The effects of tissue flossing on neuromuscular activation in patients with chronic ankle instability: a randomized controlled trial

Abstract

Chronic ankle instability (CAI) is a prevalent sequela of lateral ankle sprains, primarily characterized by impaired neuromuscular control. Although tissue flossing (TF) has demonstrated potential in acutely enhancing neuromuscular function in CAI patients, its long-term rehabilitative effects remain unclear. This study aimed to investigate the long-term neuromuscular adaptive effects of combining TF with balance training in CAI patients. Thirty-four participants with CAI were randomly assigned (using a random number remainder method) to an 8-week intervention of either balance training combined with TF (FLOSS group, n = 17) or balance training alone (CON group, n = 17).Outcome measures, assessed pre- and post-intervention, included muscle reaction time and activation level of the tibialis anterior (TA) and peroneus longus (PL) measured using surface electromyography, isometric strength was measured with a hand-held dynamometer, static balance was evaluated via a unilateral stance test (UST) on a balance system, and dynamic balance was assessed using the Y-Balance Test (YBT). Data were analyzed using a 2 (time: pre vs. post) × 2 (group: FLOSS vs. CON) repeated-measures analysis of variance. Following the intervention, a significant Time × Group interaction was found only for the RMS amplitude of the TA during the anterior reach task (F (1, 28) = 4.417, p = 0.044, ηp² = 0.121, large effect size), with no significant between-group difference in post-hoc tests (p = 0.454). Muscle reaction time and static balance improved significantly from baseline in all participants, but the magnitude of improvement did not differ between groups. No additional between-group differences were observed in ankle muscle strength, dynamic balance, or electromyographic activity in other directions. TF combined with balance training did not provide statistically significant additional long-term benefits compared to balance training alone.

Clinical trial registration: This trial was registered at the Chinese Clinical Trial Registry (Identifier: ChiCTR2400092294) (https://www.chictr.org.cn/bin/userProject?status=%E9%80%9A%E8%BF%87%E5%AE%A1%E6%A0%B8).