EFFECT OF BLOOD FLOW RESTRICTION TRAINING COMBINED WITH LOW-LOAD RESISTANCE EXERCISE ON GRIP STRENGTH AND FUNCTIONAL OUTCOMES IN CARPAL TUNNEL SYNDROME: A RANDOMIZED CONTROLLED TRIAL

Abstract

Background: Carpal tunnel syndrome (CTS) is the most common compressive neuropathy of the upper limb, and conservative management produces variable recovery in grip strength and symptom-related function. Low-load resistance training combined with blood flow restriction (BFR) may stimulate muscular adaptations without high mechanical articular stress, but its clinical efficacy in CTS has not been established. Objective: To compare the effects of low-load resistance training combined with BFR (Group A) versus low-load resistance training alone (Group B) on affected-hand grip strength and Boston Carpal Tunnel Questionnaire (BCTQ) Symptom Severity Scale (SSS) and Functional Status Scale (FSS) over an 8-week intervention. Design and Setting: A two-arm, parallel-group randomized controlled trial conducted in an outpatient clinical rehabilitation setting. Participants: Forty adult patients (aged 42.7 ± 10.3 years; 32 females, 8 males) with clinically confirmed mild-to-moderate CTS allocated equally (20 per arm). Interventions: Both groups performed identical progressive low-load resistance training (approximately 20% of 1RM; 4 sets of 30-15-15-15 reps) targeting the hand and forearm 3 times weekly for 8 weeks (24 sessions). Group A performed all sets with an upper-arm pneumatic cuff inflated to 50% limb occlusion pressure (LOP), whereas Group B performed exercise without occlusion. Outcomes: Primary outcomes were Jamar grip dynamometry (kg) and BCTQ-SSS and BCTQ-FSS scores evaluated at baseline (T0) and week 8 (T2), with intermediate evaluation at week 4 (T1). Results: All 40 participants completed the trial. In the primary baseline-adjusted ANCOVA at week 8, Group A demonstrated significantly greater improvements than Group B in grip strength (adjusted between-group difference: 2.30 kg, 95% CI 1.88 to 2.72; p < 0.001), BCTQ-SSS (−0.25, 95% CI −0.32 to −0.19; p < 0.001), and BCTQ-FSS (−0.21, 95% CI −0.27 to −0.15; p < 0.001). Treatment adherence was higher in Group A (95.8% vs 91.0%, p = 0.003). Sensitivity analyses adjusting for adherence and baseline covariates confirmed consistent treatment effects. Conclusions: Combining BFR at 50% LOP with low-load resistance exercise yielded statistically superior gains in grip strength and functional scores compared to low-load exercise alone. Grip strength improvements exceeded clinical MCID thresholds, while functional score enhancements were modest. BFR represents an effective conservative modality for CTS rehabilitation.