Effects of Tissue Flossing on Pain and Functional Performance in Patients With Achilles Tendinopathy

April 2, 2026 updated by: Riphah International University
This study is a randomized controlled trial (RCT) investigating the effectiveness of tissue flossing as an adjunctive therapy for Achilles tendinopathy. Thirty participants, aged 20-45 years with a clinical diagnosis of Achilles tendinopathy (>6 weeks), will be randomly assigned to one of two groups. The intervention group will receive a single session of tissue flossing (involving an elastic band wrapped from mid-calf to heel under moderate tension, followed by active ankle exercises) combined with conventional eccentric loading exercises. The control group will receive conventional eccentric loading exercises only. The primary outcome measures will be pain intensity, assessed using the Numeric Pain Rating Scale (NPRS); ankle range of motion, measured via the Weight-Bearing Lunge Test (WBLT); functional limitation, evaluated with the Lower Extremity Functional Scale (LEFS); and jump performance, measured by countermovement jump height using the My Jump Lab app. Assessments will be conducted at baseline, after the intervention session, and at a one-week follow-up. The study aims to determine if tissue flossing provides significant immediate and short-term improvements in pain and function, potentially offering a novel, low-cost supportive technique for rehabilitation.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
30

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Pakistan
    • Punjab Province
      • Rawalpindi, Punjab Province, Pakistan, 46000
        • Fauji Foundation Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • · Adults aged 20-45 years.

    • Clinically diagnosed with Achilles tendinopathy for more than 6 weeks.
    • Ability to walk independently.
    • Pain on palpation of the Achilles tendon.
    • A pain score greater than 3/10 on the Numeric Pain Rating Scale (NPRS).
    • Subjective reporting of pain located 2-6 cm above the tendon's insertion into the calcaneum (heel bone).
    • A positive Painful Arc sign (pain localized to the tendon that moves with ankle motion).
    • A Body Mass Index (BMI) between 18.5 and 29.9.

Exclusion Criteria:

  • · Systemic inflammatory diseases (e.g., rheumatoid arthritis).

    • A recent corticosteroid injection (e.g., within the last 3 months) or surgery related to the Achilles tendon.
    • Diagnosed neurological deficits.
    • Recent fractures in the lower limb.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Single

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Intervention group
Group receiving tissue flossing and eccentric exercises
Device: Tissue flossing
The intervention group receives a single session of tissue flossing combined with conventional treatment. The flossing protocol involves applying an elastic band (50-70% tension) from the mid-calf to the heel. While wrapped, participants perform active ankle range of motion and bodyweight heel raises for 2-3 minutes. This is immediately followed by the conventional treatment: eccentric loading exercises for the gastrocnemius (knee straight) and soleus (knee flexed 45°) muscles, consisting of 2 sets of 20 repetitions with a 5-minute rest between sets.
Other Names:
  • Voodoo flossing
Active Comparator: Control group
Group receiving only eccentric exercises
Other: Eccentric exercises
The control group will receive conventional treatment only, which consists of a standardized eccentric exercise program for the Achilles tendon. This protocol involves performing eccentric loading exercises for both the gastrocnemius muscle with the knee held straight and the soleus muscle with the knee flexed to 45 degrees. The dosage is set at two sets of twenty repetitions for each exercise, with a five-minute rest period provided between sets. This conventional regimen will be administered in three sessions over the course of one week. Participants in this group will not receive any form of tissue flossing intervention. All outcome measures, including pain, range of motion, functional performance, and jump height, will be assessed at baseline, after each treatment session, and at the one-week follow-up to evaluate progress.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Numeric Pain rating scale
Time Frame: From enrollment to the end of treatment at 1 week
Level of pain measured by Numeric Pain rating scale (NPRS), 0 means no pain and 10 means severe pain
From enrollment to the end of treatment at 1 week

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Range of motion
Time Frame: From enrollment to the end of treatment at 1 week
Range of motion at ankle joint measured using weight bearing lunge test
From enrollment to the end of treatment at 1 week
Counter-movement Jump Height
Time Frame: From enrollment to the end of treatment at 1 week
Countermovement Jump (CMJ) is a widely used, rapid, and non-invasive athletic assessment that measures lower-body explosive power, neuromuscular function, and fatigue. It involves an athlete standing upright, performing a quick downward movement (countermovement) to a self-selected depth, followed immediately by a maximal vertical jump
From enrollment to the end of treatment at 1 week
Lower Extremity Functional Scale (LEFS)
Time Frame: From enrollment to the end of treatment at 1 week
A 20-item, self-report questionnaire assessing the patient-perceived functional ability of individuals with lower extremity musculoskeletal conditions
From enrollment to the end of treatment at 1 week

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Riphah International University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Muhammad Tayyab Iqbal, DPT, Riphah International University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
September 18, 2025

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
January 30, 2026

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
January 30, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
April 2, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 2, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
April 9, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
April 9, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
April 2, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
April 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • REC/02271 Tayyab

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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