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This study is a randomized controlled trial (RCT) investigating the effectiveness of tissue flossing as an adjunctive therapy for Achilles tendinopathy. Thirty participants, aged 20-45 years with a clinical diagnosis of Achilles tendinopathy (>6 weeks), will be randomly assigned to one of two groups. The intervention group will receive a single session of tissue flossing (involving an elastic band wrapped from mid-calf to heel under moderate tension, followed by active ankle exercises) combined with conventional eccentric loading exercises. The control group will receive conventional eccentric loading exercises only. The primary outcome measures will be pain intensity, assessed using the Numeric Pain Rating Scale (NPRS); ankle range of motion, measured via the Weight-Bearing Lunge Test (WBLT); functional limitation, evaluated with the Lower Extremity Functional Scale (LEFS); and jump performance, measured by countermovement jump height using the My Jump Lab app. Assessments will be conducted at baseline, after the intervention session, and at a one-week follow-up. The study aims to determine if tissue flossing provides significant immediate and short-term improvements in pain and function, potentially offering a novel, low-cost supportive technique for rehabilitation.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental | Group receiving tissue flossing and eccentric exercises |
|
| Control group | Active Comparator | Group receiving only eccentric exercises |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Tissue flossing | Device | The intervention group receives a single session of tissue flossing combined with conventional treatment. The flossing protocol involves applying an elastic band (50-70% tension) from the mid-calf to the heel. While wrapped, participants perform active ankle range of motion and bodyweight heel raises for 2-3 minutes. This is immediately followed by the conventional treatment: eccentric loading exercises for the gastrocnemius (knee straight) and soleus (knee flexed 45°) muscles, consisting of 2 sets of 20 repetitions with a 5-minute rest between sets. |
| Measure | Description | Time Frame |
|---|---|---|
| Numeric Pain rating scale | Level of pain measured by Numeric Pain rating scale (NPRS), 0 means no pain and 10 means severe pain | From enrollment to the end of treatment at 1 week |
| Measure | Description | Time Frame |
|---|---|---|
| Range of motion | Range of motion at ankle joint measured using weight bearing lunge test | From enrollment to the end of treatment at 1 week |
| Counter-movement Jump Height | Countermovement Jump (CMJ) is a widely used, rapid, and non-invasive athletic assessment that measures lower-body explosive power, neuromuscular function, and fatigue. It involves an athlete standing upright, performing a quick downward movement (countermovement) to a self-selected depth, followed immediately by a maximal vertical jump |
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Inclusion Criteria:
· Adults aged 20-45 years.
Exclusion Criteria:
· Systemic inflammatory diseases (e.g., rheumatoid arthritis).
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| Name | Affiliation | Role |
|---|---|---|
| Muhammad Tayyab Iqbal, DPT | Riphah International University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Fauji Foundation Hospital | Rawalpindi | Punjab Province | 46000 | Pakistan |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39877264 | Background | Chen J, Wang Q, Zhao Z, Song Q, Zhao P, Wang D. Acute effects of tissue flossing on boxers with chronic knee pain. Front Bioeng Biotechnol. 2025 Jan 14;12:1508054. doi: 10.3389/fbioe.2024.1508054. eCollection 2024. | |
| 38576832 | Background | Cheatham SW, Baker R. Tissue Flossing: A Commentary on Clinical Practice Recommendations. Int J Sports Phys Ther. 2024 Apr 1;19(4):477-489. doi: 10.26603/001c.94598. eCollection 2024. |
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| Eccentric exercises | Other | The control group will receive conventional treatment only, which consists of a standardized eccentric exercise program for the Achilles tendon. This protocol involves performing eccentric loading exercises for both the gastrocnemius muscle with the knee held straight and the soleus muscle with the knee flexed to 45 degrees. The dosage is set at two sets of twenty repetitions for each exercise, with a five-minute rest period provided between sets. This conventional regimen will be administered in three sessions over the course of one week. Participants in this group will not receive any form of tissue flossing intervention. All outcome measures, including pain, range of motion, functional performance, and jump height, will be assessed at baseline, after each treatment session, and at the one-week follow-up to evaluate progress. |
|
| From enrollment to the end of treatment at 1 week |
| Lower Extremity Functional Scale (LEFS) | A 20-item, self-report questionnaire assessing the patient-perceived functional ability of individuals with lower extremity musculoskeletal conditions | From enrollment to the end of treatment at 1 week |
| 30676229 | Background | Mills B, Mayo B, Tavares F, Driller M. The Effect of Tissue Flossing on Ankle Range of Motion, Jump, and Sprint Performance in Elite Rugby Union Athletes. J Sport Rehabil. 2020 Mar 1;29(3):282-286. doi: 10.1123/jsr.2018-0302. |
| 28855793 | Background | Borda J, Selhorst M. The use of compression tack and flossing along with lacrosse ball massage to treat chronic Achilles tendinopathy in an adolescent athlete: a case report. J Man Manip Ther. 2017 Feb;25(1):57-61. doi: 10.1080/10669817.2016.1159403. Epub 2016 May 30. |