Ankle flossing alters periarticular stiffness and arterial blood flow in asymptomatic athletes

Tissue flossing has been introduced to increase impaired range of motion (ROM) and flexibility, to enhance prevention and rehabilitation, as well as to improve athletic performance; however, limited evidence exists for its efficacy. The aim of the present study was to evaluate the effects of ankle flossing on periarticular stiffness and perfusion via Acoustic Radiation Force Impulse (ARFI) elastography and Power Doppler Sonography (PDS).

Twenty-one healthy students (age: 24±2 years, BMI: 22±3 kg/m²) were recruited as participants. ARFI was performed to evaluate periarticular ankle stiffness involving the anterior ankle capsule (AC), the anterior talofibular ligament (ATFL) and the peroneus brevis muscle (PBM). Arterial blood flow was assessed in the dorsal pedal artery. Measurements were taken under resting conditions (T0) and twice after standardized ankle flossing (T1: 0 min., T2: 60 min. postintervention).

The connective tissue stiffness decreased significantly after ankle flossing compared to baseline (T1, AC: -12%, P=0.009, ATFL: -12%, P=0.003; T2, AC: -8%, P=0.002, ATFL: -9%, P=0.015). The PBM stiffness decreased by 3% (T1, P=0.304) and 4% (T2, P=0.029). The perfusion measures significantly increased by 30% at T1 compared to baseline (P=0.001); no significant changes were observed at T2 (P=0.492).

This is the first study demonstrating decreased AC and ATFL stiffness and reactive hyperemia to be key mechanisms of ankle flossing. Additional studies must be conducted to determine whether changes in biomechanical properties influence dynamic ankle stability.