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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Introduction</span><p id="para0001" class="elsevierStylePara elsevierViewall">Fascia is a continuous connective tissue&#44; forming a three-dimensional network that covers all the organs in the human body&#44; such as bones&#44; muscles&#44; nerves&#44; vessels and visceral organs&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Fascia comprises collagen fibres&#44; elastic fibres&#44; reticular fibres and ground substance&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Various mechanoreceptors exist in the fascia that respond to the different stimulations&#59; for instance&#44; Ruffini corpuscles&#44; Pacini corpuscles and free nerve endings were found not only in the superficial fascia but also in the deep fascia&#44; and these mechanoreceptors respond to the steady stretch&#44; pressure&#44; vibration&#44; and change of ambient temperature&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> From the histological finding&#44; fascia contains rich blood vessels and nerves&#44; especially in the deep layer<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a>&#46; These specific fascia structures determine their functions of supporting&#44; dividing&#44; protecting&#44; force transmission&#44; affecting metabolism and influencing information communication&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> Hyaluronic acid &#40;HA&#41;&#44; a polysaccharide found in connective tissue and a component of the ground substances&#44; withstands compression&#44; provides lubrication and hydration&#44; and plays an essential role in facilitating fascia gliding&#44; reducing fascia viscosity&#44; and aiding in accurate information transmission&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> The speculation evidence showed that abnormal fascia tension might alter the tension structure of collagen fibres and the composition of the extracellular matrix from a biological perspective&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> For example&#44; fascia adhesion may disrupt the function of HA&#44; which restricts fascia gliding&#44; affects force distribution&#44; and alters receptors&#8217; pain responses&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Additionally&#44; abnormal fascia tension may cause increased nerve pressure and traction&#44; raising the likelihood of nerve swelling in the affected area&#46; This may restrict blood supply and reduce metabolism due to increased endoneurial fluid pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> Furthermore&#44; long-term fascia adhesion may result in cumulative musculoskeletal injuries&#44; decreased mobility&#44; increased stiffness&#44; inhibited neuromuscular control&#44; and stimulated nociceptor sensitization&#44; potentially forming a vicious cycle of injury&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> To break the vicious cycles&#44; several myofascial release approaches have been developed&#44; and the tissue flossing technique by applying Flossband around the soft tissues or joints is one of those methods to address fascia dysfunction&#46;</p><p id="para0002" class="elsevierStylePara elsevierViewall">Tissue flossing using the Flossband is usually combined with passive treatments and active movements to address pain&#44; flexibility restriction&#44; and neuromuscular disorders&#46; Thus&#44; it has increasingly been used in sports and rehabilitation by practitioners for the last decade&#46; Flossband &#40;Sanctband<span class="elsevierStyleSup">TM</span> Comprefloss&#44; Malaysia&#41; is a natural rubber band that is more than one millimetre thick and is applied to different soft tissues or joints by users&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> The current literature review revealed no conclusive evidence about the precursor of Flossband&#46; In the year of 2013&#44; Kelly Starret&#44; an American physiotherapist and CrossFit coach&#44; developed a new tool called flossing to accelerate recovery&#44; improve muscle strength and increase range of motion&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> Two years later&#44; Kelly Starret and Cordoza Glen published the book&#44; <span class="elsevierStyleItalic">&#8220;Becoming a Supple Leopard&#58; The Ultimate Guide to Resolving Pain&#44; Preventing Injury&#44; and Optimizing Athletic Performance&#8221;</span>&#44; first incorporated the Flossband application&#44; which expands a new approach to manage pain&#44; improve sports performance as well as prevent injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> In the year of 2017&#44; Seven Kruse&#44; a German sports physiotherapist&#44; further expanded the Flossband application by adding the understanding of fascia in sports rehabilitation and fitness training in his book &#8220;<span class="elsevierStyleItalic">Easy Flossing</span>&#8221;&#44;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> which accelerated its popularity worldwide&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">Flossband application on the soft tissues or peripheral joints has been approved to manage pain&#44; reduce inflammation&#44; decrease myofascial tightness&#44; increase the range of motion&#44; activate the muscle&#44; and improve muscle strength&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> For example&#44; two minutes of Flossband application around the knee joint with pressure 182mmHg &#40;&#177;38mmHg&#41; significantly decreased the pain intensity of the knee pain patients with a one-time treatment&#44; compared to a control group without Flossband application&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> After two minutes of Flossband wrapping on the elbow&#44; combined with the elbow flexion and extension movements&#44; significantly reduced pain around the elbow&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Furthermore&#44; four weeks of Flossband combined with sports therapy significantly reduced ankle joint inflammation for the patients with acute ankle sprain compared to the group with sports therapy only&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> Additionally&#44; the Flossband wrapped on the thigh combined with the passive muscle twisting and active knee flexion movement significantly improved the straight leg flexibility compared to the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Moreover&#44; two minutes of Flossband wrapped on the gastrocnemius&#44; with pressure 160mmHg &#40;&#177;3mmHg&#41;&#44; combined with dynamic stretch significantly improved the calf muscle force development&#44;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> and wrapping the Flossband on the thigh with pressure 154&#46;3mmHg &#40;&#177;13&#46;3mmHg&#41;&#44; combined with dynamic squat significantly improved the maximum isometric voluntary contraction&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> Although the mechanisms underpinning the beneficial effects of Flossband application are not fully understood&#44; few hypotheses about these mechanisms were postulated&#46; A theoretical framework connecting the advantages of Flossband application mechanisms is needed to fill in the knowledge gap about the Flossband wrapping mechanisms and Flossband application mastering&#46; Therefore&#44; this paper aims to summarize the potential mechanisms of the effects of Flossband application based on the currently available evidence&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">The potential mechanisms of Flossband Application</span><p id="para0004" class="elsevierStylePara elsevierViewall">Several speculations on the potential mechanisms of Flossband application benefits&#44; for instance&#44; the theory of &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; &#8220;Soft Tissue Ischemia&#8221; and &#8220;Joint Effect&#8221;&#44; were listed below&#58;</p><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Mechanism of &#8220;Pain Gate&#8221;</span><p id="para0005" class="elsevierStylePara elsevierViewall">The &#8220;Pain Gate&#8221; mechanism is one of the speculated explanations for the benefits of Flossband application on soft tissues or joints to reduce pain&#46; This theory&#44; proposed by Wall and Melzack&#44;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> suggests that pain perception can be modulated by the opening or closing of the nerve gate located in the dorsal horn of the spinal cord&#46; This modulation occurs through the activity of small diameter C-fibers and A&#948;-fibers or larger diameter A&#946;-fibers&#46; Non-painful stimuli&#44; such as compression&#44; skin rubbing&#44; or temperature changes&#44; may activate A&#946;-fibers&#44; which may&#44; in turn&#44; activate inhibitory neurons&#46; In the animal model&#44; these inhibitory neurons may close the gate in the spinal cord&#44; thereby reducing the perception of pain by inhibiting the transmission of pain signals from C-fibers and A&#948;-fibers&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> Flossband&#44; as a compression tool&#44; exerts pressure on the skin&#44; which may activate large diameter A&#946;-fibers&#44; thereby reducing pain&#46; This activation of A&#946;-fibers could be one factor explaining the pain reduction observed after Flossband application&#46; Sympathetic activities closely related to pain perception and their excitability may exacerbate the pain perception&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> However&#44; various mechanoreceptors&#44; like Ruffini and Pacinian corpuscles&#44; are present in the skin or the fascia layers&#46; These mechanoreceptors play a role in inhibiting sympathetic nervous system activity when stimulated&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> The sympathetic nervous system is responsible for the &#8216;fight or flight&#8217; response&#44; which includes increasing heart rate&#44; constricting blood vessels&#44; regulating muscle relaxation response&#44; and others&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> When mechanoreceptors are activated&#44; they can induce a parasympathetic response&#44; promoting relaxation and reducing stress-related physiological responses&#46; Although no study has yet examined the effect of Flossband application on mechanoreceptor activation&#44; it is thought the Flossband compression on the skin may stimulate these mechanoreceptors&#44; leading to the inhibition of sympathetic activity&#46; Additionally&#44; the compression may restrict the blood flow&#44; which may produce analgesic effects through releasing beta-endorphins&#44; and the endorphins may influence the speed of pain signal transmission to the brain&#44; which may lead to improved brain response to the pain&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">It is worth noting that the mechanism of Flossband application for pain management may be associated with A&#946;-fiber activation&#44; sympathetic activities&#44; and beta-endorphin release&#46; However&#44; current evidence is insufficient to confirm these associations&#46; Therefore&#44; future research is needed to elucidate the exact mechanisms of Flossband application from these perspectives&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Mechanism of &#8220;Fascial Glide&#8221;</span><p id="para0007" class="elsevierStylePara elsevierViewall">&#8220;Fascia Glide&#8221;&#44; as the second speculated mechanism&#44; explains the benefits of Flossband application on the soft tissues to release the fascia tension&#44; improve muscle flexibility and reduce pain&#46; The assumption of Flossband wrapping on the soft tissue combined with the exercises produces the cohesion force &#40;downwards&#41; and twist force &#40;lateral to medial or media to lateral&#41;&#46; These combined forces form shear force &#40;opposite the wrapping direction&#41; acting on the myofascial&#46; Firstly&#44; the shearing force may help the fascia slide between each layer&#44; decreasing myofascial tightness&#44; which is the main effect of improving muscle flexibility after Flossband application&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> Secondly&#44; Flossband compression on the soft tissue increases the intramuscular pressure and may increase myofascial friction during muscle contraction&#44; improving the deep soft tissue temperature&#46; Previous evidence showed that improving the thermal effects of deep soft tissue decreased the fascia viscoelasticity&#44;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> which may also explain the benefits of the soft tissue extensibility after wrapping Flossband&#46; Thirdly&#44; shearing force may reshape the fascia by changing the HA status&#46; HA with a gel status may cause densification of the fascia&#44; which may relate to fascia layers not moving independently&#44;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a> and this fascia glide restriction may affect abnormal proprioception responses&#44; such as pain sensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> However&#44; Flossband application on soft tissue may help improve muscle flexibility and reduce pain by restoring fascia function&#44; remodelling the HA status&#44; and reducing receptor sensitization through fascia glide&#44; as speculated by the &#8220;Fascia Glide&#8221; theory&#46; It is worth noticing that further high-level evidence is needed to investigate these effects&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Mechanism of &#8220;Sponge Effect&#8221;</span><p id="para0008" class="elsevierStylePara elsevierViewall">&#8220;Sponge Effect&#8221; is the third speculated mechanism explaining the benefits of applying a Flossband&#46; What is the &#8220;Sponge Effect&#8221;&#63; In general&#44; the &#8220;Sponge Effect&#8221; refers to the alteration of fluid flow&#44; such as blood flow&#44; lymph flow&#44; ion flow and extracellular flow&#44; through Flossband compression and release&#46; Specifically&#44; the &#34;Sponge Effect&#34; occurs when the Flossband compresses soft tissues by wrapping from the distal to the proximal limb region&#44; squeezing blood flow toward the heart&#46; Upon releasing the Flossband&#44; fresh blood gradually returns to the compressed area&#44; accelerating blood metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> The &#8220;Sponge Effect&#8221; also impacts fascia hydration&#46; Cole<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> revealed that fascia extrudes water when compressed&#44; which affects the fascia&#39;s water content&#46; During the stretching of soft tissue&#44; fascia hydration decreases&#44; and upon release&#44; the fluid content rehydrates to the initial level or even beyond&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> Flossband compression may temporarily dehydrate the fascia&#44; which rehydrates after the compression is released&#46; This dehydration and rehydration cycle helps maintain fascia health and function&#46; However&#44; Flossband compression may also increase the viscosity of the extracellular matrix through HA aggregation&#44; which can lead to soft tissue stiffness and dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a> Releasing the Flossband promotes rehydration&#44; reducing stiffness and restoring tissue function&#46; Improved fascia hydration reduces adhesions&#44; enhances fascia gliding&#44; aids in force distribution&#44; and alters receptor responses to pain&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Furthermore&#44; the &#8220;Sponge Effect&#8221; suggests that Flossband application may affect lymphatic drainage&#46; Flossband application on the soft tissue induces the compression of the superficial fascia&#44; which may reduce the space of the fascial network&#44; leading to lymph vessel compression&#46;<a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a> Upon releasing the Flossband&#44; lymph flow restores gradually&#44; following the &#8220;low-resistance pathway&#8221; of connective tissue fibers&#44; accelerating interstitial fluid movement&#44; including water&#44; ions&#44; and small solutes&#46; This process may help reduce tissue inflammation by promoting efficient lymphatic drainage&#46;<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a> Oedema or inflammation occurs due to fluid accumulation in the body&#39;s interstitial spaces&#46; Various factors&#44; including increased vascular permeability&#44; increased vascular pressure&#44; lymphatic return obstruction&#44; and others&#44; can cause this accumulation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a> Flossband application as compression therapy may diminish inflammatory responses by decreasing fluid influx and promoting lymphatic drainage&#44; which may reduce swelling and oedema&#46; Vogrin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0041"><span class="elsevierStyleSup">41</span></a> hypothesized that Flossband application diminished inflammatory responses by reducing inflammation influx&#46; Even though the speculated mechanisms of the &#34;Sponge Effect&#34; explain how Flossband wrapping benefits soft tissue by reducing inflammation and oedema&#44; improving fluid dynamics&#44; and enhancing flexibility&#44; further high-level evidence is needed to understand how Flossband application affects inflammation and oedema&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Mechanism of &#8220;Soft Tissue Ischemia&#8221;</span><p id="para0009" class="elsevierStylePara elsevierViewall">&#8220;Soft Tissue Ischemia&#8221;&#44; as the fourth of the speculated mechanisms&#44; explains the benefit of Flossband application on the soft tissues to improve muscle contraction&#46; The mechanism of tissue flossing involved with Flossband application may be associated with soft tissue ischemia&#46; Pavl&#367; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> demenstrated that the blood flow significantly decreased after two minutes of wrapping Flossband on the upper arm compared to the other side without Flossband application&#46; Driller et al&#46;<a class="elsevierStyleCrossRef" href="#bib0042"><span class="elsevierStyleSup">42</span></a> pointed out that wrapping the Flossband with 178mmHg compression for around two minutes on the soft tissue may cause blood flow restriction or local blood occlusion&#46; Based on the previous evidence&#44; applying around 110mmHg compression on the proximal end of the forearm induced vascular occlusion&#44;<a class="elsevierStyleCrossRef" href="#bib0043"><span class="elsevierStyleSup">43</span></a> 160mmHg compression on the upper limb moderately restricts moderate blood flow&#44; and 300mmHg compression on the upper limb leads to full blood occlusion&#46;<a class="elsevierStyleCrossRef" href="#bib0044"><span class="elsevierStyleSup">44</span></a> Flossband wrapped in soft tissue were proven to produce blood flow restriction with venous occlusion&#44; and temporary soft tissue ischemia may theoretically stimulate various physiological and biochemical responses in the human body&#44; such as recruiting fast fibres&#44; increasing the secretion of growth hormone &#40;GH&#41; and norepinephrine &#40;NE&#41;&#44; activating neuronal nitric oxide synthase &#40;nNOS&#41;&#44; and increasing protein synthesis&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">45</span></a> which may contribute to enhance the strength&#46; In a word&#44; while the theoretical basis for the benefits of Flossband compression exists&#44; further research is essential to validate these effects and understand the specific hemodynamic and physiological changes associated with its use&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">Flossband compression on the blood vessels reduces blood flow&#44; which leads to a reduction in oxygen supply&#46; This supply causes lactate to accumulate in the plasma&#44; resulting in metabolite buildup and the recruitment of slow-twitch fibres&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0046"><span class="elsevierStyleSup">46</span></a> Meanwhile&#44; the metabolite accumulation may stimulate sympathetic nerve activity through chemoreceptive reflex mediated by intramuscular mechanoreceptors and group III and IV afferent fibres&#46;<a class="elsevierStyleCrossRef" href="#bib0047"><span class="elsevierStyleSup">47</span></a> The type of III and IV afferent fibres help the fast-twitched fibres recruitment&#44; which increases muscle contraction capacity&#46; Moreover&#44; some evidence showed that lactate accumulation in the intramuscular environment plays a crucial role in regulating the secretion of GH and NE&#44;<a class="elsevierStyleCrossRef" href="#bib0048"><span class="elsevierStyleSup">48</span></a> and increasing the GH and NE may contribute to muscle mass and size&#46;<a class="elsevierStyleCrossRef" href="#bib0049"><span class="elsevierStyleSup">49</span></a> Increasing the GH may stimulate the synthesis and secretion of insulin-like growth factor 1 &#40;IGF-1&#41;&#44; and IGF-1&#44; as a growth mediator&#44; fastens cell fusion and contributes to muscle hypertrophy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">50</span></a> Flossband application through compression and release&#44; the restricted blood vessels return to reperfusion and the increased flux of Ca2&#43;&#59;<a class="elsevierStyleCrossRef" href="#bib0051"><span class="elsevierStyleSup">51</span></a> On the one hand&#44; Ca2&#43; release generates the contraction of cross-bridge&#44; and on the other hand&#44; Ca2&#43; release activates the nNOS&#46; nNOS activation increases the NO release&#44; which further triggers the release of hepatocyte growth factor &#40;HGF&#41; from the muscle extracellular matrix&#44; then HGF co-localized with c-MET receptor on the satellite cells&#44; which helps the cell re-fusion&#46;<a class="elsevierStyleCrossRef" href="#bib0052"><span class="elsevierStyleSup">52</span></a> In addition&#44; some evidence reported that blood flow occlusion leads to cell swelling&#44; which may contribute to muscle growth by promoting mTOR signalling&#46;<a class="elsevierStyleCrossRef" href="#bib0053"><span class="elsevierStyleSup">53</span></a> Even though the mechanism of blood occlusion inducing the production of the Reactive Oxygen Species &#40;ROS&#41; remains controversial&#46; Some evidence reported that blood flow occlusion increases ROS production&#44; which increases muscle glucose intake&#46;<a class="elsevierStyleCrossRef" href="#bib0054"><span class="elsevierStyleSup">54</span></a> Therefore&#44; Flossband application on the soft tissues may produce the subsequent hormone regulation and metabolic responses&#44; which may help explain muscle strength increase after Flossband application&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Mechanism of &#8220;Joint Effect&#8221;</span><p id="para0011" class="elsevierStylePara elsevierViewall">&#8220;Joint Effect&#8221; is the fifth of the speculated mechanisms explaining the benefits of applying a Flossband on the peripheral joint&#44; such as decreasing pain&#44; reducing inflammation and improving joint mobility&#46; What is a &#8220;Joint Effect&#8221;&#63; &#8220;Joint Effect&#8221; hypothesizes that Flossband compression on the joint produces a cohesion force&#44; alters intra-articular fluid pressure &#40;IAP&#41;&#44; and redistributes synovial fluid within the joint cavity&#46; Evidence shows that IAP plays an essential role&#44; and it is closely related to active or passive joint movements&#44; particularly at the end range of joint flexion or extension&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">55</span></a> Rutherford<a class="elsevierStyleCrossRef" href="#bib0056"><span class="elsevierStyleSup">56</span></a> demonstrated that the effect of IAP depends on whether active muscles distract or compress the knee joint capsule&#46; Flossband wrapping on the joint provides pressure around the joint combined with active and passive movements&#44; which may increase intra-articular pressure&#44; and help retain the vital lubricating synovial fluid in the joint&#46; This can potentially provide a larger joint space&#44; improving the sliding surface between the muscles and joints&#46;<a class="elsevierStyleCrossRef" href="#bib0057"><span class="elsevierStyleSup">57</span></a> Ultrasound evidence suggests that applying external compression around the knee could increase joint space associated with fluid shifting and synovial fluid volume&#46;<a class="elsevierStyleCrossRef" href="#bib0058"><span class="elsevierStyleSup">58</span></a> When the synovial fluid returns to the synovial cavity&#44; the joint space may widen&#44; possibly explaining the range of motion after Flossband application&#46; Additionally&#44; evidence indicates that removing large effusions from the joint cavity can temporarily relieve pain&#44;<a class="elsevierStyleCrossRef" href="#bib0059"><span class="elsevierStyleSup">59</span></a> which may explain the pain reduction observed after Flossband use&#46; The &#8220;Joint Effect&#8221; speculation primarily shows that Flossband application around the joint may help return the synovial fluid to the joint cavity&#44; which may increase the joint space&#44; decrease inflammatory responses&#44; and reduce pain&#46; However&#44; it is essential to note that these effects are based on hypothesized mechanisms and initial evidence&#46; Therefore&#44; further research is essential to validate the &#8220;Joint Effect&#8221; and comprehensively understand the impact of the Flossband application on joint function and pain management&#46;</p></span></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Theoretical framework</span><p id="para0012" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a> presents a theoretical framework outlining the potential mechanisms of applying Flossband to various body parts&#46; The Flossband is primarily used on joints and muscles&#44; leading to positive outcomes such as increased flexibility&#44; reduced pain&#44; decreased inflammation and improved muscle force production&#46; These benefits are mainly associated with five hypothesized mechanisms&#44; including &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; &#8220;Soft Tissue Ischemia&#8221;&#44; and &#8220;Joint Effect&#8221;&#46; Different mechanisms are proposed based on the specific body part to which the Flossband is applied&#46; For instance&#44; four mechanisms&#44; including &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; and &#8220;Soft Tissue Ischemia&#8221;&#44; are the primary ones used to explain the benefits of Flossband application on the muscles&#46; However&#44; when explaining the benefits of conducting the Flossband on the joint&#44; the extra potential mechanism of the &#8220;Joint Effect&#8221; shall also be considered&#46; This framework first postulated how each mechanism operates through distinct pathways to produce beneficial outcomes&#46; For example&#44; applying a Flossband to muscles may influence neural response regulation&#44; modify soft tissue properties&#44; and alter intra- and inter-vascular fluid dynamics&#46; These changes contribute to managing pain&#44; increasing flexibility&#44; reducing inflammation and enhancing muscle force production&#46; Additionally&#44; the framework emphasizes the interdependence of these mechanisms&#44; highlighting the complexity of interaction among multiple factors&#46; It suggests that a comprehensive understanding of the Flossband benefits requires considering multiple mechanisms and their specific pathways&#46; Further research is essential to validate these mechanisms and elucidate their precise roles in achieving the observed therapeutic effects of the Flossband application&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Conclusion</span><p id="para0013" class="elsevierStylePara elsevierViewall">The primary speculated mechanisms behind the Flossband application include &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; &#8220;Soft Tissue Ischemia&#8221; and &#8220;Joint Effect&#8221;&#46; These mechanisms help explain the benefits of Flossband use&#44; such as reducing inflammation&#44; decreasing pain&#44; improving flexibility and enhancing muscle strength&#46; However&#44; due to the complexity and interactivity of these mechanisms&#44; the benefits derived from the Flossband application are likely better understood through the combined interaction of multiple mechanisms&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Future perspective</span><p id="para0014" class="elsevierStylePara elsevierViewall">This is the first paper to summarize the potential mechanisms behind the benefits of the Flossband application&#44; potentially contributing valuable insights to the field by enhancing our understanding of its various mechanisms&#46; However&#44; it is worth noticing that the benefits of Flossband application on different soft tissues or joints still require further investigation&#46; In particular&#44; studies should focus on the micro-level details of the biomechanical responses of the human body during and after Flossband application&#46; This includes examining changes in hormonal levels&#44; the intracellular and extracellular environment&#44; fascia hydration status&#44; blood metabolism&#44; and pain-related substances&#46;</p></span></span>"
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          "titulo" => "Introduction"
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          "titulo" => "The potential mechanisms of Flossband Application"
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              "titulo" => "Mechanism of &#8220;Pain Gate&#8221;"
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              "titulo" => "Mechanism of &#8220;Fascial Glide&#8221;"
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              "titulo" => "Mechanism of &#8220;Sponge Effect&#8221;"
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              "titulo" => "Mechanism of &#8220;Soft Tissue Ischemia&#8221;"
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            0 => "Fascia"
            1 => "Range of motion"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Flossband application in rehabilitation and sports medicine has been demonstrated to increase flexibility&#44; improve muscle strength&#44; dampen pain&#44; and reduce inflammation&#46; However&#44; scarce evidence has presented the latent mechanisms that explain the beneficial effects of Flossband application&#46; To fill the knowledge gap about the Flossband wrapping mechanisms and Flossband application mastering&#44; an initial theoretical framework delineating the advantages of Flossband application mechanisms is needed&#46; Therefore&#44; based on the current evidence&#44; this paper aims to summarize the potential mechanisms of the Flossband application benefits&#46; The primary speculated mechanisms&#44; &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; &#8220;Soft Tissue Ischemia&#8221;&#44; and &#8220;Joint Effect&#8221; were proposed to illustrate how Flossband application works on soft tissues or joints to reduce pain&#44; release fascia tension&#44; improve muscle flexibility&#44; decrease inflammation&#44; and enhance muscle activation&#46; The benefits derived from the Flossband application may be more effectively elucidated through the interaction of the five primary mechanisms mentioned above&#44; whether applied to soft tissues or joints rather than relying on a singular mechanism&#46; This consideration acknowledges the complexity and interactivity inherent in the Flossband application&#46;</p></span>"
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Special article
The potential mechanisms of tissue flossing with Flossband application around the joints or soft tissues: A theoretical framework
Jianhong Gaoa,b,
Corresponding author
jhgao523@163.com

Correspondent author.
, Jin Seng Thungb, Chen Soon Cheea, Chris Chow Li Teeb, Tengku Fadilah Tengku Kamaldenc, Shamsulariffin Samsudina, Azril Syazwan Bin Mohd Alid
a Department of Sport Studies, Faculty of Educational Studies, University Putra Malaysia, Selangor 43400, Malaysia
b Division of Research and Innovation, National Sports Institute of Malaysia, Kuala Lumpur 57000, Malaysia
c Board member, National Sports Institute of Malaysia, Kuala Lumpur 57000, Malaysia
d Sports Medicine Centre, National Sports Institute of Malaysia, Kuala Lumpur 57000, Malaysia
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    "titulo" => "The potential mechanisms of tissue flossing with Flossband application around the joints or soft tissues&#58; A theoretical framework"
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          "en" => "<p id="spara001" class="elsevierStyleSimplePara elsevierViewall">Theoretical Framework of Flossband application potential mechanisms</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0001" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0003">Introduction</span><p id="para0001" class="elsevierStylePara elsevierViewall">Fascia is a continuous connective tissue&#44; forming a three-dimensional network that covers all the organs in the human body&#44; such as bones&#44; muscles&#44; nerves&#44; vessels and visceral organs&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a> Fascia comprises collagen fibres&#44; elastic fibres&#44; reticular fibres and ground substance&#46;<a class="elsevierStyleCrossRef" href="#bib0002"><span class="elsevierStyleSup">2</span></a> Various mechanoreceptors exist in the fascia that respond to the different stimulations&#59; for instance&#44; Ruffini corpuscles&#44; Pacini corpuscles and free nerve endings were found not only in the superficial fascia but also in the deep fascia&#44; and these mechanoreceptors respond to the steady stretch&#44; pressure&#44; vibration&#44; and change of ambient temperature&#46;<a class="elsevierStyleCrossRef" href="#bib0003"><span class="elsevierStyleSup">3</span></a> From the histological finding&#44; fascia contains rich blood vessels and nerves&#44; especially in the deep layer<a class="elsevierStyleCrossRef" href="#bib0004"><span class="elsevierStyleSup">4</span></a>&#46; These specific fascia structures determine their functions of supporting&#44; dividing&#44; protecting&#44; force transmission&#44; affecting metabolism and influencing information communication&#46;<a class="elsevierStyleCrossRef" href="#bib0001"><span class="elsevierStyleSup">1</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">5</span></a> Hyaluronic acid &#40;HA&#41;&#44; a polysaccharide found in connective tissue and a component of the ground substances&#44; withstands compression&#44; provides lubrication and hydration&#44; and plays an essential role in facilitating fascia gliding&#44; reducing fascia viscosity&#44; and aiding in accurate information transmission&#46;<a class="elsevierStyleCrossRef" href="#bib0006"><span class="elsevierStyleSup">6</span></a> The speculation evidence showed that abnormal fascia tension might alter the tension structure of collagen fibres and the composition of the extracellular matrix from a biological perspective&#46;<a class="elsevierStyleCrossRef" href="#bib0007"><span class="elsevierStyleSup">7</span></a> For example&#44; fascia adhesion may disrupt the function of HA&#44; which restricts fascia gliding&#44; affects force distribution&#44; and alters receptors&#8217; pain responses&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Additionally&#44; abnormal fascia tension may cause increased nerve pressure and traction&#44; raising the likelihood of nerve swelling in the affected area&#46; This may restrict blood supply and reduce metabolism due to increased endoneurial fluid pressure&#46;<a class="elsevierStyleCrossRef" href="#bib0009"><span class="elsevierStyleSup">9</span></a> Furthermore&#44; long-term fascia adhesion may result in cumulative musculoskeletal injuries&#44; decreased mobility&#44; increased stiffness&#44; inhibited neuromuscular control&#44; and stimulated nociceptor sensitization&#44; potentially forming a vicious cycle of injury&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">10</span></a> To break the vicious cycles&#44; several myofascial release approaches have been developed&#44; and the tissue flossing technique by applying Flossband around the soft tissues or joints is one of those methods to address fascia dysfunction&#46;</p><p id="para0002" class="elsevierStylePara elsevierViewall">Tissue flossing using the Flossband is usually combined with passive treatments and active movements to address pain&#44; flexibility restriction&#44; and neuromuscular disorders&#46; Thus&#44; it has increasingly been used in sports and rehabilitation by practitioners for the last decade&#46; Flossband &#40;Sanctband<span class="elsevierStyleSup">TM</span> Comprefloss&#44; Malaysia&#41; is a natural rubber band that is more than one millimetre thick and is applied to different soft tissues or joints by users&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a> The current literature review revealed no conclusive evidence about the precursor of Flossband&#46; In the year of 2013&#44; Kelly Starret&#44; an American physiotherapist and CrossFit coach&#44; developed a new tool called flossing to accelerate recovery&#44; improve muscle strength and increase range of motion&#46;<a class="elsevierStyleCrossRef" href="#bib0012"><span class="elsevierStyleSup">12</span></a> Two years later&#44; Kelly Starret and Cordoza Glen published the book&#44; <span class="elsevierStyleItalic">&#8220;Becoming a Supple Leopard&#58; The Ultimate Guide to Resolving Pain&#44; Preventing Injury&#44; and Optimizing Athletic Performance&#8221;</span>&#44; first incorporated the Flossband application&#44; which expands a new approach to manage pain&#44; improve sports performance as well as prevent injuries&#46;<a class="elsevierStyleCrossRef" href="#bib0013"><span class="elsevierStyleSup">13</span></a> In the year of 2017&#44; Seven Kruse&#44; a German sports physiotherapist&#44; further expanded the Flossband application by adding the understanding of fascia in sports rehabilitation and fitness training in his book &#8220;<span class="elsevierStyleItalic">Easy Flossing</span>&#8221;&#44;<a class="elsevierStyleCrossRef" href="#bib0014"><span class="elsevierStyleSup">14</span></a> which accelerated its popularity worldwide&#46;</p><p id="para0003" class="elsevierStylePara elsevierViewall">Flossband application on the soft tissues or peripheral joints has been approved to manage pain&#44; reduce inflammation&#44; decrease myofascial tightness&#44; increase the range of motion&#44; activate the muscle&#44; and improve muscle strength&#46;<a class="elsevierStyleCrossRef" href="#bib0011"><span class="elsevierStyleSup">11</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">15</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0016"><span class="elsevierStyleSup">16</span></a> For example&#44; two minutes of Flossband application around the knee joint with pressure 182mmHg &#40;&#177;38mmHg&#41; significantly decreased the pain intensity of the knee pain patients with a one-time treatment&#44; compared to a control group without Flossband application&#46;<a class="elsevierStyleCrossRef" href="#bib0017"><span class="elsevierStyleSup">17</span></a> After two minutes of Flossband wrapping on the elbow&#44; combined with the elbow flexion and extension movements&#44; significantly reduced pain around the elbow&#46;<a class="elsevierStyleCrossRef" href="#bib0018"><span class="elsevierStyleSup">18</span></a> Furthermore&#44; four weeks of Flossband combined with sports therapy significantly reduced ankle joint inflammation for the patients with acute ankle sprain compared to the group with sports therapy only&#46;<a class="elsevierStyleCrossRef" href="#bib0019"><span class="elsevierStyleSup">19</span></a> Additionally&#44; the Flossband wrapped on the thigh combined with the passive muscle twisting and active knee flexion movement significantly improved the straight leg flexibility compared to the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">20</span></a> Moreover&#44; two minutes of Flossband wrapped on the gastrocnemius&#44; with pressure 160mmHg &#40;&#177;3mmHg&#41;&#44; combined with dynamic stretch significantly improved the calf muscle force development&#44;<a class="elsevierStyleCrossRef" href="#bib0021"><span class="elsevierStyleSup">21</span></a> and wrapping the Flossband on the thigh with pressure 154&#46;3mmHg &#40;&#177;13&#46;3mmHg&#41;&#44; combined with dynamic squat significantly improved the maximum isometric voluntary contraction&#46;<a class="elsevierStyleCrossRef" href="#bib0022"><span class="elsevierStyleSup">22</span></a> Although the mechanisms underpinning the beneficial effects of Flossband application are not fully understood&#44; few hypotheses about these mechanisms were postulated&#46; A theoretical framework connecting the advantages of Flossband application mechanisms is needed to fill in the knowledge gap about the Flossband wrapping mechanisms and Flossband application mastering&#46; Therefore&#44; this paper aims to summarize the potential mechanisms of the effects of Flossband application based on the currently available evidence&#46;</p></span><span id="sec0002" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0004">The potential mechanisms of Flossband Application</span><p id="para0004" class="elsevierStylePara elsevierViewall">Several speculations on the potential mechanisms of Flossband application benefits&#44; for instance&#44; the theory of &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; &#8220;Soft Tissue Ischemia&#8221; and &#8220;Joint Effect&#8221;&#44; were listed below&#58;</p><span id="sec0003" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0005">Mechanism of &#8220;Pain Gate&#8221;</span><p id="para0005" class="elsevierStylePara elsevierViewall">The &#8220;Pain Gate&#8221; mechanism is one of the speculated explanations for the benefits of Flossband application on soft tissues or joints to reduce pain&#46; This theory&#44; proposed by Wall and Melzack&#44;<a class="elsevierStyleCrossRef" href="#bib0023"><span class="elsevierStyleSup">23</span></a> suggests that pain perception can be modulated by the opening or closing of the nerve gate located in the dorsal horn of the spinal cord&#46; This modulation occurs through the activity of small diameter C-fibers and A&#948;-fibers or larger diameter A&#946;-fibers&#46; Non-painful stimuli&#44; such as compression&#44; skin rubbing&#44; or temperature changes&#44; may activate A&#946;-fibers&#44; which may&#44; in turn&#44; activate inhibitory neurons&#46; In the animal model&#44; these inhibitory neurons may close the gate in the spinal cord&#44; thereby reducing the perception of pain by inhibiting the transmission of pain signals from C-fibers and A&#948;-fibers&#46;<a class="elsevierStyleCrossRef" href="#bib0024"><span class="elsevierStyleSup">24</span></a> Flossband&#44; as a compression tool&#44; exerts pressure on the skin&#44; which may activate large diameter A&#946;-fibers&#44; thereby reducing pain&#46; This activation of A&#946;-fibers could be one factor explaining the pain reduction observed after Flossband application&#46; Sympathetic activities closely related to pain perception and their excitability may exacerbate the pain perception&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">25</span></a> However&#44; various mechanoreceptors&#44; like Ruffini and Pacinian corpuscles&#44; are present in the skin or the fascia layers&#46; These mechanoreceptors play a role in inhibiting sympathetic nervous system activity when stimulated&#46;<a class="elsevierStyleCrossRef" href="#bib0026"><span class="elsevierStyleSup">26</span></a> The sympathetic nervous system is responsible for the &#8216;fight or flight&#8217; response&#44; which includes increasing heart rate&#44; constricting blood vessels&#44; regulating muscle relaxation response&#44; and others&#46;<a class="elsevierStyleCrossRef" href="#bib0027"><span class="elsevierStyleSup">27</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0028"><span class="elsevierStyleSup">28</span></a> When mechanoreceptors are activated&#44; they can induce a parasympathetic response&#44; promoting relaxation and reducing stress-related physiological responses&#46; Although no study has yet examined the effect of Flossband application on mechanoreceptor activation&#44; it is thought the Flossband compression on the skin may stimulate these mechanoreceptors&#44; leading to the inhibition of sympathetic activity&#46; Additionally&#44; the compression may restrict the blood flow&#44; which may produce analgesic effects through releasing beta-endorphins&#44; and the endorphins may influence the speed of pain signal transmission to the brain&#44; which may lead to improved brain response to the pain&#46;<a class="elsevierStyleCrossRef" href="#bib0029"><span class="elsevierStyleSup">29</span></a></p><p id="para0006" class="elsevierStylePara elsevierViewall">It is worth noting that the mechanism of Flossband application for pain management may be associated with A&#946;-fiber activation&#44; sympathetic activities&#44; and beta-endorphin release&#46; However&#44; current evidence is insufficient to confirm these associations&#46; Therefore&#44; future research is needed to elucidate the exact mechanisms of Flossband application from these perspectives&#46;</p></span><span id="sec0004" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0006">Mechanism of &#8220;Fascial Glide&#8221;</span><p id="para0007" class="elsevierStylePara elsevierViewall">&#8220;Fascia Glide&#8221;&#44; as the second speculated mechanism&#44; explains the benefits of Flossband application on the soft tissues to release the fascia tension&#44; improve muscle flexibility and reduce pain&#46; The assumption of Flossband wrapping on the soft tissue combined with the exercises produces the cohesion force &#40;downwards&#41; and twist force &#40;lateral to medial or media to lateral&#41;&#46; These combined forces form shear force &#40;opposite the wrapping direction&#41; acting on the myofascial&#46; Firstly&#44; the shearing force may help the fascia slide between each layer&#44; decreasing myofascial tightness&#44; which is the main effect of improving muscle flexibility after Flossband application&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">30</span></a> Secondly&#44; Flossband compression on the soft tissue increases the intramuscular pressure and may increase myofascial friction during muscle contraction&#44; improving the deep soft tissue temperature&#46; Previous evidence showed that improving the thermal effects of deep soft tissue decreased the fascia viscoelasticity&#44;<a class="elsevierStyleCrossRef" href="#bib0031"><span class="elsevierStyleSup">31</span></a> which may also explain the benefits of the soft tissue extensibility after wrapping Flossband&#46; Thirdly&#44; shearing force may reshape the fascia by changing the HA status&#46; HA with a gel status may cause densification of the fascia&#44; which may relate to fascia layers not moving independently&#44;<a class="elsevierStyleCrossRef" href="#bib0032"><span class="elsevierStyleSup">32</span></a> and this fascia glide restriction may affect abnormal proprioception responses&#44; such as pain sensitization&#46;<a class="elsevierStyleCrossRef" href="#bib0033"><span class="elsevierStyleSup">33</span></a> However&#44; Flossband application on soft tissue may help improve muscle flexibility and reduce pain by restoring fascia function&#44; remodelling the HA status&#44; and reducing receptor sensitization through fascia glide&#44; as speculated by the &#8220;Fascia Glide&#8221; theory&#46; It is worth noticing that further high-level evidence is needed to investigate these effects&#46;</p></span><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0007">Mechanism of &#8220;Sponge Effect&#8221;</span><p id="para0008" class="elsevierStylePara elsevierViewall">&#8220;Sponge Effect&#8221; is the third speculated mechanism explaining the benefits of applying a Flossband&#46; What is the &#8220;Sponge Effect&#8221;&#63; In general&#44; the &#8220;Sponge Effect&#8221; refers to the alteration of fluid flow&#44; such as blood flow&#44; lymph flow&#44; ion flow and extracellular flow&#44; through Flossband compression and release&#46; Specifically&#44; the &#34;Sponge Effect&#34; occurs when the Flossband compresses soft tissues by wrapping from the distal to the proximal limb region&#44; squeezing blood flow toward the heart&#46; Upon releasing the Flossband&#44; fresh blood gradually returns to the compressed area&#44; accelerating blood metabolism&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> The &#8220;Sponge Effect&#8221; also impacts fascia hydration&#46; Cole<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">35</span></a> revealed that fascia extrudes water when compressed&#44; which affects the fascia&#39;s water content&#46; During the stretching of soft tissue&#44; fascia hydration decreases&#44; and upon release&#44; the fluid content rehydrates to the initial level or even beyond&#46;<a class="elsevierStyleCrossRef" href="#bib0036"><span class="elsevierStyleSup">36</span></a> Flossband compression may temporarily dehydrate the fascia&#44; which rehydrates after the compression is released&#46; This dehydration and rehydration cycle helps maintain fascia health and function&#46; However&#44; Flossband compression may also increase the viscosity of the extracellular matrix through HA aggregation&#44; which can lead to soft tissue stiffness and dysfunction&#46;<a class="elsevierStyleCrossRef" href="#bib0037"><span class="elsevierStyleSup">37</span></a> Releasing the Flossband promotes rehydration&#44; reducing stiffness and restoring tissue function&#46; Improved fascia hydration reduces adhesions&#44; enhances fascia gliding&#44; aids in force distribution&#44; and alters receptor responses to pain&#46;<a class="elsevierStyleCrossRef" href="#bib0008"><span class="elsevierStyleSup">8</span></a> Furthermore&#44; the &#8220;Sponge Effect&#8221; suggests that Flossband application may affect lymphatic drainage&#46; Flossband application on the soft tissue induces the compression of the superficial fascia&#44; which may reduce the space of the fascial network&#44; leading to lymph vessel compression&#46;<a class="elsevierStyleCrossRef" href="#bib0038"><span class="elsevierStyleSup">38</span></a> Upon releasing the Flossband&#44; lymph flow restores gradually&#44; following the &#8220;low-resistance pathway&#8221; of connective tissue fibers&#44; accelerating interstitial fluid movement&#44; including water&#44; ions&#44; and small solutes&#46; This process may help reduce tissue inflammation by promoting efficient lymphatic drainage&#46;<a class="elsevierStyleCrossRef" href="#bib0039"><span class="elsevierStyleSup">39</span></a> Oedema or inflammation occurs due to fluid accumulation in the body&#39;s interstitial spaces&#46; Various factors&#44; including increased vascular permeability&#44; increased vascular pressure&#44; lymphatic return obstruction&#44; and others&#44; can cause this accumulation&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">40</span></a> Flossband application as compression therapy may diminish inflammatory responses by decreasing fluid influx and promoting lymphatic drainage&#44; which may reduce swelling and oedema&#46; Vogrin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0041"><span class="elsevierStyleSup">41</span></a> hypothesized that Flossband application diminished inflammatory responses by reducing inflammation influx&#46; Even though the speculated mechanisms of the &#34;Sponge Effect&#34; explain how Flossband wrapping benefits soft tissue by reducing inflammation and oedema&#44; improving fluid dynamics&#44; and enhancing flexibility&#44; further high-level evidence is needed to understand how Flossband application affects inflammation and oedema&#46;</p></span><span id="sec0006" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0008">Mechanism of &#8220;Soft Tissue Ischemia&#8221;</span><p id="para0009" class="elsevierStylePara elsevierViewall">&#8220;Soft Tissue Ischemia&#8221;&#44; as the fourth of the speculated mechanisms&#44; explains the benefit of Flossband application on the soft tissues to improve muscle contraction&#46; The mechanism of tissue flossing involved with Flossband application may be associated with soft tissue ischemia&#46; Pavl&#367; et al&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a> demenstrated that the blood flow significantly decreased after two minutes of wrapping Flossband on the upper arm compared to the other side without Flossband application&#46; Driller et al&#46;<a class="elsevierStyleCrossRef" href="#bib0042"><span class="elsevierStyleSup">42</span></a> pointed out that wrapping the Flossband with 178mmHg compression for around two minutes on the soft tissue may cause blood flow restriction or local blood occlusion&#46; Based on the previous evidence&#44; applying around 110mmHg compression on the proximal end of the forearm induced vascular occlusion&#44;<a class="elsevierStyleCrossRef" href="#bib0043"><span class="elsevierStyleSup">43</span></a> 160mmHg compression on the upper limb moderately restricts moderate blood flow&#44; and 300mmHg compression on the upper limb leads to full blood occlusion&#46;<a class="elsevierStyleCrossRef" href="#bib0044"><span class="elsevierStyleSup">44</span></a> Flossband wrapped in soft tissue were proven to produce blood flow restriction with venous occlusion&#44; and temporary soft tissue ischemia may theoretically stimulate various physiological and biochemical responses in the human body&#44; such as recruiting fast fibres&#44; increasing the secretion of growth hormone &#40;GH&#41; and norepinephrine &#40;NE&#41;&#44; activating neuronal nitric oxide synthase &#40;nNOS&#41;&#44; and increasing protein synthesis&#44;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">45</span></a> which may contribute to enhance the strength&#46; In a word&#44; while the theoretical basis for the benefits of Flossband compression exists&#44; further research is essential to validate these effects and understand the specific hemodynamic and physiological changes associated with its use&#46;</p><p id="para0010" class="elsevierStylePara elsevierViewall">Flossband compression on the blood vessels reduces blood flow&#44; which leads to a reduction in oxygen supply&#46; This supply causes lactate to accumulate in the plasma&#44; resulting in metabolite buildup and the recruitment of slow-twitch fibres&#46;<a class="elsevierStyleCrossRef" href="#bib0034"><span class="elsevierStyleSup">34</span></a><span class="elsevierStyleSup">&#44;</span><a class="elsevierStyleCrossRef" href="#bib0046"><span class="elsevierStyleSup">46</span></a> Meanwhile&#44; the metabolite accumulation may stimulate sympathetic nerve activity through chemoreceptive reflex mediated by intramuscular mechanoreceptors and group III and IV afferent fibres&#46;<a class="elsevierStyleCrossRef" href="#bib0047"><span class="elsevierStyleSup">47</span></a> The type of III and IV afferent fibres help the fast-twitched fibres recruitment&#44; which increases muscle contraction capacity&#46; Moreover&#44; some evidence showed that lactate accumulation in the intramuscular environment plays a crucial role in regulating the secretion of GH and NE&#44;<a class="elsevierStyleCrossRef" href="#bib0048"><span class="elsevierStyleSup">48</span></a> and increasing the GH and NE may contribute to muscle mass and size&#46;<a class="elsevierStyleCrossRef" href="#bib0049"><span class="elsevierStyleSup">49</span></a> Increasing the GH may stimulate the synthesis and secretion of insulin-like growth factor 1 &#40;IGF-1&#41;&#44; and IGF-1&#44; as a growth mediator&#44; fastens cell fusion and contributes to muscle hypertrophy&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">50</span></a> Flossband application through compression and release&#44; the restricted blood vessels return to reperfusion and the increased flux of Ca2&#43;&#59;<a class="elsevierStyleCrossRef" href="#bib0051"><span class="elsevierStyleSup">51</span></a> On the one hand&#44; Ca2&#43; release generates the contraction of cross-bridge&#44; and on the other hand&#44; Ca2&#43; release activates the nNOS&#46; nNOS activation increases the NO release&#44; which further triggers the release of hepatocyte growth factor &#40;HGF&#41; from the muscle extracellular matrix&#44; then HGF co-localized with c-MET receptor on the satellite cells&#44; which helps the cell re-fusion&#46;<a class="elsevierStyleCrossRef" href="#bib0052"><span class="elsevierStyleSup">52</span></a> In addition&#44; some evidence reported that blood flow occlusion leads to cell swelling&#44; which may contribute to muscle growth by promoting mTOR signalling&#46;<a class="elsevierStyleCrossRef" href="#bib0053"><span class="elsevierStyleSup">53</span></a> Even though the mechanism of blood occlusion inducing the production of the Reactive Oxygen Species &#40;ROS&#41; remains controversial&#46; Some evidence reported that blood flow occlusion increases ROS production&#44; which increases muscle glucose intake&#46;<a class="elsevierStyleCrossRef" href="#bib0054"><span class="elsevierStyleSup">54</span></a> Therefore&#44; Flossband application on the soft tissues may produce the subsequent hormone regulation and metabolic responses&#44; which may help explain muscle strength increase after Flossband application&#46;</p></span><span id="sec0007" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0009">Mechanism of &#8220;Joint Effect&#8221;</span><p id="para0011" class="elsevierStylePara elsevierViewall">&#8220;Joint Effect&#8221; is the fifth of the speculated mechanisms explaining the benefits of applying a Flossband on the peripheral joint&#44; such as decreasing pain&#44; reducing inflammation and improving joint mobility&#46; What is a &#8220;Joint Effect&#8221;&#63; &#8220;Joint Effect&#8221; hypothesizes that Flossband compression on the joint produces a cohesion force&#44; alters intra-articular fluid pressure &#40;IAP&#41;&#44; and redistributes synovial fluid within the joint cavity&#46; Evidence shows that IAP plays an essential role&#44; and it is closely related to active or passive joint movements&#44; particularly at the end range of joint flexion or extension&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">55</span></a> Rutherford<a class="elsevierStyleCrossRef" href="#bib0056"><span class="elsevierStyleSup">56</span></a> demonstrated that the effect of IAP depends on whether active muscles distract or compress the knee joint capsule&#46; Flossband wrapping on the joint provides pressure around the joint combined with active and passive movements&#44; which may increase intra-articular pressure&#44; and help retain the vital lubricating synovial fluid in the joint&#46; This can potentially provide a larger joint space&#44; improving the sliding surface between the muscles and joints&#46;<a class="elsevierStyleCrossRef" href="#bib0057"><span class="elsevierStyleSup">57</span></a> Ultrasound evidence suggests that applying external compression around the knee could increase joint space associated with fluid shifting and synovial fluid volume&#46;<a class="elsevierStyleCrossRef" href="#bib0058"><span class="elsevierStyleSup">58</span></a> When the synovial fluid returns to the synovial cavity&#44; the joint space may widen&#44; possibly explaining the range of motion after Flossband application&#46; Additionally&#44; evidence indicates that removing large effusions from the joint cavity can temporarily relieve pain&#44;<a class="elsevierStyleCrossRef" href="#bib0059"><span class="elsevierStyleSup">59</span></a> which may explain the pain reduction observed after Flossband use&#46; The &#8220;Joint Effect&#8221; speculation primarily shows that Flossband application around the joint may help return the synovial fluid to the joint cavity&#44; which may increase the joint space&#44; decrease inflammatory responses&#44; and reduce pain&#46; However&#44; it is essential to note that these effects are based on hypothesized mechanisms and initial evidence&#46; Therefore&#44; further research is essential to validate the &#8220;Joint Effect&#8221; and comprehensively understand the impact of the Flossband application on joint function and pain management&#46;</p></span></span><span id="sec0008" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0010">Theoretical framework</span><p id="para0012" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#fig0001">Fig&#46; 1</a> presents a theoretical framework outlining the potential mechanisms of applying Flossband to various body parts&#46; The Flossband is primarily used on joints and muscles&#44; leading to positive outcomes such as increased flexibility&#44; reduced pain&#44; decreased inflammation and improved muscle force production&#46; These benefits are mainly associated with five hypothesized mechanisms&#44; including &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; &#8220;Soft Tissue Ischemia&#8221;&#44; and &#8220;Joint Effect&#8221;&#46; Different mechanisms are proposed based on the specific body part to which the Flossband is applied&#46; For instance&#44; four mechanisms&#44; including &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; and &#8220;Soft Tissue Ischemia&#8221;&#44; are the primary ones used to explain the benefits of Flossband application on the muscles&#46; However&#44; when explaining the benefits of conducting the Flossband on the joint&#44; the extra potential mechanism of the &#8220;Joint Effect&#8221; shall also be considered&#46; This framework first postulated how each mechanism operates through distinct pathways to produce beneficial outcomes&#46; For example&#44; applying a Flossband to muscles may influence neural response regulation&#44; modify soft tissue properties&#44; and alter intra- and inter-vascular fluid dynamics&#46; These changes contribute to managing pain&#44; increasing flexibility&#44; reducing inflammation and enhancing muscle force production&#46; Additionally&#44; the framework emphasizes the interdependence of these mechanisms&#44; highlighting the complexity of interaction among multiple factors&#46; It suggests that a comprehensive understanding of the Flossband benefits requires considering multiple mechanisms and their specific pathways&#46; Further research is essential to validate these mechanisms and elucidate their precise roles in achieving the observed therapeutic effects of the Flossband application&#46;</p><elsevierMultimedia ident="fig0001"></elsevierMultimedia></span><span id="sec0009" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0011">Conclusion</span><p id="para0013" class="elsevierStylePara elsevierViewall">The primary speculated mechanisms behind the Flossband application include &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; &#8220;Soft Tissue Ischemia&#8221; and &#8220;Joint Effect&#8221;&#46; These mechanisms help explain the benefits of Flossband use&#44; such as reducing inflammation&#44; decreasing pain&#44; improving flexibility and enhancing muscle strength&#46; However&#44; due to the complexity and interactivity of these mechanisms&#44; the benefits derived from the Flossband application are likely better understood through the combined interaction of multiple mechanisms&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cesectitle0012">Future perspective</span><p id="para0014" class="elsevierStylePara elsevierViewall">This is the first paper to summarize the potential mechanisms behind the benefits of the Flossband application&#44; potentially contributing valuable insights to the field by enhancing our understanding of its various mechanisms&#46; However&#44; it is worth noticing that the benefits of Flossband application on different soft tissues or joints still require further investigation&#46; In particular&#44; studies should focus on the micro-level details of the biomechanical responses of the human body during and after Flossband application&#46; This includes examining changes in hormonal levels&#44; the intracellular and extracellular environment&#44; fascia hydration status&#44; blood metabolism&#44; and pain-related substances&#46;</p></span></span>"
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        "resumen" => "<span id="abss0001" class="elsevierStyleSection elsevierViewall"><p id="spara002" class="elsevierStyleSimplePara elsevierViewall">Flossband application in rehabilitation and sports medicine has been demonstrated to increase flexibility&#44; improve muscle strength&#44; dampen pain&#44; and reduce inflammation&#46; However&#44; scarce evidence has presented the latent mechanisms that explain the beneficial effects of Flossband application&#46; To fill the knowledge gap about the Flossband wrapping mechanisms and Flossband application mastering&#44; an initial theoretical framework delineating the advantages of Flossband application mechanisms is needed&#46; Therefore&#44; based on the current evidence&#44; this paper aims to summarize the potential mechanisms of the Flossband application benefits&#46; The primary speculated mechanisms&#44; &#8220;Pain Gate&#8221;&#44; &#8220;Fascia Glide&#8221;&#44; &#8220;Sponge Effect&#8221;&#44; &#8220;Soft Tissue Ischemia&#8221;&#44; and &#8220;Joint Effect&#8221; were proposed to illustrate how Flossband application works on soft tissues or joints to reduce pain&#44; release fascia tension&#44; improve muscle flexibility&#44; decrease inflammation&#44; and enhance muscle activation&#46; The benefits derived from the Flossband application may be more effectively elucidated through the interaction of the five primary mechanisms mentioned above&#44; whether applied to soft tissues or joints rather than relying on a singular mechanism&#46; This consideration acknowledges the complexity and interactivity inherent in the Flossband application&#46;</p></span>"
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ISSN: 26665069
Original language: English
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