Tissue Flossing: A Systematic Review and Meta-Analysis of Its Effects on Range of Motion, Pain, Muscle Strength, and Performance

ABSTRACT: Yao, L, Gan, J, Romagnoli, M, Liu, D, and Staiano, W. Tissue flossing: a systematic review and meta-analysis of its effects on range of motion, pain, muscle strength, and performance. J Strength Cond Res 40(2): 225-237, 2026-This systematic review and meta-analysis evaluated the acute effects of tissue flossing (TF) on joint range of motion (ROM), pain, muscle strength, and exercise performance in healthy individuals, also examining how subjects and intervention factors modify its efficacy. Databases (PubMed, Web of Science, EBSCO, Cochrane Library) were searched through September 2025 for randomized controlled and crossover trials involving TF in healthy subjects. Two independent reviewers handled screening, extraction, methodological quality assessment (Physiotherapy Evidence Database [PEDro] scale), and evidence grading (Grading of Recommendations Assessment, Development and Evaluation). We conducted meta-analyses, meta-regressions, and subgroup analyses by gender, training status, application site, and band pressure. Twenty studies ( n = 480) were included. Tissue flossing produced a trivial but significant ROM increase (Hedges' g = 0.19; 95% CI 0.05-0.33; p = 0.01). No significant effects appeared for muscle strength, muscle function, pain, sprint, or jump outcomes. Effectiveness varied by individual and intervention characteristics. The quality of evidence was moderate. Tissue flossing may acutely enhance joint ROM but does not significantly affect performance, and its benefits depend on individual and protocol variables. However, these conclusions are limited by the moderate quality of the available evidence, underscoring the need for more rigorous studies.