Effects of tissue flossing on sports performance, injury prevention, and post-injury rehabilitation outcomes: a systematic review.

Abstract

Tissue flossing (TF) is a compression-based soft-tissue intervention increasingly used in athletic and rehabilitation settings. However, current evidence is heterogeneous and inconsistent. This systematic review synthesized the effects of TF on sports performance, injury prevention, and post-injury rehabilitation, while distinguishing experimentally demonstrated outcomes from hypothesized mechanisms. Following PRISMA 2020 guidelines, PubMed/MEDLINE, Web of Science, Scopus, and SPORTDiscus were searched, and quantitative data, including means, p values, and effect sizes, were extracted where available. Twenty peer-reviewed trials met the inclusion criteria. TF applied at approximately 50% elongation acutely improved joint range of motion (ROM; Hedges' g = 0.19, p = .010) and selected force outputs, including plantar-flexion torque, which increased by 4.3-4.9 N·m. Compared with active interventions, TF produced sustained reductions in muscle stiffness, including a mean difference of -43.40 kPa in the distal semitendinosus (p = .007). Preliminary evidence also suggested potential benefits for proprioception and feedforward neuromuscular activation in individuals with chronic ankle instability. Overall, TF may improve acute mobility, selected force outputs, and sensorimotor function. However, small sample sizes, protocol heterogeneity, and limited follow-up periods prevent definitive conclusions regarding its effectiveness for injury prevention or post-injury rehabilitation across diverse populations, intervention protocols, and longer-term clinical and functional outcomes.