OBJECTIVE: To determine whether the combined application of blood flow restriction and neuromuscular electrical stimulation significantly affects quadriceps strength, hypertrophy, pain, and fatigue. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: PubMed, Scopus, and Web of Science from inception to November 2023. STUDY SELECTION CRITERIA: Randomized and non-randomized full-text human clinical trials published in English investigating the combination between blood flow restriction and neuromuscular electrical stimulation on knee joint. DATA SYNTHESIS: The correlation data was pooled across studies using a random effects model. Cohen's D was calculated for each original study and an overall estimator, and a two-sided p value < 0.05 was considered statistically significant. RESULTS: Out of 294 records, nine studies with 257 participants were included in the systematic review. A meta-analysis revealed no significant differences in quadriceps strength at two, 3, and 6 weeks. Similarly, it was also shown in hypertrophy at 7 to 15 min, 2, and 6 weeks. CONCLUSION: The blood flow restriction combined with neuromuscular electrical stimulation had no additional effect to the original isolated techniques on quadriceps strength and hypertrophy. Moreover, causes higher pain and fatigue levels after its use.

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