This soft tissue “flossing” is also known as blood flow restriction (BFR) therapy/training is done with floss bands .

If you’ve stepped into a progressive performance training center lately, you might have witnessed some athletes wrapping an appendage with some sort of rubbery, elastic tubing that kind of looks like a therapy band—just a little beefier.

This soft tissue “flossing” is also known as blood flow restriction (BFR) therapy/training and is achieved with floss bands.

Although this method of soft tissue intervention isn’t actually new to the world of science, it repopularized again within the last decade. As a manual therapist, understanding how this tool can impact your treatment outcomes is worth a closer look.

What is Flossing and Why Should I Care?

“Flossing,” aka blood flow restriction therapy is the practice of using a therapeutic elastic band on extremities and joints.

The intention behind flossing is to create a brief and partial interruption of venous outflow (while maintaining arterial flow) to the tissues by tightening the band around the area of focus (at a tension of no more than 50 percent stretch) while performing low to no-load movements such as flexion and extension, adduction, abduction and tri-planar.

While you might be scratching your head about how disrupting circulation could possibly have a positive effect, the science behind this method of soft tissue intervention has some pretty sound research and evidence to support it.

While this article is not intended to teach the methods behind using the tool, it will provide a brief overview of the mechanisms that influence the changes discussed.

Here are the basics: We can create positive change within the tissues and joints through compression, tension and movement. All of this result in increased ranges of motion, improved recovery times, better joint centration, decrease in pain, increase in strength, and overall better movement.

We can briefly break these attributions into three primary effects.

1. Mechanical Effects



2. Neurological Effects

As we all are aware, touch immediately creates a neurological response. In the case of flossing, research has demonstrated positive results in the areas of pain management, increased proprioception, motor control and the up or down-regulation of the nervous system.

For clients managing pain, flossing can contribute to providing relief as well as bringing awareness to the area where chronic pain often has diminished it. For those who have lost feeling or sensation to an extremity as a result of injury, flossing may also play a role in rehabilitation of proprioception.

3. Chemical Effects

One of the most interesting effects from blood flow restriction intervention is the chemical cascade it produces within the tissues.

This hormone and blood flow rush following release of the tension, has been shown to improve recovery, create strength gains with minimal loads, increase hypertrophy, as well as induce a higher recruitment of fast twitch fibers due to the reduced availability of oxygen while under the restriction of the band.

These chemical responses have some pretty big implications as it pertains to rehabilitation and performance.

Flossing can be done both around the actual muscle bellies, such as quadriceps/hamstrings, biceps/triceps, and the lower leg.

Additionally, it can be applied directly to the joints such as the ankle, knee, shoulder, wrist, or elbows. It’s crucial that you avoid flossing the head, neck, or chest.

Depending on your clients’ tolerance and comfort level, when first introducing this method to your clients, starting with a lower tension range and building up to 50 percent stretch is advised. If at any time your client experiences numbness, tingling, dizziness, significant discoloration or pain immediately discontinue the treatment.

Contraindications for flossing include:

  • High blood pressure
  • Deep Vein Thrombosis
  • Pregnancy
  • Varicose Veins
  • Cardiac Disease

Always consult with your clients’ primary care physicians before using floss bands.

This article is merely scratching the surface of this technique. As a manual therapist, I’ve found flossing to be an incredibly valuable addition to my treatment sessions not only for clients, but also for myself as a practitioner.

Seek out reputable training in the method mentioned above and confidently add flossing to your toolbox of treatment modalities.

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