











































MANUSCRIPT TYPE


CLINICAL OUTCOMES RESEARCH 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020 
 

Myofascial Compression Interventions: Comparison of Roller 
Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss 
Band on Passive Knee Motion Among Inexperienced Individuals 
Scott W. Cheatham, PhD, DPT, PT, OCS, AT, CSCS*; Rodrigo E. Martinez, DAT, LAT, ATC†; Alicia Montalvo, 
PhD, LAT, ATC, CSCS†; Michelle Odai, PhD, LAT, ATC†; Stephanie Echeverry, MS, ATC†; Brianna Robinson, 
MS†; Elizabeth Bailum, BS†; Kevin Viecco, MS†; Kasey Keller, BS, ATC†; Sofia Nunez-Riveria, MS, ATC†; 
Adriana Pena, MS, ATC† 
*California Staet University Dominguez Hills, Carson, CA; †Florida International University, Miami, FL 

 

 
ABSTRACT 

Myofascial compression interventions have become popular 
in rehabilitation and fitness. To date, no studies have directly 
compared foam rolling, instrument assisted soft-tissue 
mobilization, and floss band among unexperienced 
individuals. The primary purpose of this investigation was to 
compare the immediate post intervention effects of foam 
rolling, instrument assisted soft-tissue mobilization, and floss 
band on passive knee joint range of motion (ROM) among 
inexperienced individuals using a standard treatment time. 
The secondary purpose was to determine the 
interchangeability of the interventions and to provide 
preliminary research for long-term comparison studies. This 
pretest-posttest randomized controlled trial was conducted in 
a university laboratory. Thirty participants (M=15, W=15) 
were randomly assigned to three groups: (1) foam rolling, (2) 
instrument assisted soft-tissue mobilization, and (3) floss band. 
The intervention time for each group was 2-minutes. The 
outcome was passive knee joint ROM. Between group 
analysis revealed a statistically significant post-intervention 
difference between the three interventions for passive knee 
flexion ROM (p <.001). Within group comparison for ROM 
revealed a 2 degree (p<.001) post-intervention increase for 
foam rolling, a 3.5-degree (p<.001) increase for the 
instrument assisted soft-tissue mobilization, and a 4-degree 
(p<.001) increase for the floss band. The three interventions 
produced similar immediate post intervention effects on 
passive knee joint ROM among inexperienced individuals. 
Clinically, these interventions may be interchangeable by 
producing similar effects on knee ROM. Clinicians may want 
to consider these finding prior to administering these 
interventions with their patients.   

Key Phrases 
Massage, muscle soreness, pain, release  
 
Correspondence 
Dr. Scott Cheatham, California State University Dominguez 
Hills, 1000 E. Victoria Street, Carson, CA 90747 
E-mail: Scheatham@csudh.edu  
 
 
 

Full Citation 
Cheatham SW, Martinez RE, Montalvo A, Odai M, 
Echeverry S, Robinson B, Bailum E, Viecco K, Keller K, 
Nunez-Riveria S, Pena, A. Myofascial compression 
interventions: comparison of roller massage, instrument 
assisted soft-tissue mobilization, and floss band on passive 
knee motion among inexperienced individuals. Clin Pract 
Athl Train. 2020;3(3):24-36. 
https://doi.org/10.31622/2020/0003.3.5.    
 
Submitted: February 13, 2020 Accepted: August 3, 2020 

INTRODUCTION 

Myofascial compression is a popular 

intervention used by allied health professionals.1 
There are several types of myofascial 
compression interventions such as foam rolling (FR), 
instrument assisted soft-tissue massage (IASTM), 
and floss band (FB). These interventions can be 
found in various clinical and fitness settings. The 
research on these types of interventions has 
increased over the past decade.  

The research on FR has documented positive 
outcomes with reduced post exercise decrements 
in muscle performance,2-6 increased post 
treatment pressure pain thresholds (PPT),4,7-9 and 
decreased post exercise muscle soreness in 
healthy individuals.2,3,10-12 Several recent studies 
have also documented positive post intervention 
effects of FR for different sports,11,13-15 
occupations,16 and chronic pain conditions.17 The 
IASTM research suggests that the intervention is an 
effective treatment for tendoinopathies,18,19 
arthrofibrosis,20,21 cerebral palsy,22,23 
musculoskeletal pathologies,18,24-26 post 

mailto:Scheatham@csudh.edu
https://doi.org/10.31622/2020/0003.3.5


Myofascial Compression Interventions: Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band 
on Passive Knee Motion Among Inexperienced Individuals 

 

 

25 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

mastectomy,27 post total joint arthroplasty,28,29 
and athletic performance measures.18,24-26   The FB 
research is still emerging and the available studies 
have documented post intervention improvements 
in jump and sprint performance,30,31 reduced 
effects of edema in post-surgical patients,32 and 
improved pain and function in individuals 
suffering from Achilles tendinopathy.33  

One of the most common outcome measures 
professionals use for all three interventions is joint 
range of motion (ROM).34 Researchers have found 
that FR may improve joint ROM at the 
shoulder,35,36 lumbopelvis,37,38 hip joint,39-45 knee 
joint, 9,45-47 and ankle.48,49 IASTM has also been 
shown to improve joint ROM at the 
shoulder,27,28,50,51,52 hip and knee joint,51,53,54,55 
ankle,56 and spine.57 The FB research has 
documented improved post intervention ankle joint 
ROM in healthy individuals.30,31 To date, no studies 
have directly compared the effects of all three 
interventions on joint ROM among individuals with 
no prior experience. Only one study has 
compared the effects of FR and IASTM on passive 
hip and knee joint ROM in collegiate soccer 
players.51 The study author did not document if the 
athletes had prior experience with myofascial 
compression interventions. The primary purpose of 
this investigation was to directly compare the 
immediate post intervention effects of foam 
rolling, instrument assisted soft-tissue mobilization, 
and floss band on passive knee joint ROM among 
inexperienced individuals using a standard 
treatment time. The secondary purpose was to 
determine the interchangeability of the 
interventions and to provide preliminary research 
for long-term comparison studies. The researchers 
hypothesize that all three interventions will 
produce similar post treatment effects on passive 
knee joint ROM after a standard treatment time.  

METHODS 

Participants 

Thirty healthy, active adults (M=15, W=15) were 
recruited via convenience sampling and enrolled 
in the study. Participants were randomly assigned 
into one of three groups: foam roller (FR) (N=10), 
instrument assisted soft-tissue mobilization (IASTM) 
(N=10), and flossing bands (FB) (N=10) (Figure 
1). A random number generator was used to 
allocate participants to each group. Participants 
reported no prior experience using any of the 
myofascial interventions in this study. Participant 
exclusion criteria included the following:  
musculoskeletal, systemic, neurosensory, or 
metabolic conditions that would affect joint ROM 
of the lower extremity or the inability to avoid 
medications that may affect testing.18,58,59 
Participant demographic information is described 
in Table 2. This pre-test, post-test clinical study 
was approved by the Institutional Review Board 
at Florida International University.   

Outcome Measure and Instrument 

The outcome measure used for this investigation 
was passive knee joint ROM. The Clinometer 
Smartphone Application™ (Plaincode, 
Stephanskirchen Deutschland) was used to 
measure each participant. The Clinometer app has 
been shown to be valid and reliable for 
measuring lower extremity ROM.60-64  For testing, 
the participant was placed in the prone lying 
position on a table. The investigator grasped the 
left ankle and passively moved the left knee. The 
knee was flexed to the point where the joint could 
no longer be passively moved without providing 
overpressure or to the point of initial discomfort. 
This position was held and a measurement was 
taken. The investigator monitored for any 
compensatory movement throughout the 
lumbopelvis and lower extremities. The 
investigator took the average of 3 measurements 
for each participant. Left passive knee joint ROM 
measurements have been used in prior myofascial 
compression studies.65-67 

  



Myofascial Compression Interventions: Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band 
on Passive Knee Motion Among Inexperienced Individuals 

 

 

26 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

 

Interventions  

The FR group used a commercial foam roll and 
related instructional video were used in this 
investigation (TriggerPoint, a division of Implus, 
LLC, 2001 TW Alexander Drive Durham, NC 
27709, USA). The video demonstrated the use of  

 

the foam roll on the left quadriceps muscle group. 
The GRID® surface foam roll used in this 
investigation was commercially manufactured with 
a hard-hollow core (14 cm diameter) with a 
moderately firm outer ethylene-vinyl acetate 
(EVA) foam (Figure 2). Participants were issued 
the foam roll and followed the video with no 
feedback from the observing investigator. The 

Figure 1: Data Collection Diagram 

Excluded (n= 0) 

Analysed (n= 10) 
Excluded from analysis (n= 0) 

Lost to follow-up (n= 0) 

Discontinued intervention (n= 0) 

Allocated to Foam Roll Group 
(n= 10) 

• Received allocated 
intervention (n= 10) 

 

Lost to follow-up (n= 0) 
 
Discontinued intervention (n= 
0) 

Allocated to Flossing Band 
Group (n= 10) 

• Received allocated 
intervention (n= 10) 

 

Analysed (n= 10) 
Excluded from analysis (n= 0) 

Allocation 

Analysis 

Follow-Up 

Assigned (n= 30) 

Enrollment 

Allocated to IASTM Group (n= 
10) 

• Received allocated 
intervention (n= 10) 

 

Lost to follow-up (n= 0) 

Discontinued intervention (n= 0) 

Analysed (n= 10) 
Excluded from analysis (n= 0) 

Assessed for eligibility (n= 30) 



Myofascial Compression Interventions: Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band 
on Passive Knee Motion Among Inexperienced Individuals 

 

 

27 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

instructor in the video provided a brief 
introduction and then discussed the foam rolling 
technique. The instructor divided the left 
quadriceps into zone one: top of patella to middle 
of the quadriceps and zone two: middle 
quadriceps to anterior inferior iliac spine. The 
model in the video was instructed to get in the 
plank position, position the roller above the left 
patella and roll back and forth in zone one 4x at 
a cadence of 1inch per second. The model was 
then instructed to stop at the top of zone one 
followed by 4 active knee bends to 90 degrees. 
This sequence was repeated for zone two. The 
intervention portion lasted a total of 2 minutes. 
This video has been used in prior foam roll 
research.68 

For the IASTM group, the investigator 
administered an instrument intervention using the 
Smart Tools® crossbar tool (423 grams) (Smart 
Tools, 20636 Castlemaine Circle, OH 4419, USA) 
(Figure 2) to the left quadriceps muscle. The 
investigator was a trained researcher certified in 
several IASTM paradigms. Participants lied supine 
on a table with hip and knee straight. A water-
based gel was used to decrease friction between 
the skin and instrument. The investigator delivered 
a superior and inferior longitudinal stroke with the 
crossbar perpendicular to the soft tissues while 
maintaining a 45° instrument edge angle. The 
investigator first began by placing the edge of 
the instrument just above the patella. The 
investigator then delivered a superior stroke up 
towards the anterior inferior iliac spine (AIIS). Just 
before reaching the AIIS, the investigator 
reversed the cross bar and delivered an inferior 
stroke back to the starting position while 
maintaining the edge angle. The investigator used 
a 2 second cadence to complete the sequence 
using only the weight of the tool. The total 
intervention lasted 2 minutes. 

For the FB group, a 5.08 cm (2-inch) Rockfloss® 
floss band (RockTape®, a division of Implus, LLC, 
2001 TW Alexander Drive Durham, NC 27709, 
USA) was used along with a related instructional 

video. The video demonstrated the use of the floss 
band to the left quadriceps muscle. Participants 
were issued the floss band and followed the video 
with no feedback from the observing investigator. 
The video narrator provided a brief introduction 
and then demonstrated the technique using a 
model. The model wrapped the floss band around 
the left quadriceps muscle (distal to proximal) 
using a 50% overlapping pattern with an 
elongation stretch of 50% band length (Figure 
2).69 The wrap covered the quadriceps muscles 
above the patella to below AIIS. The model then 
demonstrated an active movement sequence 
consisting of standing hip flexion (30 seconds), 
seated knee extension and flexion (30 seconds), 
and bodyweight squats (1minute). The intervention 
portion lasted a total of 2 minutes. Participants 
followed the video and wrapped their own leg.  

Figure 2: Different myofascial compression 
devices: Grid foam roller, IASTM tool, and floss 
band 

 

 



Myofascial Compression Interventions: Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band 
on Passive Knee Motion Among Inexperienced Individuals 

 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

Pilot Study 

Pilot training was conducted over two-sessions to 
practice the testing procedures and establish 
intrarater and interrater reliability among three 
investigators for passive knee joint ROM. Fifteen 
participants were independently recruited and 
enrolled for this portion of the investigation. The 
Intraclass Correlation Coefficient was used to 
calculate intrarater (ICC model 3, k) and 
interrater reliability (ICC model 2, k).63,70 The 
results revealed good intrarater (ICC= 0.99; 95% 
CI 0.88-1.0) and interrater (ICC= 0.94; 95% CI 
0.67-0.99) reliability among all investigators. 
These coefficients are in accordance with the 
minimum threshold of  ≥ .90 for ICC values 
postulated to be acceptable for clinical decision 
making.71  

Procedures  

Prior to testing, eligible participants reviewed and 
completed study related materials including the 
written IRB consent form and demographic 
questionnaire. All participants underwent one 
session of testing that included pre intervention 
measures, followed by the intervention, and then 
immediate post intervention measures. All 
participants were tested between the hours of 10 
A.M. and 2 P.M. and were instructed to not 
participate in any strenuous activity 5 hours prior 
to testing. Participants were also instructed to 
refrain from taking any medications (e.g. opioids, 
muscle relaxants) that would interfere with testing. 
All participants were blinded to the testing results 
and other individuals in the study.  

For each group, one investigator was assigned to 
take three pre intervention and three immediate 
post intervention measures and was blinded from 
the intervention. A second investigator was 
present to explain the intervention procedures (FR 
and FB) to each participant and answer any 
questions. For the IASTM group, the second 
investigator administered the intervention. These 

testing methods have been used in prior 
myofascial research.72  

Statistical Analysis 

The statistical analysis was performed by the 
program SPSS version 25.0 (IBM SPSS, Armonk, 
NY, USA). The descriptive statistics for participants 
were calculated for age, height, body mass, and 
body mass index (BMI). The ANOVA statistic was 
used for continuous descriptive data and the 
Kruskal Wallis statistic for ordinal descriptive 
data. The ANCOVA statistic was used to measure 
between group differences. The independent 
variable was the group, dependent variable was 
post test scores, and pretest scores was the 
covariate.73 Post hoc within group differences 
were measured with the paired t-test. The 
average of three joint ROM measurements was 
used for all pre-test and post-test calculations. The 
effect size was also measured (d = M1 - M2 / 
σpooled). The effect size values were interpreted as: 
>0.70 was considered strong, 0.41 to 0.70 was 
moderate, and < 0.40 was weak.74 All statistical 
assumptions were met for the ANOVA, ANCOVA 
and paired t-test statistics. Statistical significance 
was considered p< .05 using a two-tailed test. 

RESULTS  

Thirty participants were enrolled and completed 
the study (mean age= 25.43 ± 2.46 years; 
height= 170.00 ± 9.17 cm; body mass= 73.82 ± 
9.65 kg; body mass index (BMI)= 26.65 ± 3.83 
kg/m2) (Table 1). Descriptive analysis revealed no 
statistically significant difference between groups 
for age (p=0.10), height (p=0.70), body mass 
(p=0.55), or BMI (p=0.14). All enrolled 
participants completed the study with no adverse 
events or attrition. 

 The between group analysis for passive knee 
joint ROM revealed a statistically significant post 
intervention difference between the three groups 
[F (1,39) =612.32, p=<0.001, partial 
η2=0.944].  The post hoc within group analysis  



Myofascial Compression Interventions: Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band 
on Passive Knee Motion Among Inexperienced Individuals 

 

 

29 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

revealed an approximate post intervention knee 
flexion increase of 2 degrees (p <.001, ES=.26) 
for FR, 3.5 degrees (p=.004, ES= .26) for IASTM, 
and 4 degree (p<.001, ES=.47) for FB (Table 2). 

DISCUSSION  

The primary purpose of this investigation was to 
directly compare the immediate post intervention 
effects of FR, IASTM, and FB on passive knee joint 
ROM among inexperienced individuals. To date, 
no studies have compared these interventions 
among this population. The results suggest that 
these interventions produced a statistical 
significant post intervention effect. However, there 
was less than a 2◦ post treatment difference 
between interventions which may not be clinically 
meaningful in some settings. It is important to note 
that the passive joint ROM in this study was taken 
with a digital device which may be more accurate  

than standard goniometry.60 These findings are 
similar to prior research documenting increased 
post intervention knee ROM values that ranged 
from 2-7◦ for the these interventions.45-47,51,55  

The secondary purpose was to determine the 
interchangeability of the three interventions using 
a standard treatment time of 2-minutes which has 
been a common intervention time used in prior 
myofascial research.68,69 There was a ROM 
difference of 1-2◦ between all three interventions 
which suggests they may produce similar post 
treatment responses when using the same 
treatment time and body region (quadriceps 
muscle). These findings support their 
interchangeability. For example, a professional 
may administers a skilled 2-minute IASTM 
technique to the quadriceps then prescribe a 2-
minute self FR or FB intervention as a home 
exercise to maintain the effects of the IASTM 

Table 1. Participant demographics (N=30) 
Characteristics Age (years) Height (cm) Mass (kg) BMI (kg/m2) 

Foam Roll Group (N=10) 26.13 ± 2.56 
(range 23-30) 

169.50 ± 8.72                    
(range 155-183) 

72.73 ± 9.35 
(range 59-89) 

24.67 ± 2.84 
(range 21-28) 

IASTM Group (N=10)         24.80 ± 2.04 
(range 23-28) 

168.15 ± 9.49 
(range 150-180)   

77.59 ± 9.49 
(range 57-99) 

27.34 ± 4.45 
(range 21-36) 

 
Floss Band Group (N=10) 24.40 ± 2.13 

(range 22-31) 
172.39 ± 10.37            
(range 158-188) 

72.26 ± 10.57 
(range 57-108) 

27.90 ± 4.83 
(range 21-38) 

 
Data reported as mean± SD; range (min-max); m=meters; BMI= body mass index; kg/m2= kilograms-meter 
squared 

Table 2. Pre and post-intervention results (N=30) 
 Pretest Posttest Change  P-Value Effect Size 

Foam Roll Group      

Knee Flexion ROM (degrees) 115.60 ± 8.66 117.93 ± 9.06 2.33 ± 0.40 <.001 .26 

IASTM Group      

Knee Flexion ROM (degrees) 121.97 ± 13.81 125.48 ± 13.00 3.51 ± 0.81 .004 .26 

Floss Band Group      

Knee Flexion ROM (degrees) 110.73 ± 8.48 114.73 ± 8.43 4.00 ± 0.03 <.001 .47 

     Data reported as mean ± SD, kPa= kilopascals; statistical significance considered p<.05; Effect size: d = M1 - M2 / σpooled 

 



Myofascial Compression Interventions: Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band 
on Passive Knee Motion Among Inexperienced Individuals 

 

 

30 
Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

treatment. The results of this study are consistent 
with findings from the Markovic study which 
compared the efficacy of a 2-minute FR and 
IASTM intervention on soccer players.51 The 
authors documented improved post intervention 
passive knee and hip joint ROM from both 
interventions (p < 0.05). Thus, these myofascial 
compression interventions produced similar post 
treatment effects.  

There are two main scientific theories being 
postulated by researchers regarding the post 
treatment effects of these myofascial compression 
interventions. These interventions may provide a 
greater deformation of the local myofascial 
tissues which creates a mechanical and 
neurophysiological effect. For the mechanical 
effect, the pressure of the device or wrap may 
change the viscoelastic properties of the 
myofascia by mechanisms such as thixotropy 
(reduced viscosity), reducing myofascial 
restriction, fluid changes, and cellular 
responses.48,75 Clinically, these changes may be 
observed as a greater lengthening or “stretch 
tolerance” of the muscle and surrounding tissues as 
measured by changes in joint ROM. For the 
neurophysiological effect, the mechanical 
pressure from the device or wrap may have 
produced a local and global neurophysiological 
effect that influences tissue relaxation in the target 
and surrounding tissues through central nervous 
system afferent input from the Golgi tendon reflex 
and mechanoreceptors (e.g. Golgi tendon 
organ).7,48,75-78 Perhaps, the active joint 
movements in the FR and FB interventions enhance 
the effects of the devices as well as the assisted 
IASTM intervention. Prior research suggests that 
active myofascial interventions may enhance the 
neurophysiological effect producing greater 
benefits.68,79 Future studies are needed to 
validate these theories.       

Limitations 

There are four limitations with this study.  First, this 
study tested healthy non-experienced participants 

with no pathology. This limits the generalizability 
to this population. Second, the three different 
myofascial compression interventions studied were 
from specific manufacturers. Other similar 
interventions from different manufacturers may 
have produced different results. Third, the 
immediate post intervention effects were 
investigated. The long-term effects of the 
intervention cannot be determined. Fourth, the 
interventions in this study used a specific technique 
(e.g. left quadriceps) for a predetermined 2 
minute intervention time which has been used in 
prior myofascial research.68,69 Other treatment 
techniques and intervention times may have 
produced different results.  

CONCLUSION  

This was the first study to directly measure the 
immediate post treatment effects of three 
different myofascial compression interventions on 
passive knee joint ROM among individuals with no 
prior experience using a standard treatment time. 
The results suggest that all three interventions may 
produce similar immediate post treatment effects 
which supports their interchangeability. Future 
studies are needed to further validate these 
results over a long post intervention time period. 
The goal of this study was to be exploratory and 
establish the methodology for long-term 
investigations. Clinicians may want to consider 
these results when choosing and administering 
myofascial compression interventions with their 
patients.  

 Acknowledgements:  We would like to thank 
Implus, LLC for providing permission to use the 
TriggerPoint instructional video and associated 
foam roller and RockTape® floss band. We 
would also like to thank Jasmin Grimes, Kay 
Scales, Aline Valiengo, and Matthew Hershgordon 
for helping with this research project.  

 

 



Myofascial Compression Interventions: Comparison of Roller Massage, Instrument Assisted Soft-Tissue Mobilization, and Floss Band 
on Passive Knee Motion Among Inexperienced Individuals 

 

 

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
All rights reserved. ISSN Online 2577-8188                                                                      Volume 3 – Issue 3 – November 2020  

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Copyright © by Indiana State University                                                                                Clinical Practice in Athletic Training  
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0077. 

 

 

https://doi.org/10.1113/jphysiol.2011.211326
https://doi.org/10.1113/jphysiol.2011.211326
https://doi.org/10.2478/hukin-2019-0077
https://doi.org/10.2478/hukin-2019-0077

	Allocation
	Analysis
	Follow-Up
	Enrollment

