BACKGROUND: Blood flow restriction treatment for lateral epicondylitis has little empirical evidence to support its use. OBJECTIVES: To identify whether a blood flow restriction physical therapy (BFRPT) program is superior to a standard physical therapy (SPT) program when treating lateral epicondylitis. METHODS: A randomized controlled trial comparing a BFRPT program to an SPT program over six weekly visits was performed. The primary outcome was the change in the patient rated tennis elbow evaluation (PRTEE) score at 12 months. Secondary outcomes included the numeric pain rating scale (NPRS) and change in grip strength. RESULTS: Forty-one patients were enrolled and included in the intention to treat analysis. The PRTEE was analyzed with linear mixed effect model and revealed statistically significant improvements in both the SPT group -26.22 (95% CI -37.35 to -15.09, p < 0.0001), and the BFRPT group -30.54 (95% CI -42.44 to -18.63, p < 0.0001). BFRPT showed non-statistically significant improvement at 12 months compared to SPT, -4.32 (95% CI -9.17 to 17.81, p = 0.53). Secondary outcomes also showed non-statistically significant differences: NPRS at 12 months, favoring SPT with a between group difference of -0.23 (95% CI -2.56 to 2.1, p = 0.85); pain-free grip strength favoring SPT -14.05 kg (95% CI -41.28 to 11.59, p = 0.25), and maximum grip strength also favoring SPT -4.95 kg (95% CI -28.61 to 18.71, p = 0.66) at the completion of therapy. CONCLUSION: This real-world trial suggests the addition of once weekly BFRPT is no better than simply performing a standard once weekly heavy load SPT protocol with prescribed HEP.

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