Acute effects of tissue flossing on ankle range of motion in athletes with limited ankle dorsiflexion: a randomized controlled trial

Restricted ankle dorsiflexion (ADF) is a common impairment in athletes, associated with decreased performance and increased risk of injury. Tissue flossing (TF) is an emerging technique proposed to rapidly improve joint range of motion (ROM), though its acute effects on athletes with limited ADF require further investigation. This study aimed to evaluate the acute effects of a single session of TF application on ADF and plantarflexion ROM in athletes with limited ADF. Forty-four male athletes aged 25.9 ± 4.4 years with ADF-ROM < 10° were randomly allocated to a TF intervention (n = 22) or a static stretching (SS) active control group (n = 22). The TF intervention used a standard figure-of-eight bandaging technique with 50–70% overlap. While wrapped on both legs, participants performed 3 sets of ankle pumps, squats, and lunges. The SS group performed 3 × 30 s stretches for the gastrocnemius and soleus muscles on both legs. Dorsiflexion and plantarflexion ROM were measured on the dominant and non-dominant leg at baseline, immediately post-intervention, and 1 h after post-tests (follow-up). Group-by-time interactions showed significant effects on dorsiflexion ROM in both limbs (all p < 0.001; d = 0.37–0.43). Post-hoc tests indicated that TF had greater immediate effects on dorsiflexion ROM (dominant: p < 0.001; d = 1.57, non-dominant: p < 0.001; d = 1.52) than SS (dominant: p = 0.020; d = 0.53, non-dominant: p < 0.001; d = 0.33), with small but significant retention for TF at follow-up (dominant: p = 0.018; d = 0.25, non-dominant: p = 0.005; d = 0.11). A group-by-time interaction was also found for plantarflexion ROM in the dominant side (p < 0.001, d = 0.44). TF showed greater effects (p < 0.001; d = 0.62) than SS (p < 0.001; d = 0.30), with small retention gains (p < 0.001; d = 0.07). A single-session TF application in combination with physical exercise (e.g., squats) resulted in greater immediate dorsiflexion ROM improvements than traditional SS in athletes with ADF. However, due to the multimodal nature and longer duration of the flossing protocol, further research is needed to verify our results. This trial was registered at the Iranian Registry of Clinical Trials (Identifier: IRCT20230612058457N8) on August 29, 2025.