To tell chiropractors that they should floss, on first inspection, might seem as self-evident as telling them to get adjusted.
Most of them are heavily into the game of self-preservation and prefer to practice what they preach.
However, you may not be asking your patients to floss. I know I certainly am not doing so in my practice—I am flossing for them.
Roots in CrossFit
Approximately five years ago, in the surge of CrossFit’s exponential growth of popularity, a new form of self-care appeared on the health care landscape. Gyms around the world saw a rise in people partially wrapping their limbs with tight rubber compression bands, calling it “flossing.”
Enthusiasts attributed this new tool to a famous physical therapist. What started in a small corner of the fitness realm has since gained wide popularity among self-hackers, clinicians and fitness gurus worldwide. In fact, a quick search on YouTube reveals nearly 10,000 videos about the topic.
As a clinician, it’s your job to guide your patients in a wide array of health endeavors. What do you need to know about the increasing use of compression bands? Where do you begin if you want to “floss” patients yourself? It will be helpful to review some of the uses of compression bands, commonly referred as “floss.”
Mechanism of action
First, floss is a mobility tool for immediately improving joint movement, reducing soft-tissue stiffness, and allowing athletes to access their available range of motion (ROM) more easily. This mobility is primarily facilitated through alterations in blood flow parameters as well as relative tissue glide. In every CrossFit gym across the country, as well as in most strength and conditioning facilities, floss is becoming as much a part of the warmup as stretching and foam rollers have traditionally been.
Floss is also commonly used to access new ranges of motion for sticky peripheral joints. For instance, a common problem in Olympic weight- lifting, CrossFit and general resistance training is an inability to achieve the “front rack” position, whereby each upper limb needs to achieve the ROM required to touch the thumb knuckle to the anterolateral deltoid of the ipsilateral shoulder, with the elbows pointing forward at approximately chin height.
When this ROM is not accessible by the participant, floss is often the solution to enhance flexion of the elbow, pronation or extension of the wrist, and flexion and external rotation of the glenohumeral joint.
Once these joints all achieve their full expression of end-range of motion in these directions, the goal of a properly executed front-rack position can be achieved and full-capacity training can be undertaken in these ranges.
In one study looking at elbow ROM in tennis players, all subjects who demonstrated normal elbow ROM showed no improvement from the use of floss. However, the participants who showed an abnormality in the ROM of the elbow experienced large improvements in their ROM following the use of floss with mobilizations.1
It takes minimal persuasion to convince chiropractors that improved ROM through the peripherals joints is not only desirable for many conditions that they treat, but can lead to safer training environments for the spine.
In forward-thinking clinics, floss is commonly used as a rehab tool. Although it may not seem immediately evident why localized compression around the limbs of your clients might enhance their outcomes, the science is finally catching up to what the floss forerunners have been doing for years.
As with many of your interventions, the desire to turn your clients into super-humans is not usually supported by the evidence, but an intervention such as floss can have a dramatic effect on clients who have notable deficits in various objective and subjective parameters.2
In a different study, investigating the effects of floss bands with joint mobilization stretching and strengthening exercises, those who used floss experienced a larger increase in certain parameters of strength around the ankle.3
In another intervention-based study, participants who used floss around the ankle saw improvements in weight-bearing lunge performance, ankle ROM (both dorsiflexion and plantarflexion), as well as single leg jump performance.4
Variations on a theme
Finally, floss can be multi-purposed, depending on the desired outcome and parameters of flossing. As the research develops in this field, experts are pulling information from many closely related disciplines to develop specific parameters for application of the bands.
The intensity of stretch on the bands, the amount of time they are applied, activities to perform while they are on, and the subjective experience of the client are all currently being extracted from research and professional opinion from the study of blood flow restriction (BFR), strength and conditioning, and pain modulation.
Learning new techniques with new tools to add to your practice can sometimes be challenging, complex and even cost prohibitive. In contrast, the relatively inexpensive and simple approach afforded by rubber compression bands can be quickly and easily integrated into most practice styles for the treatment of various extremity complaints and findings.
Benjamin J. Stevens, DC, is a sports chiropractor in British Columbia, Canada, where he serves an active population of primarily strength- and power-oriented athletes. He has started two multidisciplinary clinics and co-owns a continuing education business, Somatic Senses Education. He writes and teaches in his spare time, as well as lecturing for RockTape. He can be contacted at firstname.lastname@example.org or through benjaminjstevens.com.
1 Hodeaux K. “The Effect of Floss Bands on Elbow Range of Motion in Tennis Players.” Theses and Dissertations. http://scholarworks.uark.edu/etd/1948. Published May 2017. Accessed Jan. 2018.
2 Kiefer BN, Lemarr KE, Enriquez CC, et al. A Pilot Study: Perceptual Effects of the Voodoo Floss Band on Glenohumeral Flexibility. International Journal of Athletic Therapy and Training.[/] 2017;22(4):29-33.
3 Bohlen J, Arsenault M, Deane B, et al. Effects of Applying Floss Bands on Regional Blood Flow. International Journal of Exercise Science: Conference Proceedings. 2014;9(2):Article 7.
4 Driller MW, Overmayer RG. The effects of tissue flossing on ankle range of motion and jump performance. Phys Ther Sport. 2017;25:20-24.