position sense (JPS) absolute error, and CAIT scores.Results: Both groups showed within-group improvement in CAIT scores, JPS, and all static indices (p<0.05).A significant Group×Time interaction favoured BFR-AJM for overall dynamic control (F (1,38) =10.87, p =0.002, η p ²=0.223; between-group d=1.04) and anterior directional control (F (1,38) =8.10, p=0.007, η p ²=0.176).No interaction was found for CAIT, JPS, or static indices.Conclusions: A single BFR-AJM session produced greater immediate improvement in dynamic postural control than AJM alone.However, without a sham cuff or mechanistic measures, this acute effect cannot be attributed specifically to BFR physiology or interpreted as evidence of sustained clinical benefit; sham-controlled, multi-session trials with individualized BFR dosing are needed.