Sunday, June 13, 2021

Evidence For Using Floss Bands

showing Byron, Thiviyan and Megan
Remember the floss band courses we used to teach? We often had participants asking what is the evidence behind increasing joint range of motion (ROM), sporting performances, helping with recovery and decreasing pain. In short, they all wanted to know how it works

I wrote previously that you've got to try it to believe it, well there is now a published *scoping review article for floss bands (Konrad et al, 2021), referenced below.

The review paper summarizes the existing evidence for the effect of floss band treatment on range of motion (ROM), sporting performance (strength or jump performance), recovery (due to DOMS) and pain (due to disease or injuries).

In all, 24 studies met the inclusion criteria with a total of 513 subjects. 15 of the 24 studies investigated the effects of a single floss band application on the ROM of several joints. On the ankle joint, flossing was found to have a significant change of 11.17% in the dorsiflexion ROM.  

4 studies investigated the effects of calf flossing on the ankle, showing a very large increase of 19.95% in dorsiflexion of the ankle.

Similarly 4 studies measured thigh flossing and found a significant increase in knee bending (3.61%), and knee straightening (7.38%). However, another study showed no improvement in hip ROM after flossing the thigh. None of studies showed any decrease in range after flossing.

Of the two studies that investigated the effects of flossing on DOMS, one study reported significantly reduced DOMS 24 and 48 hours post exercise in the study group (in the upper arms) compared to the control group. The other study (on leg muscles) found no difference in the intervention versus control group following 12, 24, 36, 48 60 and 72 hours post exercise.

When comparing flossing to other treatment like dynamic stretching, flossing had a more noticeable effect in increasing hip range of motion and maximal eccentric knee extension (Kaneda et al, 2020b). With regards to static stretching and flossing, rate of force development was more pronounced in the flossing group compared to the static stretching group (Kaneda et al 2020a). Kaneda and colleagues concluded in both studies that flossing should be applied as a warm up rather than as a stretching exercise. This is exactly what my patients who do CrossFit tell me. They normally use a floss band for warm up before they start their easier routines, before the heavy lifting.

I know all athletes are after improved performances. Results from the individual studies showed that 11 of of the 44 performance measures showed a significant improvement (comparing pre and post floss band application, Table 3 in article). There is some evidence that joint flossing (ankle and knee) can increase jump height, although sprint performance (5 to 20 m sprints) seems to be unaffected after ankle flossing. (Personally, I would floss the quads and hamstrings and calf muscles if I wanted to improve sprint times rather than the ankle). 

One study showed improvement in maximal voluntary contraction (strength) in the quadriceps muscle and hamstrings after thigh flossing.

The researchers suggest this is possibly due to hormonal responses related to the flossing. Similar to other occlusion (or blood flow restriction methods), enhanced growth hormone and norepinephrine levels increase may be responsible for increase in performance reported. More importantly, the review concluded that from the involved studies there was no detrimental effects on performance from a single floss band treatment.

Evidence also show that a single floss band treatment is able to increase ROM of the related joint and can positively affect jumping and strength performance. Possible mechanism is suggested to be changed neuromuscular function rather than changed mechanical properties.

after surgery in 2016
After Ronald Susilo (above) ruptured his patella tendon and tore his anterior cruciate ligament at the same time, he came to see me after the surgeon reattached his patella tendon. He did not have the range to even pedal one round on the stationary bike. I definitely increased his knee ROM with a single floss band treatment. He could pedal immediately after a single floss band application. 

Yes, back then it was only one subject (or n=1), however it was a definite improvement. Those of you reading then may be critical and probably not even believe it, but I have since replicated it many times in our clinic. Hence I feel that clinical evidence (what we see in the clinic) is just as good as published evidence (like this scoping review).

There will probably be long term studies about the effects of flossing treatment on joint ROM, sporting performance, whether it helps with recovery and decreasing pain. I am sure there also will be studies that say there are no benefits to it. The question is does it work for you?


Konrad A, Mocnik R and Nakamura M (2021). Effects Of Tissue Flossing On The Healthy And Impaired Musculoskeletal System: A Scoping Review. Front. Physiol. 21 May 2021. DOI: 10.3389/fphys.2021.666129

*A scoping review has a broader scope compared to traditional systematic reviews with correspondingly more expansive inclusion criteria.

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