Tissue flossing (mainly known by brand names: RockFloss or Rogue Fitness Voodoo Floss) is an increasingly popular treatment modality. The term is often used simultaneously with Blood Flow Restriction training (BFRT).
BFRT and tissue flossing involve applying an external pressure above or below a muscle or joint of the extremities, typically by using a circumferential, elastic band. The pressure provided by the coiled band safely maintains arterial inflow of blood but reduces or occludes venous outflow distal to the site.
Currently, tissue flossing is not strongly supported by high levels of evidence. Athletes, physiotherapists or practitioners that use tissue flossing techniques seek benefits of:
- reduced pain
- increased range of movement
- improved performance
- injury prevention
- reduced post training/competition muscle soreness
- improved muscle recovery
- increased muscle size gains
Most recent studies have looked at the following potential implications of this technique for:
- improving muscle recovery following strength endurance training
- alternative treatment of Osgood-Schlatter's disease
- reduction of delayed onset muscle soreness (DOMS)
- temporary, non-significant, small improvements in jump and sprint performance and ROM when used in the ankle 
The application of the tissue flossing band under tension causes compression and venous constriction. Depending on the desired outcome, exercise therapy can be used in combination with blood flow restriction or not. Researchers have found that in conjunction to using blood flow restriction techniques, low intensity resistance exercises show increased electromyo-graphy activity (EMG) compared with resistance exercise alone. After removing the compression the re-perfusion of the muscle tissue theoretically brings about these desired changes.
Further research is needed to determine the physiological mechanism behind the results brought on by blood flow restriction therapy. A number of hypothesis currently exists which could have important clinical implications, particularly for those people who are contraindicated to exercise.
ApplicationThis treatment can be applied to any appendage to have affect on a painful area or stiff joint. Such as the ankle:
It can also be applied to larger joints such as the shoulder:
The manufacturers recommend not using tissue flossing on back, neck, abdomen or head.
There is little evidence overall for this technique and of the current evidence, very few studies show either positive or negative support for use of tissue flossing. Additionally, more research is needed into the physiological changes associated with the tissue flossing method.
- Gorny V, Stöggl T. Tissue flossing as a recovery tool for the lower extremity after strength endurance intervals. Sportverletzung Sportschaden: Organ der Gesellschaft fur Orthopadisch-Traumatologische Sportmedizin. 2018 Feb.
- Weber P. Flossing: An alternative treatment approach to Osgood-Schlatter's disease: Case report of an adolescent soccer player. Journal of Bodywork and Movement Therapies. 2018 Oct 1;22(4):860-1.
- Prill R, Schulz R, Michel S. 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. The Journal of sports medicine and physical fitness. 2018 Oct.
- Driller M, Mackay K, Mills B, Tavares F. Tissue flossing on ankle range of motion, jump and sprint performance: A follow-up study. Physical Therapy in Sport. 2017 Nov 1;28:29-33.
- Driller MW, Overmayer RG. The effects of tissue flossing on ankle range of motion and jump performance. Physical Therapy in Sport. 2017 May 1;25:20-4.
- Yasuda, T., Brechue, W. F., Fujita, T., Shirakawa, J., Sato,Y., and Abe, T. (2009). Muscle activation during low-intensity muscle contractions with restricted blood ﬂow. J. Sports Sci. 27, 479–489.
- Rock Tape Go stronger go longer. Rock Tape - RockFloss tutorial - Calf. Available from: https://www.youtube.com/watch?v=L6ygP7rWwb4 [last accessed 27/10/2017]
- Kinetic Sports Rehab. How to Voodoo Floss your shoulder. Available from: https://www.youtube.com/watch?v=YerDfsn1jcA [last accessed 14.07.2015]