Effects of Kinesio Taping on Venous Symptoms, Bioelectrical Activity of the Gastrocnemius Muscle, Range of Ankle Motion, and Quality of Life in Postmenopausal Women With Chronic Venous Insufficiency: A Randomized Controlled Trial

      Abstract

      Objective

      To assess the efficacy of Kinesio taping (KT) on venous symptoms, quality of life, severity, pain, edema, range of ankle motion (ROAM), and peripheral muscle myoelectrical activity in lower limbs of postmenopausal women with mild chronic venous insufficiency (CVI).

      Design

      Double-blinded randomized controlled trial with concealed allocation.

      Setting

      Clinical setting.

      Participants

      Consecutive postmenopausal women (N=123; age range, 62–67y) with early-stage CVI. None of the participants withdrew because of adverse effects.

      Intervention

      Participants were randomly assigned to an experimental group for standardized KT application for external gastrocnemius (EG) and internal gastrocnemius (IG) muscle enhancement and ankle function correction or a placebo control group for sham KT application. Both interventions were performed 3 times a week during a 4-week period.

      Main Outcome Measures

      Venous symptoms, CVI severity, pain, leg volume, gastrocnemius electromyographic data, ROAM, and quality of life were recorded at baseline and after treatment.

      Results

      The experimental group evidenced significant improvements in pain distribution, venous claudication, swelling, heaviness, muscle cramps, pruritus, and CVI severity score (P≤.042). Both groups reported significant reductions in pain (experimental group: 95% confidence interval [CI], 1.6 to 2.1; control group: 95% CI, −0.2 to 0.3). There were no significant changes in either group in quality of life, leg volume, or ROAM. The experimental group showed significant improvements in root mean square signals (right leg: EG 95% CI, 2.99–5.84; IG 95% CI, 1.02–3.42; left leg: EG 95% CI, 3.00–6.25; IG 95% CI, 3.29–5.3) and peak maximum contraction (right leg: EG 95% CI, 4.8–22.7; IG 95% CI, 2.67–24.62; left leg: EG 95% CI, 2.37–20.44; IG 95% CI, 2.55–25.53), which were not changed in controls.

      Conclusions

      KT may reduce venous symptoms, pain, and their severity and enhance gastrocnemius muscle activity, but its effects on quality of life, edema, and ROAM remain uncertain. KT may have a placebo effect on venous pain.

      Keywords

      List of abbreviations:

      C1 (telangiectasies or reticular veins), C2 (varicose veins), C3 (edema), CI (confidence interval), CIVIQ (quality of life questionnaire in chronic lower limb venous insufficiency), CVI (chronic venous insufficiency), EG (external gastrocnemius), EMG (electromyography), GM (gastrocnemius muscle), IG (internal gastrocnemius), KT (Kinesio taping), ROAM (range of ankle motion), VAS (visual analog scale)
      Statement of Need
      Numerous studies have suggested that periodic contractions of the gastrocnemius muscle (GM) significantly contribute to improving calf muscle pump function and decreasing venous stasis. Calf muscle weakness in individuals with severe chronic venous insufficiency (CVI) may lead to altered walking gait and insufficient venous return.
      Venous return in the leg is not only facilitated by peripheral muscle pump activity but also by ankle motion, especially dorsiflexion, whose restriction can have a negative impact on venous hemodynamics.
      If physical therapy (eg, compression stockings or bandages, outpatient vascular exercise programs) is started early, subjective complaints can be alleviated and ankle flexibility and venous drainage can be improved. However, compliance with compression therapies remains low. Pain, discomfort, application difficulties, skin problems, uncomfortable footwear, and inadequate/inconsistent lifestyle advice from health care professionals have been cited as the main reasons for nonadherence. Hence, there is a need for new bandaging approaches in conventional physiotherapeutic treatments (eg, manual drainage, active kinesiotherapy, pressotherapy) in order to maximize treatment adherence and relieve symptoms.
      This article discusses elastic Kinesio taping (KT), a new modality of taping applied to normalize muscle function, increase lymphatic and vascular flow, diminish pain, and aid the correction of joint misalignment.
      This journal-based activity has been planned and developed in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the sponsorship of Professional Education Services Group (PESG).
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      Professional Education Services Group (PESG) is accredited by the ACCME to provide continuing medical education (CME) for physicians.
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      PESG designates this Journal-based CME activity for a maximum of 2.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
      All other health care professionals completing continuing education credit for this activity will be issued a certificate of participation.
      Educational Objectives
      To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:
      • 1.
        To assess the efficacy of Kinesio taping (KT) on venous symptoms, quality of life, severity, pain, edema, range of ankle motion (ROAM), and peripheral muscle myoelectrical activity in lower limbs of postmenopausal women with mild chronic venous insufficiency (CVI).
      • 2.
        List the effects of KT on venous symptoms, pain, and their severity and enhance gastrocnemius muscle activity
      • 3.
        Identify the improvement of KT in pain distribution, venous claudication, swelling, heaviness, muscle cramps, pruritus, and CVI severity score
      • 4.
        Evaluate the limitations of use of KT.
      Planning Committee
      María Encarnación Aguilar-Ferrándiz, PhD, Adelaida María Castro-Sánchez, PhD, Guillermo A. Matarán-Peñarrocha, PhD, MD, Francisco García-Muro, PT, MSc, Theys Serge, PhD, Carmen Moreno-Lorenzo, PhD, PESG staff, ACRM Editorial Office Staff.
      Faculty Profiles & Disclosure Information
      As a provider accredited by the ACCME, it is the policy of PESG to require the disclosure of anyone who is in a position to control the content of an educational activity. All relevant financial relationships with any commercial interests and/or manufacturers must be disclosed to participants at the beginning of each activity. The faculty and planners of this educational activity disclose the following:
      María Encarnación Aguilar-Ferrándiz
      Department of Physical Therapy
      University of Granada
      Granada, Spain
      No relevant financial relationships to disclose
      Adelaida María Castro-Sánchez
      Department of Nursing and Physical Therapy
      University of Almeria
      Almeria, Spain
      No relevant financial relationships to disclose
      Guillermo A. Matarán-Peñarrocha
      Andalusian Health Service
      Health District Jaen-Northeast
      Jaen, Spain
      No relevant financial relationships to disclose
      Francisco García-Muro
      Department of Physiotherapy, Faculty of Medicine
      CEU-San Pablo University
      Madrid, Spain
      No relevant financial relationships to disclose
      Theys Serge
      Department of Kinesitherapie Vasculaire
      Université Catholique de Louvain
      Cliniques Universitaires de Mont-Godinne
      Yvoir, Belgium
      No relevant financial relationships to disclose
      Carmen Moreno-Lorenzo
      Department of Physical Therapy
      University of Granada
      Granada, Spain
      No relevant financial relationships to disclose
      PESG Staff
      No relevant financial relationships to disclose.
      Allen W. Heinemann, Ph.D.
      Director, Center for Rehabilitation Outcomes Research
      Rehabilitation Institute of Chicago
      Chicago, IL
      No relevant financial relationships to disclose.
      ACRM Editorial Office Staff
      No relevant financial relationships to disclose.
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      • 1.
        When products or procedures being discussed are off-label, unlabeled, experimental, and/or investigational (not US Food and Drug Administration [FDA] approved); and
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      This continuing education activity is active starting December 1, 2013 and will expire November 30, 2014.
      Estimated time to complete this activity – 2.0 hours
      Chronic venous insufficiency (CVI) is characterized by persistent lower limb venous hypertension as a consequence of venous reflux and/or obstruction and calf muscle pump function failure.
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      The role of venous reflux and calf muscle pump function in nonthrombotic chronic venous insufficiency. Correlation with severity of signs and symptoms.
      CVI has a prevalence of 17% in the U.S. adult population and is especially frequent in postmenopausal women because of a combination of various risk factors.
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      Among other symptoms, prolonged venous hypertension can weaken calf muscles and produce pain, perception of heaviness, nocturnal cramps, restless leg syndrome, pruritus pain, and edema.
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      Efficacy and tolerability of a red-vine-leaf extract in patients suffering from chronic venous insufficiency–results of a double-blind placebo-controlled study.
      Numerous studies have suggested that periodic contractions of the gastrocnemius muscle (GM) significantly contribute to improving calf muscle pump function and decreasing venous stasis. Calf muscle weakness in individuals with severe CVI may lead to altered walking gait and insufficient venous return.
      • Van Uden C.J.
      • van der Vleuten C.J.
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      Gait and calf muscle endurance in patients with chronic venous insufficiency.
      In fact, multiple alterations at the GM level have been reported, including atrophic fiber grouping (especially type I), moderate to severe type II muscle fiber atrophy,
      • Qiao T.
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      The impact of gastrocnemius muscle cell changes in chronic venous insufficiency.
      and deoxygenation.
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      • Kono T.
      • Hamahata A.
      Advanced chronic venous insufficiency is associated with increased calf muscle deoxygenation.
      Hence, these pathologic and oxidative changes may reduce GM activity, as recorded by electromyography (EMG).
      Venous return in the leg is not only facilitated by peripheral muscle pump activity but also by ankle motion, especially dorsiflexion,
      • Theys S.
      • Schoevaerdts JC
      Does the venous pump really function by contraction of triceps surae? A myth dispelled 30 years ago by Viel.
      whose restriction can have a negative impact on venous hemodynamics. Authors have found that leg vein hypertension is related to a reduced range of ankle motion (ROAM).
      • Dix F.P.
      • Brooke R.
      • McCollum C.N.
      Venous disease is associated with an impaired range of ankle movement.
      • Panny M.
      • Ammer K.
      • Kundi M.
      • Katzenschlager R.
      • Hirschi M.
      Severity of chronic venous disorders and its relationship to the calf muscle pump.
      If physical therapy (eg, compression stockings or bandages, outpatient vascular exercise programs) is started early, subjective complaints can be alleviated and ankle flexibility and venous drainage can be improved. However, compliance with compression therapies remains low.
      • Heinen M.M.
      • van der Vleuten C.
      • de Rooij M.J.
      • Uden C.J.
      • Evers A.W.
      • van Achterberg T.
      Physical activity and adherence to compression therapy in patients with venous leg ulcers.
      Pain, discomfort, application difficulties, skin problems, uncomfortable footwear, and inadequate/inconsistent lifestyle advice from health care professionals have been cited as the main reasons for nonadherence.
      • Van Hecke A.
      • Grypdonck M.
      • Defloor T.
      A review of why patients with leg ulcers do not adhere to treatment.
      Hence, there is a need for new bandaging approaches in conventional physiotherapeutic treatments (eg, manual drainage, active kinesiotherapy, pressotherapy) in order to maximize treatment adherence and relieve symptoms.
      Elastic Kinesio taping (KT) is a new modality of taping applied to normalize muscle function, increase lymphatic and vascular flow, diminish pain, and aid the correction of joint misalignment.
      • García-Muro F.
      • Rodríguez-Fernández A.L.
      • Herrero-de-Lucas A.
      Treatment of myofascial pain in the shoulder with Kinesio taping. A case report.
      Authors have proposed its use to reduce lymphatic
      • Lipinska A.
      • Sliwinski Z.
      • Kiebzak W.
      • Senderek T.
      • Kirenko J.
      The influence of [elastic therapeutic taping] applications on lymphedema of an upper limb in women after mastectomy.
      • Tsai H.J.
      • Hung H.C.
      • Yang J.L.
      • Huang C.S.
      • Tsauo J.Y.
      Could Kinesio tape replace the bandage in decongestive lymphatic therapy for breast-cancer-related lymphedema? A pilot study.
      and venous edema, but little scientific evidence is available on the application of KT in people with vascular conditions, and its usefulness in venous disease has been poorly reported.

      Aguilar-Ferrándiz ME, Castro-Sánchez AM, Matarán-Peñarrocha GA, Guisado-Barrilao R, García-Ríos MC, Moreno-Lorenzo C. A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency. Clin Rehabil. doi:10.1177/0269215512469120.

      The precise action mechanism of KT is not fully understood. However, it is believed that KT may have short-term effects on muscle activation and support proprioceptive information.
      • Briem K.
      • Eythörsdöttir H.
      • Magnúsdóttir R.G.
      • Pálmarsson R.
      • Rúnarsdöttir T.
      • Sveinsson T.
      Effects of kinesio tape compared with nonelastic sports tape and the untaped ankle during a sudden inversion perturbation in male athletes.
      • Gonzalez-Iglesias J.
      • Fernandez-de-Las-Peñas C.
      • Cleland J.A.
      • Huijbregts P.
      • Del Rosario Gutierrez-Vega M.
      Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial.
      • Hsu Y.H.
      • Chen W.Y.
      • Lin H.C.
      • Wang W.T.
      • Shih Y.F.
      The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome.
      • Kaya E.
      • Zinnuroglu M.
      • Tugcu I.
      Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome.
      • Paoloni M.
      • Bernetti A.
      • Fratocchi G.
      • et al.
      Kinesio taping applied to lumbar muscles influences clinical and electromyographic characteristics in chronic low back pain patients.
      • Thelen M.D.
      • Dauber J.A.
      • Stoneman P.D.
      The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.
      • Yoshida A.
      • Kahanov L.
      The effect of kinesio taping on lower trunk range of motions.
      With this background, we designed a KT application to improve calf muscle pump activation and ROAM.
      The purpose of this study was to assess the efficacy of KT on clinical symptoms, quality of life, and musculoskeletal impairment in postmenopausal women with initial states of CVI in in comparison with a placebo control group. Our hypothesis was that KT could ameliorate ankle dorsiflexion and gastrocnemius activation, and therefore improve venous symptoms and quality of life.

      Methods

       Participants

      Study subjects were postmenopausal women with mild CVI from a civic center in Granada province (southern Spain), who were referred to the clinical laboratory of the University of Granada. The participants were not the same as included in other studies.

      Aguilar-Ferrándiz ME, Castro-Sánchez AM, Matarán-Peñarrocha GA, Guisado-Barrilao R, García-Ríos MC, Moreno-Lorenzo C. A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency. Clin Rehabil. doi:10.1177/0269215512469120.

      Inclusion criteria were aged between 50 and 75 years and presence of mild to moderate CVI (grades of telangiectasies or reticular veins [C1], varicose veins [C2], and edema [C3] on the Clinical, Etiological, Anatomical, Pathophysiological scale).
      • Wittens C.H.
      • de Roos K.P.
      • van den Broek T.A.
      • van Zelm R.T.
      [Guideline 'Diagnosis and treatment of varicose veins'] [Dutch].
      Exclusion criteria were severe CVI (>grade C3), arterial disorders, cardiorespiratory disease, and contraindications for KT technique,
      • Kase K.
      • Wallis J.
      • Kase T.
      Clinical therapeutic applications of the Kinesio taping method.
      including thrombosis, wounds, severe trauma, generalized edema secondary to cardiac or renal disease, presence of cancer, intolerability of or allergy to surgical tape, and pregnancy. Out of 160 participants recruited from the accessible population, 123 met study selection criteria.

       Design

      We performed a controlled clinical trial between September 2008 and January 2012. Enrolled individuals were randomly assigned to a placebo-control group (n=61) for application of a sham KT protocol or an experimental group (n=62) for a standardized KT application to enhance GM function and ankle dorsiflexion. Both interventions were performed 3 times a week during a 4-week period. Written informed consent was obtained from all participants in the study, which was approved by the bioethics committee of the University of Granada (Spain).
      Participants were blinded to treatment allocation. The experimental and placebo group allocations were determined according to randomized codes. The vascular therapist who examined the participants for eligibility criteria and collected baseline demographic data prepared the randomization code using computer software, but the therapist was not involved in the remainder of the study. Treatment allocation was concealed, and participants and study personnel were blinded to treatment assignment until after database lock. The 3 physical therapists, who were blinded to group allocation, collected all outcome measures at baseline and at 48 hours after removal of the tapes after 4 weeks of treatment. All treatment interventions were carried out by a KT instructor with wide clinical experience who was blinded to the outcome measures and baseline examination findings but not to treatment allocation; group membership was not revealed to the physical therapists gathering outcome measures.

       Intervention

      During the screening process, an experienced vascular physical therapist conducted an exploratory clinical examination to identify subjects with CVI of stages C1, C2, or C3. First, an interview was conducted to collect data on their age, body mass index, profession, waist-hip ratio, time since CVI onset, level of physical activity, and medical comorbidities. A physical examination was then performed in 2 phases (sitting and standing), examining both lower limbs to assess clinical signs of CVI and to measure peripheral pulse (by palpation), dysmetria, and degree of reflux by plethysmography (data not shown).
      A water-resistant wave-pattern adhesive tape of 5cm × 5m (Kinesio Tex Golda) was employed in both groups for KT procedures. The experimental group received taping with 3 strips according to the recommendations of Kase et al.
      • Kase K.
      • Wallis J.
      • Kase T.
      Clinical therapeutic applications of the Kinesio taping method.
      The initial application to enhance GM activation used 2 Y-shaped strips in external gastrocnemius (EG) and internal gastrocnemius (IG) muscles (fig 1). Individuals were in a prone position for the KT application. The tape direction was from origin to insertion at tensions ranging from 15% to 50%. For placement of the I-strip to promote dorsiflexion, the individual was placed in a supine position for KT functional correction of the ankle, making a bridge with 50% tension (fig 2).
      Figure thumbnail gr1
      Fig 1KT procedures for application of Y-shaped strips to the gastrocnemius muscle in the experimental group: measuring tape length for EG muscles (A) and IG muscles (B), strip cutting and modeling (C), anchoring without tension (D), final application with 15% to 50% tension in a prone position (E) and standing (F). The taping technique required the origin of the Y-shaped strip to be attached without stretching or tension and with the knee in a neutral joint position; the tails of the Y-strip were placed after maximal ankle dorsiflexion and simultaneous knee extension, following the muscle anatomy with the appropriate tension and leaving the end of the strips tension-free; the tape was then rubbed to activate the adhesive.
      Figure thumbnail gr2
      Fig 2KT procedures for applying an I-strip to facilitate ankle dorsiflexion in the experimental group: measuring tape length (A); tape application with 50% tension (B); anchoring with foot in dorsiflexion, forming a bridge (C); adhesion of strip with the foot in plantar flexion (D); activating the strip adhesive by moving hands to the center (E); and final dressing, standing (F). First, the anchors were attached to the middle third of the tibialis anterior muscle and at the level of the third metatarsal on the foot dorsum, making a bridge with 50% tension. In order to hold the anchors in place, the individual was asked to make a maximum plantar flexion, the adhesive was then activated by rubbing toward the center, and the joint was returned to a relaxed posture.
      The placebo control group received an identical number of strips using the same material. The Y-strips for the IG and EG muscles and the I-strip for the ankle were applied in the same positions as previously reported, but without respecting the correct anatomic distribution and with tension free (fig 3). Nevertheless, the tape applications in experimental and placebo groups looked highly similar.
      Figure thumbnail gr3
      Fig 3Sham KT procedures in the placebo group: Y-shaped strip placed on the gastrocnemius muscle (A) with no tension (B) and at the incorrect anatomic localization (C and D); I-strip for ankle dorsiflexion without tension (E), using only a short length of tape and without respecting the correct anatomic distribution (F).

       Outcome measures

      Participants were interviewed to gather data on venous symptoms, including heaviness perception, pain distribution, venous claudication, swelling, muscle cramps, and pruritus.
      The impact on quality of life was measured using the quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ) ranging from 0 (worst) to 100 (best).
      • Launois R.
      • Mansilha A.
      • Jantet G.
      International psychometric validation of the Chronic Venous Disease quality of life Questionnaire (CIVIQ-20).
      CVI severity was assessed by means of the Venous Clinical Severity Score, which includes 10 hallmarks of venous disease evaluated on a severity scale from 0 to 3 (absent, mild, moderate, or severe), with a maximum total score of 30 points.
      • Rutherford R.B.
      • Padberg Jr., F.T.
      • Comerota A.J.
      • Kistner R.L.
      • Meissner M.H.
      • Moneta G.L.
      Venous severity scoring: an adjunct to venous outcome assessment.
      Degree of pain was assessed by means of a 10-cm visual analog scale (VAS) from 0 (no pain) to 10 (unbearable pain). Peripheral edema was evaluated according to the volume of the lower limbs, using 220cm of Seca 206 measuring tapee for bilateral measurements of the metatarsus-hallux distance and the circumference at 12cm from the hallux, and in the leg, at 10, 20, and 30cm from the ground, in accordance with previous reports.
      • Rossi G.G.
      • Idiazabal G.
      Mathematic model for obtaining the lower limb volume.
      Based on these data, the following formula was used to calculate the volume of each limb (in cm):
      AREA(cm2)=(circumference/π/2)2×π(π=3.14)


      Circumference2×0.0795×10(Area2,3,and4)Circumference2(foot)×0.0795×metatarsus-halluxdistance(Area1)Sum of all areas = leg volume in cm3


      Activity of muscles of the peripheral muscle pump was recorded by means of a Kine-Pro Motion Wireless surface electromyography,
      • Briem K.
      • Eythörsdöttir H.
      • Magnúsdóttir R.G.
      • Pálmarsson R.
      • Rúnarsdöttir T.
      • Sveinsson T.
      Effects of kinesio tape compared with nonelastic sports tape and the untaped ankle during a sudden inversion perturbation in male athletes.
      b a motion analysis system that records myoelectrical activity with 100MΩ entrance impedance and a 10 to 500Hz signal bandwidth. Measurement variables were the mean (root main square) and maximum (peak of maximum contraction) activation of the EMG signal during gait.
      After careful skin preparation, muscle activity data during gait were sampled at 1600Hz, applying surface electrodes at IG and EG levels in both legs. We followed surface EMG for the noninvasive assessment of muscles guidelines for electrode placement and signal processing methods.

      SENIAM. Recommendations for sensor locations in lower leg and foot. Available at: www.seniam.org. Accessed February 20, 2009.

      The participant was instructed on the gait speed that was to be used for recording the muscle activity of around 8 steps (10m), conducting 2 or 3 tests with a metronome set at 1.25m/s. A standard speed was selected in order to guarantee optimal comparability of the data, given that the gait speed is known to influence spatial and temporal parameters.
      • Bejek Z.
      • Paróczai R.
      • Illyés A.
      • Kiss R.M.
      The influence of walking speed on gait parameters in healthy people and in patients with osteoarthritis.
      After setting the metronome speed, the EMG image and activity were recorded for a total of 7 seconds and rectified and normalized by the EMG value of the maximum voluntary isometric contraction (fig 4).
      Figure thumbnail gr4
      Fig 4Recording of the EMG signal during gait and data processing. EMG data were high-pass filtered at 30Hz, rectifying the curve and calculating the root mean square and peak of maximal contraction for an integration time of 100ms (offset detection). The EMG signal was normalized by the EMG value of the maximum voluntary isometric contraction at the IG and EG levels, which was recorded using the same skin preparation and electrode placement protocols. The participant was placed in a supine position with 20° knee flexion, applying manual resistance to ankle plantar flexion. The maximum voluntary isometric contraction was based on the maximum EMG signal obtained during three 5-second maximum contractions of each muscle, with a resting time of 1 second between each test.
      Finally, ROAM was measured using a digital goniometer
      • Panny M.
      • Ammer K.
      • Kundi M.
      • Katzenschlager R.
      • Hirschi M.
      Severity of chronic venous disorders and its relationship to the calf muscle pump.
      c during maximum dorsal and plantar flexion. For this purpose, the individual was placed in a relaxed supine position. A sensor was placed 10cm from the internal malleolus and another on the inner side of the foot, parallel to the axial axis and perpendicular to the tibial axis. First, the individual was instructed to place the foot in a neutral 90° position and to make a maximum dorsiflexion for recording the amplitude (ROAM dorsiflexion). In a second phase, starting at the neutral position, the participant was asked to make a maximum plantar flexion for the ROAM measurement. The total ROAM was the sum of the ROAM values obtained in the 2 phases (in degrees).

       Data analysis

      Based on published findings among the use of compression stockings by people with CVI,
      • Andreozzi G.M.
      • Cordova R.
      • Scomparin M.A.
      • Martini R.
      • D'Eri A.
      • Andreozzi F.
      Effects of elastic stocking on quality of life of patients with chronic venous insufficiency. An Italian pilot study on Triveneto Region.
      a clinically important difference of 10 points on the CIVIQ scale (primary outcome) was used to calculate the sample size required to detect this increase in quality of life for the experimental versus placebo group, using the NCSS-PASS program (http://www.ncss.com/). A sample size of 60 participants per arm was estimated to provide a 95% confidence interval (CI) with a power of 80%, assuming an SD of 19.33 for this difference and a significance level (α) of .05 (2-tailed). The sample size was increased to a total of 160 in order to allow for a loss to follow-up of up to 34%.
      SPSS version 20.0 for Windowsd was used for the data analyses. After a descriptive analysis, the normative distribution of variables was verified by means of the Kolgomorov-Smirnov test. The chi-square and McNemar tests were used to compare categorical data for venous symptom variables. Separate 2 × 2 mixed-model analysis of covariance with repeated measurements need to be conducted in order to test the effect of the treatment on quality of life as the primary outcome and severity, edema, pain, muscle activation, and ROAM as secondary outcomes with time (baseline and 4-week follow-up) as the within-subject variable and group (experimental or placebo) as the between-subjects variable. All analyses followed the intention-to-treat principle, and groups were analyzed as randomized. Changes in variable scores within and between groups were measured by means (95% CI) of t tests for paired or independent samples, as appropriate. P<.05 was considered significant in all tests.

      Results

      Out of the 160 women recruited for the study, 123 women with a mean age ± SD of 66±8 years met the inclusion criteria and were randomly assigned to the placebo control group (n=61) or the experimental KT group (n=62). A flowchart of the recruitment and follow-up of participants is depicted in figure 5. Baseline demographic characteristics were similar between groups for all variables (table 1).
      Figure thumbnail gr5
      Fig 5Design and flow of participants through the trial.
      Table 1Mean ± SD or number (%) of the groups of characteristics of patients at baseline
      CharacteristicExperimental Group n=62Control Group n=61
      Age (y)66.05±13.763.32±14.3
      Body mass index (kg/m2)28.56±5.127.65±4.8
      Waist-hip ratio0.89±0.10.90±0.1
      CVI etiology
       CongenitalNANA
       Primary53 (85.5)49 (80.3)
       Secondary9 (14.5)12 (19.7)
      CEAP classification
       C13 (4.8)3 (5.0)
       C26 (9.7)9 (14.7)
       C353 (85.5)49 (80.3)
      Time since CVI onset
       ≤10y17 (27.4)16 (26.2)
       >10y45 (72.6)45 (73.8)
      Work activity
      Housewife15 (24.1)17 (28.0)
      Profession involving prolonged sitting25 (40.3)22 (36.0)
      Profession involving prolonged standing23 (35.6)22 (36.0)
      Physical activity
       0 to <3h/wk6 (9.7)10 (16.4)
       3 to <6h/wk9 (14.5)12 (19.7)
       6 to <9h/wk17 (27.4)18 (29.5)
       9 to <12h/wk22 (35.5)17 (27.8)
       ≥12h/wk8 (12.9)4 (6.6)
      Medical comorbidities
       Diabetes8 (12.9)9 (14.7)
       Hypertension18 (29.1)15 (24.6)
       Osteoarticular disease22 (35.5)19 (31.2)
       Heart failure11 (17.7)13 (21.3)
       Dyspnea3 (4.8)5 (8.2)
      Abbreviations: CEAP, Clinical, Etiological, Anatomical, and Pathophysiological Scale; NA, not applicable.
      At 4 weeks posttreatment, significant between-group differences were observed in venous symptoms (table 2), and the experimental group alone showed improvements versus pretreatment values in claudication (P<.015), swelling (P<.002), coloring (P<.047), heaviness perception (P<.001), muscle cramps (P<.001), and pruritus (P<.016), with significant reductions of 15% to 37.2% in these symptoms. Pain distribution was also significantly reduced in the experimental group (P<.001), with most experiencing pain relief at 1 or 2 sites but with a persistence of pain at the perimalleolar and calf levels.
      Table 2Number (%) for venous symptoms and its statistical significance between groups
      Outcomes MeasuresBaseline1mo PosttreatmentP
      EG n=62CG n=61EG n=62CG n=61
       Pain localization
      P8 (12.9)5 (8.1)16 (25.8)6 (9.8).001
      Significant statistically (χ2 or McNemar test, P<.05).
      CA3 (4.8)3 (4.9)11 (17.7)3 (4.9)
      PF9 (14.5)7 (11.5)6 (9.7)9 (14.7)
      CA and P12 (19.3)16 (26.2)20 (32.2)15 (24.6)
      CA and PF9 (14.5)12 (19.7)5 (8.1)11 (18.1)
      CA, P, and PF21 (33.8)18 (29.5)4 (6.4)17 (27.9)
       Venous claudication
      Non20 (32.2)24 (39.3)34 (54.8)24 (39.3).042
      Significant statistically (χ2 or McNemar test, P<.05).
      Mild22 (35.4)25 (41.0)16 (25.8)27 (44.2)
      Moderate13 (21.0)9 (14.7)5 (8.0)7 (11.5)
      Severe7 (11.3)3 (4.9)7 (11.3)3 (4.9)
       Swelling50 (80.6)51 (83.6)35 (56.4)48 (78.7).020
      Significant statistically (χ2 or McNemar test, P<.05).
       PigmentationNANANANA
       LipodermatosclerosisNANANANA
       No. of ulcersNANANANA
       Coloring
      Normal44 (71.0)46 (75.4)52 (83.9)43 (70.5).038
      Significant statistically (χ2 or McNemar test, P<.05).
      Ochre18 (29.0)15 (24.6)10 (16.1)18 (29.5)
      CyanosisNANANANA
       Heaviness52 (83.9)48 (78.7)31 (50.1)44 (72.1).030
      Significant statistically (χ2 or McNemar test, P<.05).
       Muscles cramps39 (62.9)39 (63.9)18 (29.0)41 (67.2).001
      Significant statistically (χ2 or McNemar test, P<.05).
       Pruritus11 (17.7)7 (11.5)4 (6.4)7 (11.5).529
      Abbreviations: CA, calf; CG, control group; EG, experimental group; NA, not applicable; P, perimalleolus; PF, popliteal fossa.
      Significant statistically (χ2 or McNemar test, P<.05).
      The experimental group evidenced a significant improvement in CVI severity (P=.001) but showed no significant pre-post treatment changes in quality of life or lower limb volumes (P>.05) (table 3).
      Table 3Mean ± SD for quality of life, severity, pain, volume, ROAM, and within and between groups score change (95% CI)
      Outcome/GroupBaseline1mo PosttreatmentWithin-Group Score ChangeBetween-Group Score ChangeP
      CIVIQ (0–100)
      Primary outcome.
       Experimental65.5±9.1066.2±8.9−0.96 (0.10 to −2.10)−1.20 (3.50 to −5.80).325
       Control63.3±10.9063.6±11.4−0.30 (0.60 to −1.20)
      VCSS (0–30)
       Experimental5.5±1.203.6±1.61.80 (1.60 to 2.10)−1.30 (−0.80 to −1.80).001
      Significant group × time interaction (analysis of covariance, P<.05).
       Control5.1±1.304.9±1.50.10 (−0.20 to 0.30)
      VAS (0–10)
       Experimental5.7±2.103.6±1.42.10 (1.90 to 2.50)−1.74 (−2.30 to −1.15).003
      Significant group × time interaction (analysis of covariance, P<.05).
       Control5.6±2.305.3±1.80.32 (0.07 to 0.57)
      Volume (cm3)
       Experimental
      RLL2290.3±265.802285.3±276.95.10 (−1.00 to 11.10)−3.60 (−107.10 to 114.20).662
      LLL2276.7±249.402268.3±250.37.50 (−1.60 to 16.60)−19.7 (85.8 to −125.2).784
       Control
      RLL2292.3±324.402288.9±327.63.40 (−0.70 to 7.60)
      LLL2299.9±322.102287.9±313.410.90 (−11.90 to 33.70)
      Total ROAM (deg)
       Experimental
      RLL67.9±4.1067.9±4.10.10 (−0.20 to 0.30)−0.20 (1.40 to −1.80).901
      LLL67.1±4.3066.9±4.70.20 (−0.50 to 0.90)−0.02 (1.70 to −1.70 ).277
       Control
      RLL68.0±4.7067.9±4.50.10 (−0.10 to 0.30)
      LLL66.2±4.3066.3±4.6−0.20 (0.10 to −0.50)
      Dorsiflexion ROAM (deg)
       Experimental
      RLL20.3±3.1022.4±2.7−0.10 (0.30 to −0.50)−0.10 (0.80 to −1.10).765
      LLL20.9±3.4021.1±3.0−0.20 (0.20 to −0.70)0.80 (−0.40 to 2.00).411
       Control
      RLL20.5±2.7020.5±2.4−0.03 (0.20 to −0.30)
      LLL20.3±3.4720.3±3.5−0.02 (−0.40 to 0.40)
      Abbreviations: LLL, left lower limb; RLL, right lower limb; VCSS, Venous Clinical Severity Score.
      Primary outcome.
      Significant group × time interaction (analysis of covariance, P<.05).
      Within-group comparisons demonstrated significant differences in the pain score between baseline and 4 weeks posttreatment in both groups (control: P=.001; experimental: P=.007), although the improvement was significantly greater in the experimental group than in the controls (see table 3).
      Analysis of covariance showed statistical significance for the dependent variable root mean square (fig 6), finding more electrical activation in the experimental versus placebo group for the external and internal calf muscle of both lower limbs. Within-group analysis for this variable showed significant pre- versus posttreatment improvements in the experimental group (right lower limb: EG 95% CI, −3.18 to −5.19; IG 95% CI, −2.16 to −3.81; left lower limb: EG 95% CI, −2.42 to −5.67; IG 95% CI, −3.08 to −4.98) but not in the placebo group. Similar results were obtained for the dependent variable peak of maximal contraction (fig 7), finding a statistically significant greater improvement in the experimental versus placebo group and significant within-group improvements in the experimental group (right lower limb: EG 95% CI, −8.18 to −14.06; IG 95% CI, −4.90 to −5.79; left lower limb: EG 95% CI, −5.96 to −10.40; IG 95% CI, −6.42 to −9.04) but not in the placebo group.
      Figure thumbnail gr6
      Fig 6Mean activation of EG and IG muscles in both lower limbs, expressed as a percentage of maximal voluntary isometric contraction at baseline and postapplication in control (gray box) and experimental groups (striped box). Abbreviations: LLL, left lower limb; RLL, right lower limb; RMS, root mean square. *P<.05 (95% CI). Analysis of covariance showed significant group × time interactions between groups for right (EG muscle: F=67.89; P=.001; 95% CI, 2.99–5.84; IG muscle: F=53.02; P=.001; 95% CI, 1.02–3.42) and left (EG muscle: F=28.18; P<.001; 95% CI, 3.00–6.25; IG muscle: F=65.01; P=.001; 95% CI, 3.29–5.3) lower limbs.
      Figure thumbnail gr7
      Fig 7Maximum peak contraction of EG and IG muscles in both lower limbs, expressed as a percentage of maximal voluntary isometric contraction at baseline and postapplication for control (gray box) and experimental (striped box) groups. Abbreviations: LLL, left lower limb; PMC, peak of maximal contraction; RLL, right lower limb. *P<.05 (95% CI). Analysis of covariance showed significant group × time interactions between groups for right (EG muscle: F=51.66; P=.001; 95% CI, 4.8–22.7; IG muscle: F=23.10; P<.001; 95% CI, 2.67–24.62) and left (EG muscle: F=72.14; P=.002; 95% CI, 2.37–20.44; IG muscle: F=70.59; P=.001; 95% CI, 2.55–25.53) lower limbs.
      There were no significant posttreatment differences between or within groups in total or dorsiflexion ROAM values (see table 3).

      Discussion

      In this study, venous symptoms, CVI severity, pain, and electromyographic activation of peripheral vein pump muscles during gait were all significantly improved in women with CVI after 4 weeks of standardized KT treatment in comparison with those receiving a placebo KT application. However, KT had no effect on quality of life, leg edema, or ROAM. The placebo group also experienced a posttreatment improvement in pain, though smaller, suggesting that this technique has a placebo effect on pain intensity.
      The improvements in venous symptoms and severity observed may be attributable to the increased gastrocnemius myoelectrical activation that the KT therapy induced. Inadequate action of calf venomuscular pumps leads to a reduction in venous emptying that underlies CVI.
      • Van Uden C.J.
      • van der Vleuten C.J.
      • Kooloos J.G.
      • Haenen J.H.
      • Wollersheim H.
      Gait and calf muscle endurance in patients with chronic venous insufficiency.
      • Qiao T.
      • Liu C.
      • Ran F.
      The impact of gastrocnemius muscle cell changes in chronic venous insufficiency.
      Various authors have demonstrated that improved muscle contraction after a specific exercise program
      • Kan Y.M.
      • Delis K.T.
      Hemodynamic effects of supervised calf muscle exercise in patients with venous leg ulceration: a prospective controlled study.
      • Padberg F.T.
      • Johnston M.V.
      • Sisto S.A.
      Structured exercise improves calf muscle pump function in chronic venous insufficiency: a randomized trial.
      or compression therapy
      • Chauveau M.
      • Fullana J.M.
      • Gelade P.
      • Vicaut E.
      • Flaud P.
      Digital simulation of venous and lymphatic edema and the effects of compression.
      • Heising S.
      • Haase H.
      • Sippel K.
      • Riedel F.
      • Jünger M.
      Cutaneous vasomotion in patients with chronic venous insufficiency and the influence of compression therapy.
      exerts a beneficial effect on venous return and the ejection of calf venous blood. Previous reports are in agreement with our EMG findings and have showed that KT may ameliorate muscle activity in people with musculoskeletal impairment
      • Hsu Y.H.
      • Chen W.Y.
      • Lin H.C.
      • Wang W.T.
      • Shih Y.F.
      The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome.
      • Paoloni M.
      • Bernetti A.
      • Fratocchi G.
      • et al.
      Kinesio taping applied to lumbar muscles influences clinical and electromyographic characteristics in chronic low back pain patients.
      and healthy individuals.
      • Słupik A.
      • Dwornik M.
      • Białoszewski D.
      • Zych E.
      Effect of Kinesio Taping on bioelectrical activity of vastus medialis muscle. Preliminary report.
      The tension of the tape
      • Gonzalez-Iglesias J.
      • Fernandez-de-Las-Peñas C.
      • Cleland J.A.
      • Huijbregts P.
      • Del Rosario Gutierrez-Vega M.
      Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial.
      and resulting muscle contraction would amplify venous compression by the peripheral calf muscle during dorsiflexion, exerting a positive circulatory effect.
      However, neither quality of life nor lower limb volume was improved by KT in our study population. The improvement in quality of life was only 2.1 points or lower on the CIVIQ scale, whereas compression stockings were reported to achieve a minimum improvement of 10 points.
      • Andreozzi G.M.
      • Cordova R.
      • Scomparin M.A.
      • Martini R.
      • D'Eri A.
      • Andreozzi F.
      Effects of elastic stocking on quality of life of patients with chronic venous insufficiency. An Italian pilot study on Triveneto Region.
      However, a previous study
      • Andreozzi G.M.
      • Cordova R.
      • Scomparin M.A.
      • Martini R.
      • D'Eri A.
      • Andreozzi F.
      Effects of elastic stocking on quality of life of patients with chronic venous insufficiency. An Italian pilot study on Triveneto Region.
      on quality of life in CVI assessed outcomes after a minimum of 3 to 4 months of treatment with compression bandages or stockings, whereas our intervention was only for 4 weeks. Future investigations should evaluate the impact of long-term treatments on quality of life. Although the subjective perception of swelling was improved after our KT therapy, the total lower limb volume showed no significant change, suggesting that the activation and compression effects of KT on peripheral muscles were not sufficient to improve edema. Further work is needed to improve the compression capacity of our KT procedure, for example, by increasing tape tension or adding peripheral compression devices.

      Aguilar-Ferrándiz ME, Castro-Sánchez AM, Matarán-Peñarrocha GA, Guisado-Barrilao R, García-Ríos MC, Moreno-Lorenzo C. A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency. Clin Rehabil. doi:10.1177/0269215512469120.

      The effect of taping on pain (ie, improvement of 2.1cm on the VAS) was consistent with a clinically worthwhile effect of 2cm.
      • Launois R.
      • Mansilha A.
      • Jantet G.
      International psychometric validation of the Chronic Venous Disease quality of life Questionnaire (CIVIQ-20).
      However, the maximum improvement was 2.5cm, which is relatively low given the VAS range of 0 to 10cm. Numerous authors have found that KT application reduces pain,
      • García-Muro F.
      • Rodríguez-Fernández A.L.
      • Herrero-de-Lucas A.
      Treatment of myofascial pain in the shoulder with Kinesio taping. A case report.
      • Gonzalez-Iglesias J.
      • Fernandez-de-Las-Peñas C.
      • Cleland J.A.
      • Huijbregts P.
      • Del Rosario Gutierrez-Vega M.
      Short-term effects of cervical kinesio taping on pain and cervical range of motion in patients with acute whiplash injury: a randomized clinical trial.
      • Hsu Y.H.
      • Chen W.Y.
      • Lin H.C.
      • Wang W.T.
      • Shih Y.F.
      The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome.
      • Paoloni M.
      • Bernetti A.
      • Fratocchi G.
      • et al.
      Kinesio taping applied to lumbar muscles influences clinical and electromyographic characteristics in chronic low back pain patients.
      • Thelen M.D.
      • Dauber J.A.
      • Stoneman P.D.
      The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.
      • Kalichman L.
      • Vered E.
      • Volchek L.
      Relieving symptoms of meralgia paresthetica using Kinesio taping: a pilot study.
      but the action mechanisms remain unknown. Castro-Sánchez et al
      • Castro-Sánchez A.M.
      • Lara-Palomo I.C.
      • Matarán-Peñarrocha G.A.
      • Fernández-Sánchez M.
      • Sánchez-Labraca N.
      • Arroyo-Morales M.
      Kinesio taping reduces disability and pain slightly in chronic non-specific low back pain: a randomised trial.
      recently proposed various hypothetical mechanisms including interference with the transmission of painful stimuli, interaction between sensory modalities and interconnecting intermodal/cross-modal networks, action on C-fibers via keratinocyte activation, and an increase in neural feedback. In addition, besides these theoretical models, the simple traction of the tape on the skin may provide cutaneous proprioceptive feedback via increased stimulation of cutaneous mechanoreceptors and muscle afferents, which could be responsible for the reduction in pain sensation.
      • Halseth T.
      • McChesney J.W.
      • DeBeliso M.
      • Vaughn R.
      • Lien J.
      Effect of kinesio taping on proprioception in the ankle.
      Furthermore, movement restrictions imposed by mechanical taping (despite the elasticity of KT) may influence pain levels.
      • Sawkins K.
      • Refshauge K.
      • Kilbreath S.
      • Raymond J.
      The placebo effect of ankle taping in ankle instability.
      Peripheral stasis can potentiate a leukocyte-endothelial inflammatory reaction, which is considered the main stimulator of nociceptors of the venous wall and paravasal tissue.
      • Bogachev VIu
      • Shekoian A.O.
      [Pain and other symptoms of chronic venous diseases: pathophysiology and therapeutic principles] [Russian].
      Thus, restriction by the taping of GM movement and its compression effect may have contributed to the pain relief obtained by KT in our study.
      Pain levels were also positively affected in the placebo group (95% CI, .07–.57), suggesting that our technique has a certain placebo effect on pain intensity. The input of visual (colors) and proprioceptive cutaneous afferents from KT may endow the technique with pain effects related to positive expectations of the therapeutic outcome.

      Aguilar-Ferrándiz ME, Castro-Sánchez AM, Matarán-Peñarrocha GA, Guisado-Barrilao R, García-Ríos MC, Moreno-Lorenzo C. A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency. Clin Rehabil. doi:10.1177/0269215512469120.

      • Benson H.
      The nocebo effect: history and physiology.
      Sensory feedback generated by the placebo tape could instill the belief that the tape would have a positive effect on injuries, improving perceptions of stability, confidence, and reassurance.
      • Sawkins K.
      • Refshauge K.
      • Kilbreath S.
      • Raymond J.
      The placebo effect of ankle taping in ankle instability.
      • Delahunt E.
      • McGrath A.
      • Doran N.
      • Coughlan G.F.
      Effect of taping on actual and perceived dynamic postural stability in persons with chronic ankle instability.
      In addition, placebo treatment was found to induce endogenous opiates via activation of different brain areas and facilitate descending inhibition of nociceptive reflexes through the periaqueductal gray substance.

      Aguilar-Ferrándiz ME, Castro-Sánchez AM, Matarán-Peñarrocha GA, Guisado-Barrilao R, García-Ríos MC, Moreno-Lorenzo C. A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency. Clin Rehabil. doi:10.1177/0269215512469120.

      • Dobrila-Dintinjana R.
      • Nacinović-Duletić A.
      Placebo in the treatment of pain.
      Hence, a placebo effect may contribute to the effectiveness of KT.
      Our hypothesis that KT would improve ROAM in women with CVI is not supported by our results, suggesting that the tape does not have a mechanical effect. Karadag-Sagyi et al
      • Karadag-Saygi E.
      • Cubukcu-Aydoseli K.
      • Kablan N.
      • Ofluoglu D.
      The role of kinesiotaping combined with botulinum toxin to reduce plantar flexors spasticity after stroke.
      also found no improvement in ROAM after KT application to correct spastic equinus in stroke patients. In contrast, other authors reported positive effects on range of motion in different diseases.
      • Hsu Y.H.
      • Chen W.Y.
      • Lin H.C.
      • Wang W.T.
      • Shih Y.F.
      The effects of taping on scapular kinematics and muscle performance in baseball players with shoulder impingement syndrome.
      • Kaya E.
      • Zinnuroglu M.
      • Tugcu I.
      Kinesio taping compared to physical therapy modalities for the treatment of shoulder impingement syndrome.
      • Paoloni M.
      • Bernetti A.
      • Fratocchi G.
      • et al.
      Kinesio taping applied to lumbar muscles influences clinical and electromyographic characteristics in chronic low back pain patients.
      • Thelen M.D.
      • Dauber J.A.
      • Stoneman P.D.
      The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial.
      • Yoshida A.
      • Kahanov L.
      The effect of kinesio taping on lower trunk range of motions.
      These differences with our study may be related to the longer time since onset of the venous disease in the present series (>10y in 68% of our study population), whose restricted ankle movement may therefore have become a stable orthopedic alteration refractory to physiotherapy. However, although KT may not produce a structural joint improvement, it may have proprioceptive effects on the joint position by facilitating dorsiflexion during gait. Further studies using imaging techniques are warranted to record movement and joint position after KT application.
      Although our 4-week course of treatment did not achieve improvements in all outcome measures, KT possesses certain characteristics that can be expected to improve compliance with this therapy in comparison with other compression systems. It can be rapidly applied, is air permeable and water resistant, and can be worn for several days without removal. KT may therefore be especially useful in people with mild CVI who find it difficult to adhere to conventional compression methods.

      Aguilar-Ferrándiz ME, Castro-Sánchez AM, Matarán-Peñarrocha GA, Guisado-Barrilao R, García-Ríos MC, Moreno-Lorenzo C. A randomized controlled trial of a mixed Kinesio taping-compression technique on venous symptoms, pain, peripheral venous flow, clinical severity and overall health status in postmenopausal women with chronic venous insufficiency. Clin Rehabil. doi:10.1177/0269215512469120.

      Besides allowing the wearers to shower or bathe without removing the tapes, their water-resistant property means that KT can be used in combination with an aquatic therapy rehabilitation program, unlike other peripheral compression techniques.

       Study limitations

      This study of a large sample of women with mild CVI is the first, to our knowledge, to contribute scientific evidence on the application of KT guidelines in this type of population. A further limitation is the short duration of the KT application, and there is a need for studies on the effects of multiple applications over a longer time period. In addition, these results cannot be extrapolated to men, because only women were included in our study.
      Further research is warranted to support the design of optimal taping procedures for people with CVI and to evaluate their effectiveness in combination with other physiotherapeutic treatments or hydrotherapy exercise programs.

      Conclusions

      KT may reduce venous symptoms, pain and their clinical severity degree, and enhance GM activity, but its effects on quality of life, edema, and ROAM remain uncertain. KT may have a placebo effect on venous pain.

      Suppliers

      • a.
        Kinesio Tex Gold; Fisioimplant S.L., 15 S Betanzos, Alpederete, Madrid, Spain CP28430.
      • b.
        Kine-Pro; Sanro electromedicina, 10 S Carretera de Humera, Madrid, Spain CP28224.
      • c.
        Digital goniometer SG 110; Penny and Giles Biometrics Ltd, Units 25-26, Nine Mile Point Ind Est, Newport, NP11 7HZ, UK.
      • d.
        SPSS Inc, 233 S Wacker Dr, 11th Fl, Chicago, IL 60606.
      • e.
        Seca 206; Seca, Ortosan 5, S Avenida de Barcelona, Castellón de la Plana, Barcelona, Spain CP18004.

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