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Low-load blood flow restriction training as a viable alternative to high-load eccentric training for improving Achilles tendon properties: the superiority of a calf-specific regimen
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Jingyuan FAN1, Jing LI1, Weimin PAN1, 2, Longguo ZHANG1, Huan FENG1, Xiaoyu WEI3, Yan HUANG1, Yingpeng JIANG4, Min LIU5
Journal of Army Medical University | 2026, 48(4) : 470 - 478
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Journal of Army Medical University | 2026, 48(4): 470-478
• Military Medicine •
Low-load blood flow restriction training as a viable alternative to high-load eccentric training for improving Achilles tendon properties: the superiority of a calf-specific regimen
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Jingyuan FAN1, Jing LI1, Weimin PAN1, 2, Longguo ZHANG1, Huan FENG1, Xiaoyu WEI3, Yan HUANG1, Yingpeng JIANG4, Min LIU5
Affiliations
  • 1College of Sports and Health Sciences, Xi’an Physical Education University, Xi’an, Shaanxi
  • 2Engineering Research Center of Innovative Technology of Intelligent Sports Equipment, Universities of Shaanxi Province, Xi’an, Shaanxi
  • 3Department of Rehabilitation Medicine, Xi’an Gaoxin Hospital, Xi’an, Shaanxi
  • 4Department of Rehabilitation Medicine, Shanxi Rongjun Hospital, Taiyuan, Shanxi
  • 5Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
Published: 2026-02-28 doi: 10.16016/j.2097-0927.202511036
Outline
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Objective

To compare the effects of 2 different blood flow restriction (BFR) rehabilitation protocols versus classic high-load eccentric resistance training on the morphology and biomechanical properties of the Achilles tendon in healthy adults, and to provide alternative training strategies for preventing Achilles tendon injuries in military training.

Methods

A randomized controlled trial was conducted. Fifty-five healthy adults from a university in Xi’an were enrolled between December 20 and 23, 2024, and randomly assigned to one of three groups using a random number table: a high-load eccentric resistance training group (HL, n=18), a low-load eccentric resistance training with calf-applied BFR group (C-BFR, n=16), and a low-load eccentric resistance training with thigh-applied BFR group (T-BFR, n=19). All groups completed an 8-week training program. Achilles tendon cross-sectional area was assessed using color Doppler ultrasonography at baseline, 6 weeks and 8 weeks. Achilles tendon stiffness and Young’s modulus were evaluated using color Doppler ultrasonography and a wireless microFET3 dynamometer. The maximal voluntary isometric contraction (MVIC) of the medial gastrocnemius was simultaneously measured using the wireless microFET3 and surface electromyography. Countermovement jump (CMJ) height and drop jump (DJ) ground contact time were measured using a three-dimensional force platform.

Results

After 8 weeks of intervention, color Doppler ultrasonography assessment revealed that the cross-sectional area of the Achilles tendon significantly increased in all three groups compared to baseline (P<0.01, η²=0.847), with a greater increase in the C-BFR group than in the T-BFR group. Tendon stiffness significantly increased in all three groups compared to baseline (P<0.01, η²=0.722), and the increase was greater in the C-BFR group than in the HL and T-BFR groups. For Young’s modulus, no statistically significant change was observed in the T-BFR group compared to baseline (P>0.05), while both the C-BFR and HL groups showed significant increases (P<0.05, η²=0.181), with a greater increase in the C-BFR group than in the HL and T-BFR groups. The MVIC of the medial gastrocnemius significantly increased in all three groups compared to baseline (P<0.01, η²=0.775), with a greater increase in the C-BFR group than in the T-BFR group. CMJ height significantly increased in all three groups (P<0.01, η²=0.569), with a greater increase in the C-BFR group than in the T-BFR group. DJ ground contact time significantly shortened in all three groups (P<0.01, η²=0.518), and the shortening was greater in the C-BFR group than in the T-BFR group.

Conclusion

Both C-BFR and T-BFR combined with low-load eccentric resistance training can achieve improvements in Achilles tendon morphology, biomechanical properties, and kinematic performance similar to those achieved with classic high-load eccentric resistance training. Furthermore, compared to the T-BFR protocol, the C-BFR protocol demonstrates superior benefits.

Achilles tendon  /  blood flow restriction training  /  resistance training  /  biomechanics  /  athletic injuries
樊竞远, 李婧, 潘玮敏, 张龙国, 冯欢, 魏晓宇, 黄艳, 蒋应鹏, 刘民. 低负荷血流限制训练可作为高负荷离心训练的有效替代以改善跟腱性能:小腿方案为更优选择. 陆军军医大学学报, 2026 , 48 (4) : 470 -478 . DOI: 10.16016/j.2097-0927.202511036
Jingyuan FAN, Jing LI, Weimin PAN, Longguo ZHANG, Huan FENG, Xiaoyu WEI, Yan HUANG, Yingpeng JIANG, Min LIU. Low-load blood flow restriction training as a viable alternative to high-load eccentric training for improving Achilles tendon properties: the superiority of a calf-specific regimen[J]. Journal of Army Medical University, 2026 , 48 (4) : 470 -478 . DOI: 10.16016/j.2097-0927.202511036
Year 2026 volume 48 Issue 4
68
33
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Article Info
doi: 10.16016/j.2097-0927.202511036
  • Receive Date:2025-11-07
  • Online Date:2026-10-23
  • Published:2026-02-28
Article Data
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History
  • Received:2025-11-07
  • Revised:2026-01-12
Affiliations
    1College of Sports and Health Sciences, Xi’an Physical Education University, Xi’an, Shaanxi
    2Engineering Research Center of Innovative Technology of Intelligent Sports Equipment, Universities of Shaanxi Province, Xi’an, Shaanxi
    3Department of Rehabilitation Medicine, Xi’an Gaoxin Hospital, Xi’an, Shaanxi
    4Department of Rehabilitation Medicine, Shanxi Rongjun Hospital, Taiyuan, Shanxi
    5Department of Orthopedics, Xijing Hospital, Air Force Medical University, Xi’an, Shaanxi, China
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表12种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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