The Effect of Ankle Floss Band Application on Football Players:Serial Group Design Study

doi:10.21203/rs.3.rs-5268291/v1

Background:This study aimed to assess the effectiveness of ankle dorsiflexion exercises with floss bands on balance, proprioception, and physical performance in football players.

Methods:A serial group design was used.The study group(SG)(n=36) received floss band application, followed by a 72-hour rest,while the control group (CG)(n=36) received foam sponge bandage application.Both groups performed identical exercises.Measurements were taken before and after bandaging and exercises.Ankle dorsiflexion range of motion (DF-ROM) was evaluated using the weight-bearing lunge test,static balance was assessed via a smartphone application,dynamic balance was measured with the Y-balance test,and proprioception was tested with the joint position sense test.Jump performance was evaluated through the triple hop test.

Results:Intra-group evaluations showed significant improvements in ankle DF-ROM,static and dynamic balance,proprioception, and jump performance in the SG (p < 0.05),while the CG only showed significant improvement in the Y-balance test (p < 0.05).Comparatively, the SG exhibited significantly higher DF-ROM than the CG (p < 0.05).Effect sizes indicated greater post-test improvements in static balance, dynamic balance, proprioception, and the triple hop test for the SG.

Conclusions:Integrating floss band training into football players' training or rehabilitation may enhance athletic performance and motor control.

Trial Registration: The study protocol was approved by the Ethics Committee of Alanya Alaaddin Keykubat University, Non-Interventional Clinical Research Ethics Committee on October 10, 2023, with decision number 2023/01, and was conducted in accordance with the principles set forth in the Declaration of Helsinki. The study was registered at www.ClinicalTrials.gov (identifier: NCT06491277).

Floss band

Blood Flow Restriction

Performance

Proprioception

Football has a long historical tradition as a competitive event, dating back to ancient times. The game is played by a number of different players in various positions, each of which requires a specific combination of tactical intelligence and physical abilities[1]. The ability to perform this activity successfully requires a combination of endurance, skill, and coordination, as well as explosive strength and technical abilities such as the ability to change direction suddenly and accelerate rapidly [2]. The ability to control the musculoskeletal system and maintain optimal neuromuscular performance is of paramount importance in preventing injuries among athletes [3]. The ankle is a common site of injuries in football. The causes of these injuries include prolonged competition and insufficient rest breaks. Additionally, strength, flexibility, and balance disorders of the ankle and surrounding muscles and ligaments can increase the risk of injury in athletes [4]. The physical characteristics of the ankle and lower extremities have a significant impact on a football player's performance and injury risk. This underscores the importance of rehabilitation techniques such as the band. These techniques can enhance range of motion, optimize performance, and expedite the recovery process for athletes [5].

The floss band was initially proposed by Starrett and Cordoza. It has been postulated that this method can enhance range of motion, augment performance (e.g., strength or jumping ability), expedite recovery, and mitigate pain from injuries in athletes [5]. A review of the literature reveals that numerous studies have been conducted in relation to the floss band [6]. The application of the band has been demonstrated to elicit effects comparable to those observed in blood flow restriction exercises. This approach has been shown to enhance muscle performance and accelerate the recovery process[7],[8]. The utilization of the band in athletes has been demonstrated to enhance range of motion, alleviate muscle tension, and mitigate fatigue and muscle soreness [9]. It has been demonstrated that the floss band, which has been proven to enhance athletic performance, affects balance, proprioception, and performance thereby improving athletic performance[8]. However, there are no studies in the literature investigating the effects of band application on the ankle on balance and proprioception.

The objective of this study was to examine the influence of the floss band on balance, proprioception, and performance, with a particular focus on its effects on athletic performance.

2.1 Study Population and Participants

The study protocol was approved by the Ethics Committee of XX Non-Interventional Clinical Research Ethics Committee on October 10, 2023, with decision number 2023/01, and was conducted in accordance with the principles set forth in the Declaration of Helsinki. The study was registered at www.ClinicalTrials.gov (identifier: XX).

2.2 Eligibility Criteria for Participants

Inclusion criteria: Being between the ages of 18 and 25, and having participated in regular football training for at least 3 years. Exclusion criteria:A history of fractures or surgeries involving the lower extremities, A diagnosed ankle or lower extremity condition, Presence of pain in the ankle or lower extremities ,A systemic condition such as deep vein thrombosis or embolism, Experiencing pain during any measurement.

2.3 Sample Size and Trial Design

A power analysis determined that with the inclusion of at least 72 participants (at least 36 per group), a statistical power of 85% could be achieved at a 95% confidence level [8].Our study was conducted with the participation of 36 professional football players from Antalya Spor Football Club between September to December 2023 . The study design employed a within-subject, serial group design, in which all players took part in both groups. This approach minimizes the impact of individual differences, allowing for more controlled comparisons, as each participant serves as their own control. Furthermore, the serial design was chosen to eliminate variations stemming from different coaching methods.

2.4 Interventions

Study Group: The study commenced with the application of the floss bands to the football players. The football players who had been evaluated prior to the application of the floss bands were evaluated once more following the application of the floss bands, to measure the effectiveness of the band. This group was designated the "Study Group (SG)." Floss bands are made of natural rubber (Sanctband COMPRE Floss 5.1 cm × 3.5 m; Sanct Japan Co., Ltd.) was applied with a tension of 50% at a point 5 cm below the ankle joint line, approximately 2 cm above the insertion of the Achilles tendon. The tension of the band was then increased to 70-75% to achieve the desired level of compression [6, 8].

Control Group: Following the designated rest period, the football players were evaluated prior to the application of the foam sponge bandage. After 72 hours, the foam sponge bandage was applied, and subsequent evaluations were conducted using tape to assess the efficacy of the application. This group was designated as the "Control Group (CG)"[10] [9]. The Cramer Tape Underwrap (7 cm x 27 m) brand foam bandage was wrapped in a manner that began 5 cm below the ankle joint line without tension. The control group underwent the same exercise protocol as the SG [11].

Exercise protocol: The individuals in both groups performed ankle dorsiflexion (toe raises), squats and lunges in 3 sets of 8 repetitions each with their ankles wrapped. A five-minute stationary cycling session was performed to facilitate warm-up before starting the practice [12]. The range of motion of the ankle in dorsiflexion was evaluated using the weight transfer lunge test, static balance was assessed with a smartphone application, dynamic balance was evaluated with the Y balance test, and proprioception was assessed with the joint position sense test. Additionally, a jump test was employed to assess jump performance.

2.5 Outcome Measures Tests

Weight Bearing Lunge Test: The range of motion for ankle dorsi-flexion was evaluated. For this test, markings were made on the edge of the wall with tape. The football players were instructed to stand at the marked point with their thumbs 10 cm away from the wall and attempt to touch the wall with their knees without lifting their heels off the ground. The feet of football players who were unable to touch the knee to the wall were retracted by 1 cm each time, ensuring that the heel remained in contact with the ground. In the event that the knee did not make contact with the wall in the initial position, the test was repeated by moving the foot 1 cm forward. The pelvic bone was stabilized to demonstrate the superior aspect of the iliac crest, and the hands were positioned at this point to prevent trunk movement. The distance at which the football players could reach the knee was recorded. Three trials were conducted for each participant, and the highest value was documented [13].

Static Balance Assessment: In this study, the static balance of football players was assessed using an application called "Accelerometer," developed using an Apple iPhone 14 and the Dream Arc App Inventor platform. The football players were instructed to stand upright on a flat surface with the test foot positioned on the line dividing the heel and second toe, while the other foot was lifted off the ground. The smartphone was positioned on the midpoint of the tibia bone to directly assess ankle balance, rather than the center of body mass. The mobile phone was secured to the mid-shin with an exercise armband, with the screen oriented in a forward direction. The football players were instructed to maintain a single-leg stance for a period of 30 seconds. Three trials were conducted, and the highest value was recorded. The application recorded acceleration data in three axes (x, y, z) with a sampling rate of 20 Hz for 30 seconds. Higher acceleration values indicated a lower level of balance [14].

Dynamic Balance Test: The Y balance test is a dynamic test with good reliability that requires strength, flexibility, and proprioception. It is widely used among athletes. For the test, three equal-length bands are placed on the floor and a Y-shape is formed between these bands at 90°, 135°, and 135° angles. The test foot is positioned at the junction of the bands and instructed to reach three distinct directions (anterior, posterolateral, and posteromedial) while maintaining balance with the other foot. Football players attempted to reach the maximum distance for these three directions, and these distances were recorded. The test was repeated until three successful reaches were performed for each direction. The highest value of the three successful test scores obtained was normalized to the leg length [15].

Proprioception Assessment: In evaluating the subject's joint position sense, the athlete was seated on a chair with the sole of the foot in contact with the floor and the eyes closed. Range of motion for the right and left ankles was assessed using a smartphone goniometer application. The tested ankle was passively dorsiflexed 10 degrees and then returned to its original position. The football player was then instructed to actively move the foot to the same position, and the degree of deviation from the targeted 10 degrees was recorded. This procedure was repeated three times, and the mean deviation was calculated [16].

Triple Hop Test: The test is a commonly utilized method for the functional assessment of ankle and knee joints. The test is designed to assess the participant's balance, performance, and joint stability. A 6-meter scale was prepared, and the footballer was instructed to stand on the designated foot and assume the starting position with arms by the trunk and knees bent at 45 degrees. The footballer was then asked to leap forward three times to the maximum distance, maintaining the same line and foot as the initial jump. The distance between the footballer's heel and the starting point was measured, and the longest of the two trials was recorded [17].

2.6 Statistical Analysis

The data were analyzed with the IBM SPSS Statistics 25 software package (Armonk, NY: IBM Corp.). Continuous variables are expressed as mean ± standard deviation, median (25th-75th percentiles), minimum-maximum values, and categorical variables as number and percentage. The conformity of the data to a normal distribution was examined with the Shapiro-Wilk test. In dependent group examinations, when parametric test assumptions were met, the dependent groups t-test was employed; when parametric test assumptions were not met, the Wilcoxon paired two-sample test was utilized. Additionally, Cohen's d effect size coefficient was utilized to examine the effect sizes obtained from the changes. In all examinations, p < 0.05 was considered statistically significant.

The study was conducted on a sample of 36 football players who took part in both groups with a mean age of 18.58 ± 0.81 years from Antalya Football Club (Figure 1).

Figure 1. Flow Chart

Upon analysis of the intragroup evaluation results of the SG before and after the intervention, it was observed that only the Y balance test posteromedial reach (YBT PM) exhibited no statistically significant change before and after the intervention (p=0.926 (z=-0.093)) (Table 1). A statistically significant increase was observed in the measurements of ankle dorsi flexion (A-DF), Y balance test anterior reach (YBT Ant.), Y balance test posterolateral reach (YBT PL), and triple hop test (THT) following the intervention period when compared to the measurements obtained prior to the intervention (p= 0.0001* (z=-4.197), p= 0.001* (z=-3.378), p=0.0001* (z=-3.778) and p=0.0001* (z=-4.203), respectively) (Table 1). A statistically significant reduction in static balance (SB) and joint position sense (JPS) was observed in the study group following the intervention, when compared to the pre-intervention measurements (p=0.01* (t=2.705) and p=0.035* (t=2.198), respectively) (Table 1.)

Table 1. The difference between the pre and post intervention scores for the study group.

	The difference between the pre- and post-intervention scores for the study group				The difference between the pre- and post-intervention scores for the control group
	A.O±S.S	Med (IQR)	Min.- Maks.	P	A.O±S.S	Med (IQR)	Min.- Maks.	p
A-DF Pre-int	9,28 ± 1,73	9 (8 - 10)	6 - 14	0,0001* (z=-4,17)	9,67 ± 1,62	9 (9 - 11)	7 - 14	0,083 (z=-1,732)
A-DF – Post-int	10,17 ± 1,84	10 (8,25 - 12)	8 - 14		9,83 ± 1,81	9,5 (8 - 11)	7 - 14
Difference A-DF	-0,89 ± 0,89	-1 (-1,75 - 0)	-3 - 1		-0,17 ± 0,56	0 (-0,75 - 0)	-1 - 1
SB- Pre-int	0,05 ± 0,02	0,04 (0,03 - 0,06)	0,01 - 0,09	0,01* (t=2,705)	0,04 ± 0,02	0,04 (0,02 - 0,05)	0,01 - 0,1	0,572 (z=-0,565)
SB Post-int	0,04 ± 0,02	0,04 (0,02 - 0,05)	0,01 - 0,11		0,04 ± 0,02	0,04 (0,02 - 0,05)	0,01 - 0,11
Difference ST	0,01 ± 0,02	0,01 (-0,01 - 0,03)	-0,03 - 0,05		0 ± 0,01	0 (-0,01 - 0,01)	-0,02 - 0,02
YBT Ant. Pre-int	82,71 ± 7,73	82,49 (77,68 - 86,5)	67,41 - 101,01	0,001* (z=-3,378)	85,46 ± 8,34	83,42 (79,85 - 93,13)	67,41 - 99,43	0,044* (z=-2,011)
YBT Ant. Post-int	84,97 ± 7,16	85 (79,82 - 88,73)	68,53 - 103,03		87,49 ± 7,62	86,6 (80,75 - 94,33)	74,1 - 99,8
Difference YBT Ant.	-2,26 ± 3,97	-1,66 (-3,23 - -0,34)	-16,13 - 4,42		-2,03 ± 8,5	-3,5 (-6,96 - 1,31)	-18,42 - 20,88
YBT PL Pre-int	108,97 ± 5,05	108,43 (107,29 - 110,37)	95,09 - 122,22	0,0001* (z=-3,78)	108,48 ± 8,06	109,05 (101,88 - 115,6)	93,8 - 121,1	0,02* (t=-2,444)
YBT PL Post-int	111,05 ± 4,72	110,36 (108,17 - 113,14)	102,12 - 122,22		110,67 ± 7,63	112,35 (105,7 - 117,4)	93,1 - 121,4
Difference YBT PL	-2,08 ± 3,46	-1,85 (-2,68 - -0,47)	-11,53 - 5,4		-2,19 ± 5,37	-2,25 (-6,26 - 1,4)	-12,7 - 13,4
YBT PM Pre-int	104,51 ± 5,73	104,43 (100,65 - 107,79)	93,13 - 116,66	0,926 (z=-0,093)	109,61 ± 8,72	110,91 (101,42 - 116,88)	92,17 - 122,11	0,036* (t=-2,175)
YBT PM Post-int	104,65 ± 6,38	103,75 (99,53 - 108,6)	93,87 - 118,27		111,75 ± 5,95	111,11 (108,22 - 115,65)	99,03 - 123,74
Difference YBT PM	-0,15 ± 4,59	0 (-2,19 - 1,78)	-16,13 - 9,8		-2,15 ± 5,92	-2,36 (-5,66 - 0,77)	-18,36 - 9,72
JPS Pre-int	3,61 ± 1,64	3 (2 - 5)	1 - 7	0,035* (t=2,198)	3,69 ± 1,12	3,5 (3 - 5)	2 - 6	0,416 (t=0,824)
JPS Post-int	3,03 ± 1,56	3 (2 - 4)	1 - 6		3,42 ± 1,59	3 (2 - 4,75)	1 - 7
Difference JPS	0,58 ± 1,59	1 (-0,75 - 2)	-3 - 4		0,28 ± 2,02	0,5 (-1 - 2)	-4 - 4
THT Pre-int	457,19 ± 15,13	458 (451,25 - 465,75)	410 - 488	0,0001* (z=-4,20)	466,67 ± 15,74	468,5 (454,25 - 480,25)	441 - 493	0,07 (z=-1,809)
THT Post-int	466,03 ± 20,27	466 (454,25 - 472,75)	427 - 510		470,44 ± 16,19	469,5 (457 - 480,75)	437 - 511
Difference THT	-8,83 ± 13,71	-6 (-11,75 - -1,25)	-48 - 28		-3,78 ± 12,78	-2 (-8,5 - 3)	-65 - 14

*p<0.05 statistically significant change; A.O: Arithmetic mean; S.S: Standard deviation; Med (IQR): Median (25th - 75th percentiles); min. - max: Minimum - maximum values; t: Dependent groups t-test; z: Wilcoxon paired two-sample test; ES: Effect Size, SG: study group, CG: control group, Pre-Intervention: pre- int Post-Intervention:post-int, A-DF: ankle dorsi flexion, SB: static balance, YBT Ant.: y balance test anterior reach, YBT PL: y balance test posterolateral reach, YBT PM: y balance test posteromedial reach, JPS: joint position sense, THT: triple hop test.

The analysis of the control group (CG) evaluation results before and after the application revealed no statistically significant change in the ankle dorsi flexion (A-DF), static balance (SB), joint position sense (JPS), and triple hop test (THT) measurements before and after the application (p= 0.083 (z=-1.732), p= 0.572 (z=-0.565), p= 0.416 (t=0.824), p= 0.07 (z=-1.809), respectively) (Table 2). A statistically significant increase was observed in the Y balance test anterior reach (YBT Ant.), Y balance test posterolateral reach (YBT PL), and Y balance test posteromedial reach (YBT PM) measurements following the intervention period when compared to the measurements taken prior to the intervention (p= 0.044* (z=-2.011), p=0.02* (t=-2.444), p=0.036* (t=-2.175), respectively) (Table 2).

Table 2.The difference between the pre and post intervention scores for the Control Group.

	Control Group (CG) And Study Group (SG) Pre- İmplementation Difference				Control Group (CG) And Study Group (SG) Post- İmplementation Difference
	A.O±S.S	Med (IQR)	Min.- Maks.	P	A.O±S.S	Med (IQR)	Min.- Maks.	P
A-DF Pre-int	9,67 ± 1,62	9 (9 - 11)	7 - 14	0,005* (z=-2,84)	9,83 ± 1,81	9,5 (8 - 11)	7 - 14	0,019* (z=-2,35)
A-DF – Post-int	9,28 ± 1,73	9 (8 - 10)	6 - 14		10,17 ± 1,84	10 (8,25 - 12)	8 - 14
Difference A-DF	0,39 ± 0,73	0 (0 - 1)	-1 - 2		-0,33 ± 0,79	0 (-1 - 0)	-2 - 1
SB- Pre-int	0,04 ± 0,02	0,04 (0,02 - 0,05)	0,01 - 0,1	0,001* (t=-3,69)	0,04 ± 0,02	0,04 (0,02 - 0,05)	0,01 - 0,11	0,464 (z=-0,73)
SB Post-int	0,05 ± 0,02	0,04 (0,03 - 0,06)	0,01 - 0,09		0,04 ± 0,02	0,04 (0,02 - 0,05)	0,01 - 0,11
Difference ST	-0,01 ± 0,02	-0,01 (-0,03 - 0)	-0,05 - 0,03		0 ± 0,01	0 (-0,01 - 0,01)	-0,04 - 0,02
YBT Ant. Pre-int	85,46 ± 8,34	83,42 (79,85 - 93,13)	67,41 - 99,43	0,078 (t=1,81)	87,49 ± 7,62	86,6 (80,75 - 94,33)	74,1 - 99,8	0,132 (t=1,544)
YBT Ant. Post-int	82,71 ± 7,73	82,49 (77,68 - 86,5)	67,41 - 101,01		84,97 ± 7,16	85 (79,82 - 88,73)	68,53 - 103,03
Difference YBT Ant.	2,75 ± 9,09	0,21 (-3,23 - 7,22)	-14,6 - 26,86		2,52 ± 9,78	3,24 (-6,39 - 7,81)	-19 - 24,67
YBT PL Pre-int	108,48 ± 8,06	109,05 (101,88 - 115,6)	93,8 - 121,1	0,974 (z=-0,03)	110,67 ± 7,63	112,35 (105,7 - 117,4)	93,1 - 121,4	0,909 (z=-0,11)
YBT PL Post-int	108,97 ± 5,05	108,43 (107,29 - 110,37)	95,09 - 122,22		111,05 ± 4,72	110,36 (108,17 - 113,14)	102,12 - 122,22
Difference YBT PL	-0,49 ± 9,84	0,51 (-7,84 - 8,41)	-25,82 - 12,77		-0,38 ± 8,5	1,85 (-7,45 - 6,27)	-20,28 - 10,78
YBT PM Pre-int	109,61 ± 8,72	110,91 (101,42 - 116,88)	92,17 - 122,11	0,006* (z=-2,76)	111,75 ± 5,95	111,11 (108,22 - 115,65)	99,03 - 123,74	0,0001* (t=4,60)
YBT PM Post-int	104,51 ± 5,73	104,43 (100,65 - 107,79)	93,13 - 116,66		104,65 ± 6,38	103,75 (99,53 - 108,6)	93,87 - 118,27
Difference YBT PM	5,1 ± 10,45	6,93 (-2,2 - 13,63)	-23,38 - 19,3		7,1 ± 9,25	9,1 (0,65 - 13,16)	-16,12 - 22,18
JPS Pre-int	3,69 ± 1,12	3,5 (3 - 5)	2 - 6	0,812 (t=0,23)	3,42 ± 1,59	3 (2 - 4,75)	1 - 7	0,006* (z=-2,72)
JPS Post-int	3,61 ± 1,64	3 (2 - 5)	1 - 7		3,03 ± 1,56	3 (2 - 4)	1 - 6
Difference JPS	0,08 ± 2,09	0 (-1 - 2)	-4 - 4		0,39 ± 0,77	0 (0 - 1)	-1 - 2
THT Pre-int	466,67 ± 15,74	468,5 (454,25 - 480,25)	441 - 493	0,021* (t=2,42)	470,44 ± 16,19	469,5 (457 - 480,75)	437 - 511	0,28 (t=1,096)
THT Post-int	457,19 ± 15,13	458 (451,25 - 465,75)	410 - 488		466,03 ± 20,27	466 (454,25 - 472,75)	427 - 510
Difference THT	9,47 ± 23,47	5 (-4,5 - 27,75)	-35 - 71		4,42 ± 24,17	7,5 (-9 - 22,75)	-50 - 56

*p<0.05 statistically significant change; A.O: Arithmetic mean; S.S: Standard deviation; Med (IQR): Median (25th - 75th percentiles); min. - max: Minimum - maximum values; t: Dependent groups t-test; z: Wilcoxon paired two-sample test; ES: Effect Size, SG: study group, CG: control group, Pre-Intervention: pre- int Post-Intervention:post-int, A-DF: ankle dorsi flexion, SB: static balance, YBT Ant.: y balance test anterior reach, YBT PL: y balance test posterolateral reach, YBT PM: y balance test posteromedial reach, JPS: joint position sense, THT: triple hop test.

No statistically significant difference was identified in the Y balance test anterior reach (YBT Ant.), Y balance test posterolateral reach (YBT PL), and joint position sense (JPS) measurements obtained from the study (SG) and control (CG) groups prior to the commencement of the intervention (p= 0.078 (t=1.816), p=0.974 (z=-0.033), p=0.812 (t=0.239), respectively) (Table 2). The pre-treatment values of the CG exhibited significantly higher measurements in the ankle dorsi flexion (A-DF), Y balance test posteromedial reach (YBT PM), and triple hop test (THT) measurements when compared to the pre-treatment values of the SG. Conversely, the pre-treatment values of the CG demonstrated significantly lower measurements in the static balance (SB) measurement when compared to the pre-treatment values of the SG (P= 0.005* (z=-2.841), 0.006* p= (z=-2.768), p=0.021* (t=2.421) and p= 0.001* (t=-3.695), respectively) (Table 2).

The results of the study demonstrated no statistically significant difference between the SG and CG groups in terms of static balance (SB), Y balance test anterior reach (YBT Ant.), Y balance test posterolateral reach (YBT PL), and triple hop test (THT) measurements following the interventions (p= 0.464 (z=-0.732), p=0.132 (t=1.544), p=0.909 (z=-0.115) and p=0.28 (t=1.096) respectively). The ankle dorsi flexion (A-DF) measurement revealed significantly lower values in the control group (CG) compared to the study group (SG). Similarly, the Y balance test posteromedial reach (YBT PM) and joint position sense (JPS) measurements demonstrated significantly higher values in the CG compared to the SG (p=0.019* (z=-2.355), p=0.0001* (t=4.605) and p=0.006* (z=-2.725), respectively) (Table 2).

Upon examination of the results of the pre-post difference and effect sizes of the study (SG) and control (CG) groups, it becomes evident that the change in AB-DF values subsequent to CG application exerts a comparatively diminished effect in comparison to the change observed following SG application (ES: 0.7>0.289) (Graph 1). In the SB examinations, it was observed that the change resulting from CG application was less pronounced than that resulting from SG application (ES: 0.451>0.094) (Graph 1). The results demonstrate that the change observed following CG application exerts a comparatively lesser influence than that observed following SG application in YBT Ant examinations (EB: 0.563>0.335) (Figure 1). In YBT PL examinations, the change observed after CG application is found to have a lesser impact than that observed after SG application (ES: 0.63>0.407) (Graph 1). Conversely, in YBT PM examinations, the change observed after CG application is found to have a greater impact than that observed after SG application (ES: 0.02<0.363) (Graph 1).

In JPS examinations, the change observed after CG application was found to have a lesser impact than that observed after SG application (ES: 0.366>0.137) (Graph 1). Similarly, in THT examinations, the change after CG application was found to have a lesser impact than that after SG application (EB: 0.7>0.302) (Graph 1).

Graph 1. Pre-post intervention difference and effect size table for the study group and control group

This study, which was conducted using a serial group design, investigated the effects of floss band application on balance, proprioception, and performance.The evaluation of the effect size within and between groups revealed that the SG was effective in ankle dorsi flexion, the Y balance test (anterior and posterolateral reach), and the triple hop test scores. The results demonstrated a notable decline in both static balance and joint position sense test scores, which concurrently indicated a reduction in the discrepancy between static balance and joint position sense. This outcome is indicative of enhanced proprioception and balance. The sole statistically significant discrepancy observed in the CG pertained to the Y-balance dynamic balance test posteromedial effect size and difference value.

A review of the literature revealed that several studies had demonstrated the efficacy of floss band application in improving ankle dorsi flexion range of motion and enhancing jumping performance, findings that were consistent with those of our own study [5, 8]. In the study by Driller and Overmayer [18], active dorsiflexion and plantar flexion exercises were performed following the application of the floss band on the ankles of 52 recreational athletes.The results indicated increased ankle mobility and improved jump performance, similar to the findings of our study [8]. Although the precise physiological mechanism remains elusive, Starrett and Cordoza (2015) posit that the floss band may induce fascial displacement and transiently impede blood flow to the muscles, thereby contributing to these observed benefits [5].

Like our study, Lee and Byun (2022) investigated the acute effects of floss band application on ankle range of motion and vertical jump performance in 21 taekwondo athletes. The participants were divided into three groups of seven: the first group consisted of athletes with functional ankle instability, the second group included those with moderate ankle instability, and the final group comprised healthy athletes. Ankle range of motion and vertical jump distance were assessed prior to the application of the floss band. Following the pre-test assessments, exercises such as active ankle dorsiflexion and plantar flexion, toe raises, squats, squat jumps, and split squat jumps were performed with the floss band. Post-exercise measures revealed a significant increase in both dorsiflexion and vertical jump performance in Group 1, consisting of athletes with functional ankle instability. These findings suggest that floss band application may be an effective intervention for enhancing performance and reducing the risk of ankle injury.[19].

Mills et al. (2020) reported significant changes in weight transfer lunge testing and vertical jump parameters following ankle dorsiflexion range of motion exercises with floss band application in professional American football players [20]. They identified the potential mechanisms underlying the impact of blood flow restriction exercises on functional performance, including hormonal system and catecholamine responses, the muscle's force production capacity, and enhanced excitation-contraction coupling within the muscle [8] [21].

In the present study, the assessment of proprioception was conducted using the joint position sense (JPS) test [10]. The results of this study demonstrated a statistically significant reduction in deviation, indicating an improvement in proprioception. To the best of our knowledge, no previous studies have investigated the effects of floss band exercises on ankle proprioception. Therefore, our study represents a novel contribution to the field.

In this study, static balance measurements were performed with a smartphone application called "Accelerometer". An analysis of the intra- and inter-group evaluation revealed that the SG showed a change with a larger effect size compared to CG. After the application, the evaluation scores showed a statistically significant decrease in the SG. The observed decline in deviation levels suggests an improvement in balance ability [22].

In a study similar to ours, Chang et al. (2021) applied floss band around the knee and measured balance using the Y balance test. They reported that floss band application had a positive effect on balance. They attributed this improvement to increased soft tissue flexibility and quadriceps muscle strength (10). Therefore, it can be concluded that floss band application, regardless of the joint it is applied to, enhances balance by increasing joint position sense and proprioception, as indicated in our study [10, 23]. Additionally, enhanced range of motion is positively correlated with dynamic balance, as measured by the Y balance test. The increased dorsiflexion range observed in our study aligns with improved performance on the Y balance test [24].

The increased balance scores observed after foam sponge bandage application are likely attributable to the compression provided to the ankle joint. As noted by Sun et al. (2021), an increase in sensory input is associated with improvements in balance performance [25]. As outlined in the methodology of our study, each football player was initially included in the study group. Each player in the study group completed the tests twice, once before and once after the application. Consequently, the fact that the control group players were tested after a 72-hour interval may have led them to achieve higher scores. Additionally, the fact that the tests conducted on the control group were not performed for the first time prior to the application may have contributed to the observed differences in the pre-application evaluation scores of the control group. Many studies indicate that repeated testing tends to improve scores due to habituation to the test. The magnitude of the reported learning effect varies considerably across studies, ranging from approximately 4.5–33% of the effect observed in baseline assessments [26], [27].

Our study employs a serial group design, with a 72-hour resting period between treatments. This interval was selected based on the findings of Ross and Kandassamy (2017), who demonstrated that this duration is sufficient to prevent any permanent effects of the application protocol on the leg. Nevertheless, a statistical difference was observed between the initial measurements taken before the application in both the floss band and control groups [9]. The difference in outcomes indicates that floss band application has a lasting effect that persists for more than 72 hours. In their 2017 study, Driller and Overmayer evaluated the long-term effect of a single session of floss band, with a maximum duration of seven hours. Their findings demonstrated that the intervention remained effective in enhancing ankle dorsi flexion range of motion even after the seven-hour mark [8]. To date, no studies have evaluated the lasting effect beyond the seven-hour mark. Our study may, therefore, contribute to the existing literature by demonstrating that the lasting effect may extend beyond seven hours.

In this study, no adverse effects were reported by the participants during or after the mechanical compression and temporary blood flow restriction. It has been suggested that the application of the floss band can safely improve ankle range of motion, proprioception, and balance in football players. Although the exact mechanism of the floss band remains unclear, it is believed to enhance joint stability and sensory feedback. Additionally, it may create a placebo effect that increases athletes' sense of confidence. Future studies could investigate the potential effects of the floss band in this regard.

Enhancing an athlete's confidence is crucial in sports like football, where repeated jumping and landing movements significantly affect performance [1].The exact mechanism of floss band application has yet to be elucidated. However, it is hypothesized that by enhancing proprioceptive feedback through mechanoreceptor stimulation, it positively affects balance control, thereby providing joint stability and creating a placebo effect that increases the sense of security [5] [3]. Our study showed that the application of the floss band to the ankle has a beneficial impact on both static and dynamic balance in football players. Additionally, the floss band application to the ankle was effective in improving proprioception in football players. Future research could explore the impact of floss band use on confidence before and after exercise.

In our study, the pressure in the target tissue following floss band application was not assessed using an objective measurement method such as laser Doppler flowmetry. Future research should incorporate such assessment techniques.

Conflict of Interest and Source of Funding

No funding was secured for this study. All authors declare no conflict of interest. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation. The results of the present study do not constitute an endorsement by the American College of Sports Medicine.

Confirmation of ethical compliance

The study protocol was approved by the Ethics Committee of XXXXX Non-Interventional Clinical Research Ethics Committee on October 10, 2023, with decision number 2023/01, and was conducted in accordance with the principles set forth in the Declaration of Helsinki.

No financial assistance was provided towards this research.

CRediT authorship contribution statement

Harun Mete KOC: Writing – review & editing, Writing – original draft, Methodology, Investigation, Formal analysis, Data curation, Conceptualization.Ayca Araci: Conceptualization, Data curation, Formal analysis, Methodology, Writing – original draft, Writing – review & editing.Gul Baltaci: Writing – review & editing, Writing – original draft, Formal analysis, Data curation, Conceptualization.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Graph 1 is not available with this version.

Graph 1. Pre-post intervention difference and effect size table for the study group and control group

No competing interests reported.

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The Effect of Ankle Floss Band Application on Football Players:Serial Group Design Study

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Abstract

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1. Introduction

2. Methods

3. Results

4. Discussion

5. Conclusions

6. Limitations

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References

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