The Effects of Flossing on Joint Range of Motion and Tissue Stiffness

Flossing, a myofascial release (MR) technique, has gained attention for its potential to improve performance-related factors such as range of motion (ROM), muscle strength, and pain relief. This technique involves wrapping a natural rubber floss band around muscles and joints to apply pressure while performing active and passive movements. Recent studies suggest that flossing can increase ROM, enhance muscle strength, and alleviate pain in conditions like delayed-onset muscle soreness, Osgood-Schlatter disease, and Kienböck disease. However, the specific mechanisms and tissues affected by flossing remain unclear.

A recent study from Japan investigated the effects of flossing on ankle dorsiflexion ROM, muscle strength, and tissue stiffness in healthy young men. The study used a randomized crossover design with 14 participants, comparing a flossing intervention (FLOSS) to a control condition (CON). The flossing intervention involved wrapping a floss band around the lower leg and performing active exercises, while the control group performed the same exercises without flossing.

Key Findings

1. Increased Ankle Dorsiflexion ROM:
   • Flossing significantly increased ankle dorsiflexion ROM (23.9° to 29.6°, P < 0.04) compared to the control group, which showed no significant change.
   • The rate of change in ROM was significantly greater in the FLOSS group (28.3%) than in the CON group (14.6%, P = 0.04).
2. No Change in Muscle Strength:
   • Flossing did not significantly affect the maximum voluntary contraction (MVC) of ankle plantar flexors in either group.
3. Tissue Stiffness:
   • No significant changes were observed in muscle or fascial stiffness, except for a trend toward reduced stiffness in the upper medial gastrocnemius (UMG) in the FLOSS group (P = 0.05).
   • The deep fascia (DF) and deep intermuscular fascia (DIF) showed no significant changes in stiffness, though a non-significant decrease in DF stiffness was observed.

Discussion
The study suggests that flossing may improve joint ROM by reducing fascial viscosity and enhancing tissue gliding, potentially due to the thixotropic effect of pressure applied by the floss band. However, the lack of significant changes in muscle strength and tissue stiffness indicates that the effects of flossing may be more pronounced in specific tissues or under certain conditions.

Clinical Implications

• ROM Improvement: Flossing can be an effective tool for increasing joint ROM, particularly in areas with restricted movement due to adhesions or fascial dysfunction.
• Pain Management: Flossing may help alleviate pain in conditions like delayed-onset muscle soreness and other musculoskeletal disorders.
• Performance Enhancement: While flossing did not significantly improve muscle strength in this study, it may still be beneficial for performance-related factors like jumping ability, as suggested by previous research.