Effects of Tissue Flossing on the Healthy and Impaired Musculoskeletal System: A Scoping Review

Andreas Konrad, Richard Močnik, Masatoshi Nakamura, Andreas Konrad, Richard Močnik, Masatoshi Nakamura

Abstract

There is a belief that tissue flossing can improve the range of motion or performance, speed up recovery, and decrease the pain caused by various diseases or injuries. As a result, many therapists, patients, and athletes are now using this technique. Consequently, in the last 5 years, a number of studies have addressed these assumptions. The purpose of this scoping review is to introduce the application of a floss band and to summarize the existing evidence for the effect of floss band treatment on the range of motion, performance, recovery, and pain (due to disease or injuries). A further goal is to suggest what needs to be addressed in future studies. The online search was performed in PubMed, Scopus, and Web of Science databases. Any studies dealing with the effects of a floss band treatment on the range of motion, performance, recovery, or pain parameters in any population (e.g., patients, athletes) were included in this review. Twenty-four studies met the inclusion criteria, with a total of 513 participants. The included studies revealed that there is evidence that a single floss band treatment is able to increase the range of motion of the related joint and can positively affect jumping and strength performance. However, these findings show only small to moderate effect sizes. Although not yet clearly understood, a possible mechanism for such changes in the range of motion or performance is likely due to changed neuromuscular function, rather than changed mechanical properties, of the muscle (e.g., stiffness). All in all, there is a need to conduct long-term studies about the effects of flossing treatment on the range of motion and performance (e.g., strength or jumping parameters) and its related mechanism (e.g., pain tolerance). There is weak evidence that flossing can be of value for pain relief in the treatment of certain diseases and for speeding up recovery after exercise. Moreover, there is weak evidence that flossing might have a superior conditioning (warm-up) effect compared to stretching when the goal is to improve the range of motion or certain aspects of muscle strength, while no such superior effect has been reported when compared to foam rolling.

Keywords: blood flow restriction; flexibility; occlusion; recovery; strength; voodoo band.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Konrad, Močnik and Nakamura.

Figures

Figure 1
Figure 1
Typical example of a floss band treatment, with the floss band wrapped around the thigh. An additional movement during the floss band treatment (e.g., deep squat during thigh flossing) should enhance the efficacy.
Figure 2
Figure 2
Flowchart of the systematic screening process (Preferred Reporting Items for Systematic Reviews and Meta-analyses).

References

    1. Baumgart C., Freiwald J., Kühnemann M., Hotfiel T., Hüttel M., Hoppe M. (2019). Foam rolling of the calf and anterior thigh: biomechanical loads and acute effects on vertical jump height and muscle stiffness. Sports 7:27. 10.3390/sports7010027
    1. Behm D. G. (2018). The Science and Physiology of Flexibility and Stretching. London: Routledge.
    1. Behm D. G., Blazevich A. J., Kay A. D., McHugh M. (2016). Acute effects of muscle stretching on physical performance, range of motion, and injury incidence in healthy active individuals: a systematic review. Appl. Physiol. Nutr. Metab. 41, 1–11. 10.1139/apnm-2015-0235
    1. Behm D. G., Wilke J. (2019). Do self-myofascial release devices release myofascia? Rolling mechanisms: a narrative review. Sport. Med. 49, 1173–1181. 10.1007/s40279-019-01149-y
    1. Bohlen J., Arsenault M., Deane B., Miller P., Guadagno M., Dobrosielski D. A. (2014). Effects of applying floss bands on regional blood flow. Int. J. Exerc. Sci. Conf. Proc. 9. Available at:
    1. Borda J., Selhorst M. (2017). The use of compression tack and flossing along with lacrosse ball massage to treat chronic Achilles tendinopathy in an adolescent athlete: a case report. J. Man. Manip. Ther. 25, 57–61. 10.1080/10669817.2016.1159403
    1. Brown F., Gissane C., Howatson G., van Someren K., Pedlar C., Hill J. (2017). Compression garments and recovery from exercise: a meta-analysis. Sport. Med. 47, 2245–2267. 10.1007/s40279-017-0728-9
    1. Cage S. A. J., Warner B., Stevenson P., Arce-Esquivel A. A. (2018). Flossing bands to treat Keinböck's disease in a collegiate men's basketball player: a case report. Int. Phys. Med. Rehabil. J. 3, 166–168. 10.15406/ipmrj.2018.03.00096
    1. Carlson S., Rife G., Williams Z., Carlson S., Rife G., Zachary W. (2019). Comparing the Effects of Tissue Flossing and Instrument Assisted Soft Tissue Mobilization on Ankle Dorsiflexion. Available online at: (accessed January 29, 2021).
    1. Cheatham S. W., Baker R. (2019). Quantification of the rockfloss® floss band stretch force at different elongation lengths. J. Sport Rehabil. 29, 377–380. 10.1123/jsr.2019-0034
    1. Cheatham S. W., Martinez R. E., Montalvo A., Odai M., Echeverry S., Robinson B., et al. . (2020). Myofascial compression interventions: comparison of roller massage, instrument assisted soft-tissue mobilization, and floss band on passive knee motion among inexperienced individuals. Clin. Pract. Athl. Train. 3, 24–36. 10.31622/2020/0003.3.5
    1. Cohen J. (1988). Statistical Power Analysis for the Behavioral Sciences, 2nd Edn. Hillsdale: Erlbaum.
    1. Driller M., Mackay K., Mills B., Tavares F. (2017). Tissue flossing on ankle range of motion, jump and sprint performance: a follow-up study. Phys. Ther. Sport 28, 29–33. 10.1016/j.ptsp.2017.08.081
    1. Driller M. W., Overmayer R. G. (2017). The effects of tissue flossing on ankle range of motion and jump performance. Phys. Ther. Sport 25, 20–24. 10.1016/j.ptsp.2016.12.004
    1. Galis J., Cooper D. (2020). Application of a floss band at differing pressure levels: effects at the ankle joint. J. Strength Cond. Res. 10.1519/JSC.0000000000003833. [Epub ahead of print].
    1. Gorny V., Stöggl T. (2018). Tissue flossing as a recovery tool for the lower extremity after strength endurance intervals. Sportverletz. Sportschaden 32, 55–60. 10.1055/s-0043-122782
    1. Hjortskov N., Skotte J., Hye-Knudsen C., Fallentin N. (2005). Sympathetic outflow enhances the stretch reflex response in the relaxed soleus muscle in humans. J. Appl. Physiol. 98, 1366–1370. 10.1152/japplphysiol.00955.2004
    1. Hopkins W. (2004). How to interpret changes in an athletic performance test. Sportscience 8, 1–7.
    1. Jakeman J. R., Byrne C., Eston R. G. (2010). Lower limb compression garment improves recovery from exercise-induced muscle damage in young, active females. Eur. J. Appl. Physiol. 109, 1137–1144. 10.1007/s00421-010-1464-0
    1. Kaneda H., Takahira N., Tsuda K., Tozaki K., Kudo S., Takahashi Y., et al. . (2020b). Effects of tissue flossing and dynamic stretching on hamstring muscles function. J. Sport. Sci. Med. 19, 681–689.
    1. Kaneda H., Takahira N., Tsuda K., Tozaki K., Sakai K., Kudo S., et al. . (2020a). The effects of tissue flossing and static stretching on gastrocnemius exertion and flexibility. Isokinet. Exerc. Sci. 28, 205–213. 10.3233/IES-192235
    1. Kiefer B. N., Lemarr K. E., Enriquez C. C., Tivener K. A., Daniel T. (2017). A pilot study: perceptual effects of the voodoo floss band on glenohumeral flexibility. Int. J. Athl. Ther. Train. 22, 29–33. 10.1123/ijatt.2016-0093
    1. Kielur D. S., Powden C. J. (2020). Changes of ankle dorsiflexion using compression tissue flossing: a systematic review and meta-analysis. J. Sport Rehabil. 19, 1–9. 10.1123/jsr.2020-0129
    1. Konrad A., Bernsteiner D., Budini F., Reiner M. M., Glashüttner C., Berger C., et al. . (2020a). Tissue flossing of the thigh increases isometric strength acutely but has no effects on flexibility or jump height. Eur. J. Sport Sci. 10.1080/17461391.2020.1853818. [Epub ahead of print].
    1. Konrad A., Budini F., Tilp M. (2017a). Acute effects of constant torque and constant angle stretching on the muscle and tendon tissue properties. Eur. J. Appl. Physiol. 117, 1649–1656. 10.1007/s00421-017-3654-5
    1. Konrad A., Glashüttner C., Reiner M. M., Bernsteiner D., Tilp M. (2020b). The acute effects of a percussive massage treatment with a hypervolt device on plantar flexor muscles' range of motion and performance. J. Sport. Sci. Med. 19, 690–694.
    1. Konrad A., Močnik R., Nakamura M., Sudi K., Tilp M. (2021). The impact of a single stretching session on running performance and running economy: a scoping review. Front. Physiol. 11:630282. 10.3389/fphys.2020.630282
    1. Konrad A., Reiner M. M., Thaller S., Tilp M. (2019). The time course of muscle-tendon properties and function responses of a five-minute static stretching exercise. Eur. J. Sport Sci. 19, 1195–1203. 10.1080/17461391.2019.1580319
    1. Konrad A., Stafilidis S., Tilp M. (2017b). Effects of acute static, ballistic, and PNF stretching exercise on the muscle and tendon tissue properties. Scand. J. Med. Sci. Sport. 27, 1070–1080. 10.1111/sms.12725
    1. Konrad A., Tilp M. (2014). Increased range of motion after static stretching is not due to changes in muscle and tendon structures. Clin. Biomech. 29, 636–642. 10.1016/j.clinbiomech.2014.04.013
    1. Konrad A., Tilp M. (2020). The acute time course of muscle and tendon tissue changes following one minute of static stretching. Curr. Issues Sport Sci. 5:003. 10.15203/CISS_2020.003
    1. Macefield G., Hagbarth K. E., Gorman R., Gandevia S. C., Burke D. (1991). Decline in spindle support to alpha-motoneurones during sustained voluntary contractions. J. Physiol. 440, 497–512. 10.1113/jphysiol.1991.sp018721
    1. Magnusson S. P., Simonsen E. B., Aagaard P., Dyhre-Poulsen P., McHugh M. P., Kjaer M. (1996). Mechanical and physiological responses to stretching with and without preisometric contraction in human skeletal muscle. Arch. Phys. Med. Rehabil. 77, 373–378. 10.1016/S0003-9993(96)90087-8
    1. Marco G.-L. A., Juan C.-T. M., Julián G.-M., Miguel G.-J. (2020). The effects of tissue flossing on perceived knee pain and jump performance: a pilot study. Int. J. Hum. Mov. Sport. Sci. 8, 63–68. 10.13189/saj.2020.080203
    1. Mills B., Mayo B., Tavares F., Driller M. (2019). The effect of tissue flossing on ankle range of motion, jump, and sprint performance in elite rugby union athletes. J. Sport Rehabil. 29, 282–286. 10.1123/jsr.2018-0302
    1. Munn Z., Peters M. D. J., Stern C., Tufanaru C., McArthur A., Aromataris E. (2018). Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med. Res. Methodol. 18:143. 10.1186/s12874-018-0611-x
    1. Nakamura M., Onuma R., Kiyono R., Yasaka K., Sato S., Yahata K., et al. . (2021). Acute and prolonged effects of different durations of foam rolling on range of motion, muscle stiffness, and muscle strength. J. Sports Sci. Med. 20, 62–68. 10.52082/jssm.2021.62
    1. Nakamura M., Yasaka K., Kiyono R., Onuma R., Yahata K., Sato S., et al. . (2020). The acute effect of foam rolling on eccentrically-induced muscle damage. Int. J. Environ. Res. Public Health 18:75. 10.3390/ijerph18010075
    1. Pakarklis D., Šiupšinskas L. (2018). Instant Effects of Tissue Flossing on Ankle Range of Motion and Dynamic Balance in Handball Players. . Available online at: (accessed January 28, 2021).
    1. Paquette M. R., Peel S. A., Schilling B. K., Melcher D. A., Bloomer R. J. (2017). Soreness-related changes in three-dimensional running biomechanics following eccentric knee extensor exercise. Eur. J. Sport Sci. 17, 546–554. 10.1080/17461391.2017.1290140
    1. Pisz A., Kralova K., Blazek D., Golas A., Stastny P. (2020). Meta-analyses of the effect of flossing on ankle range of motion and power jump performance Electromyographic activity of upper-body muscles during various resistance exercises. Balt. J. Health Phys. Act. 12, 19–26. 10.29359/BJHPA.12.2.03
    1. Plocker D., Wahlquist B., Dittrich B. (2015). Effects of tissue flossing on upper extremity range of motion and power. Int. J. Exerc. Sci. Conf. Proc. 12. Available at:
    1. Prill R., Schulz R., Michel S. (2019). Tissue flossing: a new short-term compression therapy for reducing exercise-induced delayed-onset muscle soreness a randomized, controlled and double-blind pilot crossover trial. J. Sports Med. Phys. Fitness 59, 861–867. 10.23736/S0022-4707.18.08701-7
    1. Reiner M. M., Glashüttner C., Bernsteiner D., Tilp M., Guilhem G., Morales-Artacho A., et al. . (2021). A comparison of foam rolling and vibration foam rolling on the quadriceps muscle function and mechanical properties. Eur. J. Appl. Physiol. 121, 1461–1471. 10.1007/s00421-021-04619-2
    1. Ross S., Kandassamy G. (2017). The effects of “Tack and Floss” active joint mobilisation on ankle dorsiflexion range of motion using voodoo floss bands. J. Phys. Ther.
    1. Starrett K., Cordoza G. (2015). Becoming A Supple Leopard 2nd Edition: The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance. New York, NY: Victory Belt Publishing. Available online at: (accessed December 11, 2020).
    1. Stevenson P. J., Lat A., Stevenson R. K., Lat B. A., Duarte K. W. (2019). Acute effects of the voodoo flossing band on ankle range of motion. J. Med. Biomed. Appl. Sci. 7, 244–253. 10.15520/jmbas.v7i6.190
    1. Takarada Y., Takazawa H., Sato Y., Takebayashi S., Tanaka Y., Ishii N. (2006). Comparison of hormone responses following light resistance exercise with partial vascular occlusion and moderately difficult resistance exercise without occlusion. J. Appl. Physiol. 101, 1616–1622. 10.1152/japplphysiol.00440.2006
    1. Vogrin M., Kalc M., Ličen T. (2020). Acute effects of tissue flossing around the upper thigh on neuromuscular performance: a study using different degrees of wrapping pressure. J. Sport Rehabil. 25, 1–8. 10.22541/au.158870163.35192682
    1. Vogrin M., Novak F., Licen T., Greiner N., Mikl S., Kalc M. (2021). Acute effects of tissue flossing on ankle range of motion and tensiomyography parameters. J. Sport Rehabil. 30, 129–135. 10.1123/jsr.2019-0160
    1. Weber P. (2018). Flossing: an alternative treatment approach to Osgood-Schlatter's disease Case report of an adolescent soccer player. J. Bodyw. Mov. Ther. 22, 860–861. 10.1016/j.jbmt.2018.09.043
    1. Wienke A. K., Thiel C., Kopkow C. (2020). Effekte von Medical flossing bei patienten mit schulterbeschwerden: randomisierte kontrollierte Pilotstudie. Physioscience 16, 5–15. 10.1055/a-1078-6882
    1. Wilke J., Müller A. L., Giesche F., Power G., Ahmedi H., Behm D. G. (2020). Acute effects of foam rolling on range of motion in healthy adults: a systematic review with multilevel meta-analysis. Sport. Med. 50, 387–402. 10.1007/s40279-019-01205-7

Source: PubMed

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

3
Abonnieren