Study on the Effect of Blood Flow Restriction Training Combined With IASTAM on Symptoms in Patients With Chronic Ankle Instability
Phase: NA
Conditions: Chronic Ankle Instability,CA
Sponsor: Yang Liu

Experimental Reserch Program
Title: The effect of blood flow restriction training on chronic ankle instability symptoms in sports
dance athletes
Experimental period: December：11/20/2023-12/30/2023
Ethics Review Number of Wuhan Sports University School of Medicine:2023102
Project Summary
Chronic Ankle Instability (CAI) is a common sports injury disorder. Athletes also suffer from
patellofemoral pain in their daily lives and training. Instrument Assisted Soft Tissue Mobilization
(IASTM) is a physical therapy technique that uses specially designed tools such as metal or plastic
scraping boards to assist in handling soft tissue problems. Mainly used in rehabilitation medicine,
sports medicine, and plastic surgery, it is used to handle tension, adhesion, pain, and motor
dysfunction of muscles, fascia, and tendons [25, 26, 27]. Blood Flow Restriction Training (BFRT)
is a special training technique aimed at limiting blood flow through the use of cuffs or elastic
bands on the limbs, in order to promote muscle growth and improve strength
Therefore, in order to further optimize the rehabilitation process of CAI, this study designed a
comprehensive rehabilitation training program that combines blood flow restriction training
(BFRT) with ankle balance training, ankle peripheral reinforcement training, and IASTM physical
release. BFRT was chosen because it has the adaptability to generate muscle strength at lower
loads, providing a relatively low-risk approach for rehabilitation. The combination of ankle
balance training and reinforcement training, as well as the physical release of IASTM, is expected
to play a synergistic role in promoting the rehabilitation process. By comparing conventional
balance training with pure BFRT training, this study aims to evaluate the effect of BFRT assisted
rehabilitation on ankle rehabilitation of sports dance athletes, providing new theoretical and
empirical support for the rehabilitation field. Through in-depth research, it is expected to provide
more effective and comprehensive rehabilitation plans for sports dance athletes, improve their
rehabilitation speed and effectiveness, and better safeguard their health and career.

Basic information
Agreement Title:The effect of blood flow restriction training on chronic ankle instability
symptoms in sports dance athletes
Acceptance number: 2023102
Date; 2023.11.20-2023.12.30
The guarantor; Liu Yang, Wuhan Sports College, Hubei Province, China
Telephone; 18935836605
Clinical laboratory; Wuhan Sports Institute Sports Rehabilitation Laboratory and Wuhan Sports
Institute National Fitness Center
Sports dance, also known as international standard dance, is divided into two series: Latin
and Modern. In this high-intensity sport, athletes often face the risk of various sports injuries,
among which chronic ankle instability (CAI) is a common and significant problem in dance sports
[1,2]. Repeated sprains during exercise and long-term ankle joint dysfunction are important factors
leading to CAI [3,4]. Its main feature is the reduced stability of the ankle joint, which increases the
risk of ankle re sprains for patients during walking, exercise, or other activities [4,5]. For sports
dancers, the ankle is one of the joints that bear the greatest pressure during exercise, and its
complex structure and frequent exercise requirements make the ankle joint more susceptible to
injury. The injury of the ankle joint is highly correlated with the characteristics of sports dance
projects. Due to the need for sports dance athletes to perform high-frequency and difficult
movements, the ankle is in a constantly changing load state. This sport characteristic puts the
ankle at a high risk of injury [6]. Especially in dance events that require frequent changes in
direction and jumping movements, ankle sprains, ligament strains, and other forms of injury are
very common [7]. Secondly, in addition to the unpredictable demands of dance movements on the
ankle, some high demand movements may lead to ankle injuries in unstable states. Continuous
high-intensity dance training and performance may increase the risk of ankle muscle fatigue and
injury [8]. Ankle joint injury may not only affect the athletic performance of athletes, but also lead
to delays in the rehabilitation process, which can have adverse effects on the athlete's career. After
the rest symptoms disappear, the muscles around the ankle joint may become weak due to trauma

or inadequate recovery, including the gastrocnemius and tibialis anterior muscles around the ankle.
Muscle weakness or incomplete ligament healing can lead to insufficient joint support, resulting in
loss of ankle stability, which is also an important factor in inducing CAI [9,10]. Moreover, the
ability of nerves to control muscle movement may be affected, leading to inadequate muscle
coordination and increasing the risk of ankle instability [11]. Therefore, strengthening training for
the strength and stability of the ankle joint after rehabilitation is particularly important.
Blood Flow Restriction Training (BFRT) is a special training technique aimed at limiting
blood flow by using cuffs or elastic bands on the limbs to promote muscle growth and improve
strength [13]. BFRT was originally designed for rehabilitation injured athletes because it can
improve muscle strength while reducing load, helping to avoid further injuries during the
rehabilitation process [14]. But as research deepens, it is gradually being applied to a wider range
of fitness and training fields [15,16]. One major advantage of BFRT is that it allows for efficient
training under relatively light loads, reducing the burden on joints and tendons, making it suitable
for people who find it difficult to withstand high-intensity training due to injuries or other reasons
[14]. Meanwhile, BFRT also has the characteristic of achieving muscle growth and strength
growth in a short period of time, and it is considered a time-saving training method [14]. BFRT
can not only be used for strength training, but also for rehabilitation, improving endurance, and
improving sports performance, making it have potential applications in various fields [15]. In
rehabilitation training, it can be applied to multiple body parts to promote the recovery of injured
areas and improve muscle strength, including; Direct effects on limb muscle groups and elbow
and knee joints, indirect effects on shoulders, hips, and buttocks [17, 18, 19, 20], among which
studies have shown that BFRT has an activating effect on the calf muscle group of CAI athletes.
Under low load resistance exercise, the oxygen saturation of the calf muscle group is significantly
reduced, and the muscle fatigue perception score is significantly improved, which has an impact
on the strength of the lower limbs of CAI patients There is a promoting effect in terms of
functionality and other aspects [21, 22, 23].
Instrument Assisted Soft Tissue Mobilization (IASTM) is a physical therapy technique that
utilizes specially designed tools (such as metal or plastic scraping boards) to assist in the treatment
of soft tissue problems [24]. Mainly used in rehabilitation medicine, sports medicine, and plastic
surgery, it is used to handle tension, adhesion, pain, and motor dysfunction of muscles, fascia, and

tendons [25, 26, 27]. The edge design of IASTM special tools can loosen adhesions in tissues,
improving their elasticity and plasticity. Regulating pathological areas through neural pathways,
reducing pain and improving neurological function [28]. And different types of treatment tools
improve the accuracy of treatment, promote blood circulation, accelerate the rehabilitation process,
improve tissue elasticity, expand joint range of motion, and have lower risks and complications
compared to invasive surgery [29,30,31]. Studies have shown that IASTM can significantly
improve lower limb joint function, reduce pain, and increase range of motion [19, 28].
Therefore, in order to further optimize the rehabilitation process of CAI, this study designed a
comprehensive rehabilitation training program that combines blood flow restriction training
(BFRT) with ankle balance training, ankle peripheral reinforcement training, and IASTM physical
release. BFRT was chosen because it has the adaptability to generate muscle strength at lower
loads, providing a relatively low-risk approach for rehabilitation. The combination of ankle
balance training and reinforcement training, as well as the physical release of IASTM, is expected
to play a synergistic role in promoting the rehabilitation process. Through in-depth research, it is
expected to provide more effective and comprehensive rehabilitation plans for sports dance
athletes, improve their rehabilitation speed and effectiveness, and better safeguard their health and
career.
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Research Objective
Through experimental observation of exercise intervention (blood flow restriction training

combined with low load ankle muscle strength training and balance training) combined with
instrument tool therapy (Instrument Soft Tissue Release Technique, IASTM), the intervention
effect on ankle function, strength, and joint range of motion of sports dance athletes with ankle
instability was observed.
Research process and methods
Method; Select 30-45 subjects with unstable, restricted, or uncomfortable ankle joints as
observation subjects, and randomly divide them into ankle joint blood flow restriction training
combined with IASTM group (n=10-15), ankle joint blood flow restriction training alone
(n=10-15), and traditional ankle strength training (n=10-15). The intervention lasted for 4-6 weeks,
once a week. Cumberland ankle instability assessment, FAAM ankle function assessment score,
and ankle range of motion measurement were performed at three time points before intervention,
after the first intervention, and after 4 weeks/6 weeks of intervention for the three groups. The
ankle strength test was only compared and analyzed at two time points before and after
intervention.
Process: This study is divided into three stages: pre intervention stage, post initial intervention
stage, and post intervention stage. In the pre intervention stage, researchers will conduct
preliminary evaluations and data statistics on subjects, including Cumberland ankle instability
assessment, FAAM ankle function assessment score, and ankle range of motion measurement.
During the intervention phase, participants from each group will undergo a 6-week exercise
intervention, with a training frequency of 2 sessions per week and each session lasting 20-30
minutes. During BFRT exercise, a cuff will be wrapped around the proximal one-third of the upper
limb of the subject to improve muscle strength and endurance by restricting blood flow. In this
state, corresponding ankle training movements (stability training, ankle peripheral muscle group
training) will be completed.

Research object
Select students majoring in sports dance who have chronic ankle instability and undergo five
tests, including balance test, single leg standing, Trendelenburg test, balance test, dynamic balance
test, Anterior Drawer test, and Y-Balance test. If two or more tests meet the positive test, it is
determined that chronic ankle instability is present, Can be included in the experimental subjects.
This experiment has been approved by the Ethics Review Committee of the Medical College of
Wuhan Sport University.
Table 1 Inclusion and Exclusion Criteria
Standard
Inclusion Criteria
Exclusion Criteria
Age
118-35 years old
under 18 years old or above 35 years o
Course Of
Disease
Suffering from chronic ankle instability
symptoms that last for at least 3 months
Acute ankle injury or no joint injury
CAIT score
The CAIT score is 24 points or less.
CAIT score above 24 points
Functional
screening
Two or more tests tested positive for ankle
joint function screening before the
experiment
Failed ankle function screening
Structural
inspection
No structural joint lesions or congenital
ankle deformities,
Structural lesions or congenital ankle
deformities present in the ankle joint
Medical
History
Have not undergone ankle surgery or have
external injuries
Have undergone ankle surgery or have obvious
injuries or wounds
Health
Condition
No serious heart, lung, nervous system or
other systemic diseases
Serious heart, lung, nervous system or other
systemic diseases
Agree to
participate in
research
Limited athletic ability, unable to complete
research tasks
Disagree to participate in the study, or inability
to understand and comply with the research
protocol

Experimental Group
The experimental group used exercise intervention BFRT combined with physical release
ASTM as the main intervention measure. The training programs applied by BFRT include ankle
stability training and ankle joint surrounding muscle group strength training. Ankle stability
training mainly uses the tool Bosu ball [37] to intervene in four movements: single leg support
training, kick balance training, plank support, and deep squat. Ankle muscle group strength
training mainly includes heel lifting training and foot dorsiflexion, eversion, and inversion training
with the assistance of elastic band resistance. Due to the fact that most CAI patients have limited
dorsiflexion and insufficient valgus force, the focus of the exercise intervention plan is to increase
the intensity of dorsiflexion and valgus training.
In this experiment, IASTM used a fascial knife as the treatment tool. There are mainly five
types of knives, including C-type scanning knife, B-type bat knife, M-type large M-knife, A-type
shark knife, and S-type hook knife. According to the special shape of each knife, their functions
and uses are also different. The IASTM intervention was completed before BFRT, with the main
purpose of releasing the soft tissues around the calf and ankle joints through physical intervention
with a fascial knife, in order to improve ankle pain and restore ankle range of motion
Control Group
The control group of this study consisted of traditional ankle joint stability training and ankle
joint peripheral muscle group strength training, with the same specific training plan as the
experimental group
Research indicators
Cumberland ankle instability questionnaire
The Cumberland Ankle Instability Tool (CAIT) [42] assessed patients' perception of ankle
instability, including the frequency, intensity, and impact of symptoms. CAIT typically includes a
specific range of questions, each of which may have different scores. The total score is usually
between 0 and 30 points

FAAM Ankle Function Assessment Questionnaire
Foot and Ankle Ability Measure (FAAM) is a scale used to evaluate ankle joint function, which
includes questions about pain, function, and quality of life, and can be used to assess the overall
condition of patients with ankle instability. The functional score includes two types of assessments:
the functional level of daily life (FAAM-ADL) and the functional level of physical activity
(FAAM-SPORT). The score range is usually from 0 to 100, where 100 represents completely
normal ankle joint function, and 0 represents extreme restriction or complete inability to use the
ankle joint.
Ankle joint range of motion
This study used a high-precision joint angle measuring ruler to measure the range of motion of
different ankle functions in both sitting and supine positions, including measurements of
dorsiflexion and plantar flexion of the ankle, as well as measurements of varus and eversion of the
foot .
Ankle joint strength test
The experimental strength data was tested using a handheld digital muscle strength tester
(model: FM-204M series muscle strength tester). The measurement unit of this muscle strength
tester is N, with a measurement unit range of ± 50kgf and a measurement accuracy of ± 0.5% FS
(range) ± 1 digital peak. The measured data includes both peak strength and instantaneous strength
values. Therefore, this study used a handheld digital muscle strength tester, where participants sat
in a suitable position, fixed the bottom of the instrument on the ground, and then applied force in
different directions through their ankles. Measure the maximum force in the dorsiflexion and
plantarflexion of the ankle joint, as well as in the abduction and adduction directions of the foot.
The strength test for each different exercise segment needs to be completed three times, and the
average of the maximum strength values from the three tests is taken.
Statistical analysis
This study used SPSS 26.0 statistical software for data reading, testing, and statistical analysis.

The general information of the subjects is analyzed using an independent sample t-test. The
measurement data conforms to a normal distribution. Because there are three time points (pre
intervention, first intervention, and 6-week intervention) in the experimental data for measuring
ankle joint function indicators and range of motion indicators, repeated measures analysis of
variance is used for data statistics and analysis. Ankle joint strength was only measured at two
time points (before intervention and after 6 weeks of intervention), and the data was only analyzed
using paired t-tests. P<0.05 is a significant difference with statistical significance.
Quality Assurance
This experiment undergoes strict quality control, including inclusion criteria for experimental
subjects, setting of research indicators, assurance during the experimental process, management
and analysis of data records after the experiment, all of which are guaranteed by the experimental
leader! Quality monitoring is carried out during the research process, and any issues that arise are
promptly adjusted and corrected to ensure the normal progress of the study. The implementation of
quality assurance measures can improve the reliability and validity of research, making the results
more credible, reliable, and scientific.
Expected results of the study
This study is only a rehabilitation plan designed to improve the stability of athletes' ankle joints
through physical therapy combined with exercise intervention. It is hoped that this experiment can
provide rehabilitation ideas and methods for solving ankle joint function problems in athletes.
Achievement dissemination and publishing policies
Researchers will serve as the lead publisher responsible for the publication of this experiment
and paper.
Project Deadline
20/10/2023

Recruitment end date
19/011/2023
Overall test start date
20/11/2023
Overall Trial End Date30/12/2023
Ethics
The intervention of human ankle joint stability involved in this experiment involves physical
therapy with external tools, without involving the use of any new drugs or rigorous ethical issues.
When incorporating participants, they will be required to sign an informed consent form and
submit an ethics review form to the school. Finally, it is confirmed that the informed consent of all
subjects and/or their legal guardians has been obtained, and it is confirmed that this experiment
has been approved by the ethical review of the human body experiment at Wuhan Sports
University. Confirm that all methods are carried out in accordance with relevant guidelines and
regulations.
Informed consent form
Prior to the start of the experiment, informed consent forms should be provided, requiring
participants to know the specific protocol and risks of the experiment, and to sign informed
consent forms after understanding the protocol.