science friday for athletes: tissue flossing COMPRESSION THERAPY

High winds and heavy surf off Lake Michigan shore. Taken by PKSenagore October 2019. All rights reserved.

TO REDUCE DOMS AND BOOST RECOVERY.  A NEW COMPRESSION TECHNIQUE THAT PROMISES to decrease exercise-induced delayed onset of muscle soreness (DOMS) and speed skeletal muscle regeneration is referred to in the scientific literature as “tissue flossing”.  According to a SHAPE.com article by Gabrielle Kassel, CrossFit and bodybuilding enthusiasts who have popularized the practice in recreational athletes, call it Muscle Flossing or VooDoo Flossing.
 
In her article, one of Kassel’s experts describes how flossing is performed. Joints or specific muscle groups are tightly wrapped with a special latex band, after which the joint powered by the muscles is moved through its full range of motion (ROM), for 30 seconds to 2 minutes. After the wrapping is removed the joint is again mobilized and taken through the ROM moves.

Kassel indicates that Rouge Fitness and WOD Fitters have products that have been used by bodybuilders and CrossFit enthusiasts for some time. These same products, which look like mini-resistance band material but are strips, have been used in the research studies.
 
The fitness experts in her SHAPE.com article are of the opinion that the process of flossing is less time consuming and more efficient at “boosting” mobility and accelerating recovery than foam rolling, which also works to compress muscles above and below joints but is not meant to be performed on joint tissues.
 
Researchers are beginning to investigate the benefits of this relatively new fitness practice.  Scientific studies have examined the merits of this therapy for DOMS reduction (positive findings), ankle mobility and jump and sprint performance, (positive findings) and for recovery from endurance exercise (no significant effect). 
 
In the DOMS research study, the short-term flossing therapy involved post-exercise wrapping of a muscle group with a length of the resistance band-like latex material, in the manner of an Ace bandage.  The wrap was removed after the study participant spent 3 minutes actively moving the  joint. 

The DOMS study results were published May 2019 in the Journal of Sports Medicine and Physical Fitness article  "Tissue flossing: a new compression therapy to reduce delayed onset muscle soreness. A comparison, controlled and double cross-over trial" by scientists from Brandenburg University of Technology in Germany. The authors concluded that compared to "gold standard therapy", whole body-cryotherapy (WBC) and cold-water-immersion (CWI), tissue flossing was lightly less effective but much more practical in lessening the discomfort and performance effects of DOMS.

Recent works examining self-myofascial release (SMFR), mainly by foam rolling, have discussed it's value as a maintenance and recovery tool especially in reducing DOMS. However one review indicated more clinical research is needed to determine the method's "efficacy and effectiveness" in treating myofascial pain. Perhaps flossing, as a newly recognized compression therapy, will be included in future scientific efforts?

After reading the full DOMS research article my impressions were that: 1) the placebo effect of wrapping vs not-wrapping has not been discussed and may not have been considered in these studies; 2) comparisons of the effectiveness of flossing versus rolling alone versus rolling accompanied by active joint mobility work haven’t been attempted; and 3) differences in ease of learning to safely perform flossing versus foam rolling has not been assessed.
 
To me, flossing seems to require more effort than foam rolling when it comes to routine whole-body self-care and DOMS relief after and sometimes before workouts, and possibly involves a greater risk of self-harm with improper technique.  However, for specific joints or muscle groups needing special or extra attention or healing from significant injury, flossing may further boost recovery after workouts or injury! It may be deemed an appropriate alternative to blood flow restriction therapy, also a new but more extreme form of compression therapy showing promise for athletic training and post-injury rehabilitation. 
 
The physiological mechanisms* responsible for benefits derived from various forms of self-myofascial release like are not yet completely understood.  The addition of tissue flossing to the physical therapy toolbox for training and injury prevention and recovery is great news. Hopefully there will be additional insights into how, when, and where each of the types of compression therapy can be applied for the most good.

Check out Gabrielle Kassel's full piece on this topic to be in the know at the gym.
 
RUN AND MOVE HAPPY!

*NOTE: Self-myofascial release does NOT cause the breaking up of fascia tissue as explained by experts in the Kassel article.  Rather its effects are  "due to the activation of central pain modulatory mechanisms, through neural inhibition mechanisms (Cavanaugh et all (2017)" as referenced by a study of foam rolling.  In other words, nerves activated by SMFR send signals to the brain to modulate the perception of pain, allowing improved movement. Evidence that the brain is involved comes from studies in which foam rolling of one extremity has shown a similar although lesser effect of decreased pain sensation in the contralateral (opposite side) limb.  The brains neural 'message' therefore seems to be reaching a body site not directly stimulated by SMFR. A previous Earned Runs blog post discussed this topic.
 
https://www.shape.com/fitness/tips/what-is-muscle-flossing-voodoo-floss
 
https://www.ncbi.nlm.nih.gov/pubmed/30411598 DOMS
 
www.ncbi.nlm.nih.gov/pubmed/28950149 ROM jump and sprint
 
https://www.ncbi.nlm.nih.gov/pubmed/28254581 ROM  and jump
 
https://www.ncbi.nlm.nih.gov/pubmed/29401529 endurance and flossing
 
https://www.ncbi.nlm.nih.gov/pubmed/30100300 foam rolling with active joint motion
 
https://www.ncbi.nlm.nih.gov/pubmed/31609881 Blood flow restriction

Rogue Fitness VooDoo Floss Bands
 
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