Acute Effects of Tissue Flossing on Knee Flexion Range of Motion in Healthy Adults: A Randomized Controlled Trial

Background/Objectives: Tissue flossing (TF) with elastic bands (floss bands) is a therapeutic strategy to improve joint range of motion (ROM). While TF has demonstrated 3-7% ROM improvements in ankle and shoulder joints, its effects on knee flexion remain underexplored. Therefore, the objective of this study was to investigate the acute effects of TF on active and passive knee flexion range of motion in healthy adults. Methods: Sixty healthy participants (median age 23.0 [IQR 2.0] years; 30 male, 30 female) were randomized to an intervention group (IG; n = 30) receiving floss band (COMPRE Sanctband^®, Level 1; 50% tension, 50% overlap) application combined with knee mobilization (20 active/passive repetitions over 2 min), or a control group (CG; n = 30) performing the same mobilization without band application. Active (AROM) and passive (PROM) knee flexion were measured pre- (M0) and post-intervention (M1) using a validated smartphone goniometer (Goniometer Pro), by a blinded assessor. Results: Baseline characteristics (age, body mass index) did not differ between groups (p > 0.05); however, baseline AROM differed significantly between groups (p = 0.041). The IG showed significantly greater improvements than CG in AROM (Δ5.0° [4.0%] vs. Δ0.0°, p < 0.001) and PROM (Δ6.0° [4.5%] vs. Δ1.0° [0.8%], p < 0.001). Conclusions: TF combined with mobilization produced greater immediate increases in knee flexion ROM than mobilization alone, with large effect sizes. These findings support adequately powered, sham-controlled trials in clinical populations before clinical effectiveness can be inferred.