Tendon Flossing: Techniques, Benefits, and Safety Guidelines

How to floss a tendon?

Tendon flossing, also known as compression flossing, involves wrapping a specialized elastic band tightly around a tendon or joint area and then performing movements to improve tissue mobility, reduce pain, and enhance recovery. This technique aims to create a compressive and shearing force on the soft tissues, promoting fluid dynamics and fascial glide.

Understanding Tendon Flossing (Compression Flossing)

Tendon flossing is a technique employed in rehabilitation and performance enhancement, utilizing a thick, elastic rubber band (often called a "Voodoo Floss" band) to apply targeted compression to a specific area of the body, including muscles, fascia, joints, and tendons. The method involves wrapping the band tightly around the affected region and then moving the limb through its full range of motion. The primary goal is to mobilize soft tissues, improve circulation, reduce swelling, and alleviate pain, particularly in areas affected by stiffness or tendinopathies.

The Science Behind Tendon Flossing

While research is still emerging, several mechanisms are hypothesized to explain the effects of compression flossing:

• Fluid Dynamics: The compression temporarily restricts blood flow. Upon release, a rush of fresh blood (hyperemia) is thought to flush metabolic waste and bring nutrients to the area, promoting healing and reducing inflammation.
• Fascial Glide and Shear: The tight wrap compresses and creates a shearing force on the fascial layers and other connective tissues. This can help break up adhesions, improve the sliding surfaces between tissues, and restore normal movement patterns.
• Pain Modulation: The intense pressure and subsequent movement may stimulate mechanoreceptors, potentially overriding pain signals through the gate control theory of pain.
• Improved Range of Motion: By mobilizing restricted tissues and reducing swelling, flossing can immediately improve joint and tissue extensibility, leading to increased range of motion.

When to Consider Tendon Flossing

Tendon flossing is often considered for individuals experiencing:

• Tendinopathies: Conditions like Achilles tendinopathy, patellar tendinopathy ("jumper's knee"), or lateral/medial epicondylitis ("tennis/golfer's elbow").
• Joint Stiffness: Restricted movement in ankles, knees, elbows, or shoulders.
• Post-Exercise Recovery: To accelerate the removal of metabolic byproducts and reduce muscle soreness.
• Preparation for Activity: To improve tissue pliability and range of motion before exercise.

Equipment Needed

The primary equipment required is a specialized compression floss band. These bands are typically:

• Made of latex rubber.
• Thick (1-2 mm) and wide (2-4 inches).
• Available in various lengths (e.g., 7 feet) and resistance levels (thickness).

General Principles for Tendon Flossing

Before attempting to floss a tendon, understand these core principles:

• Direction of Wrap: Generally, wrap from distal (further from the body's center) to proximal (closer to the body's center), overlapping by about 50%.
• Tension: Apply significant but tolerable tension. The area should feel compressed, but not painfully so. Aim for 50-75% of maximum stretch.
• Duration: Typically 1-2 minutes. Prolonged use can lead to nerve compression or tissue damage.
• Movement: Actively move the affected joint or limb through its full range of motion while the band is applied.
• Removal: Remove the band immediately if you experience numbness, tingling, severe pain, or color changes in the skin (e.g., excessive pallor or blueness).

Step-by-Step Guide: How to Floss a Tendon

Here's a general approach, followed by specific examples. Always consult a healthcare professional or certified trainer before starting.

1. Preparation:

   • Ensure the skin is clean and dry. Avoid applying over open wounds, rashes, or areas with compromised circulation.
   • Have your floss band ready.
   • Understand the specific movements you will perform while the band is on.

2. Wrapping Technique:

   • Start Point: Begin wrapping just below the affected tendon, anchoring the band with a single, less-tense wrap.
   • Ascending Wrap: Wrap upwards, overlapping each previous layer by approximately 50%. Maintain consistent, firm tension. The tension should be significant but not excruciating.
   • Cover the Tendon: Ensure the entire affected tendon and surrounding joint area are covered by the band.
   • Secure the End: Tuck the end of the band securely under a previous wrap.

3. Movement During Flossing:

   • Once the band is applied, immediately perform active movements. For a tendon, this means moving the joint it crosses through its full available range of motion.
   • Perform 10-15 repetitions of various movements (e.g., flexion, extension, rotation) or functional movements relevant to your activity (e.g., squats for patellar tendon, calf raises for Achilles).
   • The movements should be controlled and deliberate, pushing to the edge of your comfortable range.

4. Removal:

   • After 1-2 minutes (or sooner if discomfort or adverse sensations occur), quickly unwrap and remove the band.
   • Observe the area for a rush of blood (hyperemia), which is normal and indicates improved circulation.

Specific Tendon Flossing Examples

Achilles Tendon Flossing

1. Wrap: Start just above the toes (or around the mid-foot) and wrap upwards, covering the entire ankle joint and extending 2-3 inches above the Achilles tendon insertion on the heel.
2. Movement: Perform ankle dorsiflexion and plantarflexion (pointing toes up and down), ankle circles, and gentle calf raises or squats if comfortable.

Patellar Tendon Flossing

1. Wrap: Start just below the knee joint, wrapping upwards to cover the patella (kneecap) and extending a few inches above the knee.
2. Movement: Perform knee flexion and extension (bending and straightening the knee), partial squats, or lunges.

Elbow Tendon Flossing (e.g., for Tennis Elbow)

1. Wrap: Start just above the wrist, wrapping upwards to cover the entire elbow joint and extending a few inches above the elbow crease. Ensure the area of the painful tendon origin (e.g., lateral epicondyle for tennis elbow) is well-covered.
2. Movement: Perform wrist flexion and extension, pronation and supination (rotating forearm), and elbow flexion and extension. You can also perform grip exercises (e.g., squeezing a ball).

Important Considerations and Best Practices

• Pressure and Tightness: The band should be tight enough to feel significant compression and restrict superficial blood flow, but never so tight that it causes numbness, tingling, sharp pain, or changes in skin color beyond a mild redness upon removal.
• Duration: Stick to the 1-2 minute guideline. Longer durations increase the risk of nerve or vascular compromise.
• Frequency: Can be used before or after workouts, or as part of a rehabilitation protocol, typically 1-3 times per day for acute issues, or as needed.
• Pain Signals: While some discomfort is expected, sharp, shooting, or radiating pain is a sign to immediately remove the band.
• Hygiene: Keep your floss band clean to prevent skin infections.

Potential Benefits

• Improved joint range of motion and flexibility.
• Reduced pain and stiffness in tendons and surrounding tissues.
• Enhanced blood flow and nutrient delivery to the area.
• Faster recovery from intense exercise or injury.
• Breakdown of superficial fascial adhesions.

Who Should Avoid Tendon Flossing? (Contraindications)

Tendon flossing is not suitable for everyone. Avoid this technique if you have:

• Open wounds, cuts, or abrasions in the area.
• Acute inflammation or infection.
• Deep vein thrombosis (DVT) or history of blood clots.
• Peripheral vascular disease or compromised circulation.
• Nerve impingement or neuropathy.
• Fragile skin or conditions like uncontrolled diabetes.
• Allergies to latex (if the band contains latex).
• Recent fractures or dislocations.
• Pregnancy (especially around the abdomen or lower extremities).
• Uncontrolled high blood pressure.

When to Consult a Professional

While tendon flossing can be a beneficial self-care tool, it's crucial to consult a qualified healthcare professional (e.g., physical therapist, sports medicine physician, certified athletic trainer) before incorporating it into your routine, especially if:

• You are experiencing persistent or severe pain.
• You are unsure of the cause of your symptoms.
• You have any pre-existing medical conditions.
• You are not seeing improvement with self-application.
• You want personalized guidance on technique and application.

Conclusion

Tendon flossing, or compression flossing, is a technique that can offer benefits for improving tissue mobility, reducing pain, and aiding recovery for various tendon and joint issues. By applying targeted compression and movement, it aims to enhance fluid dynamics and fascial glide. However, proper technique, adherence to safety guidelines, and understanding contraindications are paramount. Always prioritize consulting with an expert to ensure this method is appropriate and effective for your specific needs.