Today we have a technique used in the sports field: Floss Band or Compression Bands
It is a novel technique that offers certain benefits, such as improving joint mobility or accelerating muscle recovery, among others. Let’s analyse it!
What is Flossing Band and how does it work?
Also known as CTF (Compression Tack and Flossing), Tissue Flossing or Floss Band, it is an active or passive mobilisation technique that consists of wrapping the joint or body region, partially occluding the blood flow.
The direction of the band wrap should be from the distal to the proximal end.
The middle of the belt will need to follow the 50% overlap pattern (overlap at each successive wrap) with a relative elongation or stretch force range of 50-90% of the length of the belt.
After this, the elastic will be tightened stretching the band to a desired length (eg 50%).
After that, the client/athlete will perform an intervention of between 1´-3´ of FB, which may include several active and passive movements of the involved body region (Borda and Selhorst, 2017; Cheatham and Baker, 2019; Driller, Mackay, Mills & Tavares, 2017; Driller and Overmayer, 2017).
Floss Bands (figure 1) are generally made of latex and are available in different widths, densities and lengths (Cheatham and Baker, 2019)
Here we leave a demonstrative video where you can see how the athlete wraps the knee joint and performs a series of exercises:
Origin of the technique
Floss is a popular strategy used by sports and sports medicine professionals (Cheatham and Baker, 2019)
This technique is based on the theory of Reactive Hyperemia (temporary interruption of blood flow) and Blood Flow Restriction (BFR), also called the latter , KAATSU or Vascular Occlusion Training (Hodeaux, 2017).
This tool gained popularity in the book by Starrett and Cordoza (2013) where the authors introduced band compression to increase joint travel, positing that the potential mechanisms behind the benefit of wearing bands can be attributed to fascial shearing and /or re-perfusion of blood to the muscle.
Knee Floss Band
- Increases in growth hormone and catecholamines;
- Greater muscle strength, contractility; and
- Increased efficiency of excitation-contraction coupling in muscles (Driller et al., 2017; Hodeaux, 2015)
Flossing Band what is it for
Numerous uses and functionalities are attributed to this new and popular technique within the field of sports training, rehabilitation, readaptation and physical-sports retraining (Cheatham and Baker, 2019; Carlson, Rife & Williams, 2019; Gorny & Stöggl, 2018; Hodeaux, 2017):
- Decreased blood flow to the limb.
- Constriction of the involved joint.
- Increased .
- Decrease in muscle pain.
- Increased joint mechanics.
- Increased myofascial function.
- Useful in the Rehabilitation, Readaptation and Retraining of sports injuries.
- Improved sports performance.
- Promotion of Reactive.
- Reduction of pain and edema.
- Rupture of the adhesive tissue of the previously injured muscles.
How to apply the Floss Band
- Cover the area proximally and distally, wrap the muscle belly (and/or tendon), half of the band will overlap each successive wrap,
- The patient/athlete may feel mild discomfort with this technique (“remove the wrap if you experience numbness or tingling or if your limb turns pale or blue”)
- Maintain a stretch of 75 to 90% in the band (there are differences in bandage depending on the joint)
- Remove the floss band after surgery and walk (or perform upper limb aerobic activity) for one minute to allow blood flow to return to the target joint.
Studies and Evidence
The practical applicability of tissue flossing is limited by the methodological differences of the studies, among which the following sections stand out:
Different work contents
- Mobilizations and strength exercises (Bohlen, Arsenault, Deane, Miller, Guadagno & Dobrosielski, 2014; Weber et al., 2018),
- Tissue Flossing and massage with a Lacrosse ball (Borda and Selhorst, 2017)
- Mobilizations (Driller et al., 2017; Driller and Overmayer, 2017; Gorny & Stöggl, 2018; Hodeaux, 2017; Mills, Mayo, Tavares & Driller, 2019)
- Stretches (Kiefer, Lemarr, Enriquez, Tivener & Daniel, 2017)
- Rehabilitation exercises with Floss Band (Plocker, Wahlquist & Dittrich, 2015)
- Strength exercises to muscle failure and Floss Band (Prill, Schulz & Michel, 2018)
- Blood flow (resting arterial inflow and reactive hyperaemic blood flow) of the calf and strength in plantar flexion and dorsiflexion (Bohlen et al., 2014).
- Treatment of Achilles Tendinopathy (Borda and Selhorst, 2017).
- Ankle ROM (talocrural joint), jump and sprint performance at different time points (5´, 15´, 30´ and 45´) (Driller et al., 2017).</li >
- Posterior ankle ROM and jump height (Driller & Overmayer, 2017).
- Regeneration after strength-endurance exercises and to reduce late-onset muscle soreness (DOMS) (Gorny & Stöggl, 2018).
- The elbow ROM (Hodeaux, 2017).
- Postoperative edema of the lower limb pedal (Kage and Patil, 2018).
- Soft tissue flexibility and movement perception of the shoulder (glenohumeral joint) (Kiefer et al., 2017).
- Sport performance and ankle ROM (Mills et al., 2019).
- Upper extremity power (UEP) and shoulder ROM (Plocker et al., 2015).
- Perceived DOMS (Prill et al., 2018).
- Osgood-Schlatter disease (Weber, 2018).
- Intervention durability
- Heterogeneity in subjects
- Various measuring instruments
- Variety in the magnitudes of the load during the interventions
- Brands of the Floss Bands
- Bilateral (Bohlen et al., 2014; Driller et al., 2017; Mills et al., 2019; Plocker et al., 2015; Weber, 2018)
- Unilateral (Borda and Selhorst, 2017; Driller and Overmayer, 2017; Gorny & Stöggl, 2018; Hodeaux, 2017; Kage and Patil 2018; Kiefer et al., 2017; Prill et al., 2018).</ li>
- 14 days (Bohlen et al., 2014), 6 weeks (Borda and Selhorst, 2017)
- 1 session (Driller and Overmayer, 2017; Gorny & Stöggl, 2018; Kiefer et al., 2017; Plocker et al., 2015; Prill et al., 2018)
- 2 sessions (Hodeaux, 2017; Mills et al., 2019), 4 months (Kage & Patil, 2018), and
- 9 weeks (Weber, 2018).
- Adolescent athletes (Borda and Selhorst, 2017; Bohlen et al., 2014), recreational athletes (Driller et al., 2017; Driller and Overmayer, 2017),
- Active and healthy subjects (Gorny & Stöggl, 2018), elite level tennis players (Hodeaux, 2017)
- Post-operative subjects with edema of the pedal of the lower extremities (Kage and Patil, 2018),
- University students (Kiefer et al, 2017; Prill et al., 2018),
- Professional male rugby athletes (Mills et al., 2019),
- Male athletes (Plocker et al., 2015) and young male soccer player (Weber, 2018).
- Dynamometer (Bohlen et al., 2014), venous occlusion plethysmography (Bohlen et al., 2014), LEFS and VAS (Borda and Selhorst, 2017), Weight-Bearing Lunge Test (WBLT)
- Counter Movement Jump (CMJ) and 15m sprint (Driller et al., 2017; Mills et al., 2019),
- ROM of ankle dorsiflexion and plantarflexion, single leg vertical jump height and speed (Driller & Overmayer, 2017), goniometer (Hodeaux, 2017; Plocker et al., 2015),
- DOMS and VAS questionnaire (Prill et al., 2018).
- 1-3 sets x 10 repetitions (Bohlen et al., 2014; Borda and Selhorst, 2017),
- 2´ of work x 1 series (Driller et al., 2017; Gorny & Stöggl, 2018; Mills et al., 2019),
- 20 repetitions x 1 series (Driller and Overmayer, 2017),
- 6 exercises x 3 repetitions x 1 series (Hodeaux, 2017),
- for 24h (Kage and Patil, 2018),
- 5 sets x 30” (Kiefer et al., 2017),
- 3´ x 1 series (Prill et al., 2018),
- 3 times/week (Weber, 2018).
- Daily intervention with the TF (Borda and Selhorst, 2017; Kage and Patil, 2018).
- Theraband® (Borda and Selhorst, 2017)
- Life Flossbands® (Driller et al., 2017; Driller and Overmayer, 2017; Mills et al., 2019)
- Rogue Fitness® (Hodeaux, 2017; Kage and Patil, 2018; Kiefer et al., 2017; Plocker et al., 2015; Prill et al., 2018).
- Small sample sizes (Kiefer et al., 2017; Borda and Selhorst, 2017; Weber, 2018).
- Diffusion of success by other treatments: eccentric exercise (Borda and Selhorst, 2017).
- Ignorance of the characteristics of the Floss Bands.
- Except Rockfloss® (Cheatham and Baker, 2019).
- Few studies measure cuff pressure: 178 ± 18 mmHg (Driller et al 2017; Driller and Overmayer, 2017) and 180 mmHg (Mills et al., 2019).
- Lack of a placebo/sham condition (Driller et al. 2017; Mills et al., 2019).
- Psychological advantage may be associated with the use of the Floss Band (Driller et al., 2017; Mills et al., 2019).
Practical applications of the Flossing Band
The above practical points need to be studied as they are based on models and theoretical deductions. For this reason, the evidence that uses the Floss Band strategy has been reviewed and analysed exhaustively.
As a result, a series of practical applications have been obtained:
Appropriate tool and strategy
- Improve ROM (ankle joint), jump, and sprint performance in recreational athletes, up to 45 minutes after band removal (Driller et al. 2017).
- Increase dorsiflexion, plantar flexion, and single leg jump performance in recreational athletes (Driller & Overmayer, 2017).
- The treatment of pedal edema effectively (Kage and Patil, 2018).
- Increase shoulder flexibility in college students (psychological, not physical) (Kiefer et al., 2017).
- Develop ROM (ankle joint), CMJ and sprint performance, up to 30 minutes after application in elite level rugby athletes (Mills et al., 2019).
- Reduce perceived in university students (Prill et al., 2018).
Tissue Flossing presents non-significant or confusing results
- Vascular function (Bohlen et al., 2014): no changes in reactive hyperemic blood flow were found, suggesting no adverse or beneficial effects.
- Achilles tendinopathy (Borda and Selhorst, 2017): Manual treatment (floss band and eccentric exercises) successfully resolved the symptoms of Achilles tendinopathy in a patient who had previously not responded to traditional conservative care.</ li>
- DOMS reduction (Gorny & Stöggl, 2018): the results show that TF does not improve or delay regeneration after the training program.
- Increased elbow ROM (Hodeaux, 2017): floss bands do not significantly improve elbow ROM compared to other treatment methods.
- Development of shoulder ROM and upper extremity power (UEP) (Plocker et al., 2015): Data indicated that subjects’ ROM and UEP did not improve significantly after of the use of the floss band.
- The successful and promising treatment of Flossing in Osgood-Schlatter disease (Weber, 2018).
The floss band (Rockfloss®) presents a workload indicator: the stretch force. Cheatham and Baker (2019) observed that there was a linear increase in the stretch force as the bands increased. they became longer (25%, 50%, 75%, 100%, 125%, 150%).
Validity (ICC ¼ 0.99, CV ¼ 1.1%) and reliability (CV ¼ 4.9%) of the pressure sensor (Kikuhime) as a tool in the sports configuration of the Floss Band (Driller et al., 2017; Driller and Overmayer, 2017; Mills et al., 2019).
- 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. Journal of Manual & Manipulative Therapy, 25(1), 57-61.
- Cheatham, S. W., & Baker, R. (2019). Quantification of the Rockfloss® Floss Band Stretch Force at Different Elongation Lengths. Journal of Sport Rehabilitation, 1, 1-4.
- Driller, M., Mackay, K., Mills, B., & Tavares, F. (2017). Tissue flossing on ankle range of motion, jump and sprint performance: A follow-up study. Physical Therapy in Sport, 28, 29-33.
- Driller, M. W., & Overmayer, R. G. (2017). The effects of tissue flossing on ankle range of motion and jump performance. Physical Therapy in Sport, 25, 20-24.
- Hodeaux, K. (2017). The Effect of Floss Bands on Elbow Range of Motion in Tennis Players. University of Arkansas.
- Starrett, K., & Cordoza, G. (2013). Becoming a Supple Leopard: The Ultimate Guide to Resolving Pain, Preventing Injury, and Optimizing Athletic Performance. In The Systems (pp. 217-222). Las Vegas, NV: Victory Belt Publishing Inc.
- Carlson, S., Rife, G. & Zachary, W. (2019). “Comparing the Effects of Tissue Flossing and Instrument Assisted Soft Tissue Mobilization on Ankle Dorsiflexion”.The Research and Scholarship Symposium, 5.
- Gorny, V., & Stöggl, T. (2018). Tissue flossing as a recovery tool for the lower extremity after strength endurance intervals. Sportverletzung Sportschaden: Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin, 32(1), 55-60.
- Bohlen, J., Arsenault, M., Deane, B., Miller, P., Guadagno, M., & Dobrosielski, D. A. (2014). Effects of applying floss bands on regional blood flow. In International Journal of Exercise Science: Conference Proceedings (Vol. 9, No. 2, p. 7).
- Weber, P. (2018). Flossing: An alternative treatment approach to Osgood-Schlatter’s disease: Case report of an adolescent soccer player. Journal of Bodywork and Movement Therapies, 22(4), 860-861.
- 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. Journal of Sport Rehabilitation, (00), 1-5.
- 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. International Journal of Athletic Therapy and Training, 22(4), 29-33.
- Plocker, D., Wahlquist, B., & Dittrich, B. (2015). Effects of tissue flossing on upper extremity range of motion and power. In International Journal of Exercise Science: Conference Proceedings, 12(1), p. 37.
- Prill, R., Schulz, R., & Michel, S. (2018). Tissue flossing: a new short-duration compression therapy for reducing exercise-induced delayed-onset muscle soreness. A randomized, controlled and double-blind pilot cross-over trial.
- Kage, V. & Patil, Y (2018) Effectiveness of Voodoo Floss Band versus Crepe Bandage in Subjects with Post- Operative Lower Limb Pedal Edema: A Randomized Clinical Trial’, International Journal of Current Advanced Research, 07(6), pp. 13498-13501
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