Introduction

Evidence-Based Physical Therapy (EBP) uses the best research evidence with clinical expertise and user’s preferences to produce the most appropriate and effective care. At week 44 in 2025, we had International Course in Spain, A Coruna, in the Faculty of Physiotherapy at University of Coruña about EBP. The program was opened with welcome words of the president of The European Network of Physiotherapy in Higher Education (ENPHE) and followed with the basis of EBP and teachers who highlighted the main challenges at different Physical Therapy fields. More than 30 physiotherapy students and 9 teachers from six universities (Savonia University of Applied Sciences, Finland, Universidade da Coruña, Spain, Charles University Czech Republic, CERRFF and École D´Assas, France, and Escola de Santa María de O Porto, Portugal), actively participated this week and shared experiential group dynamics and social activities. The students collaborated and wrote articles on a range of topics, including evidence-based neurology, respiratory and musculoskeletal disorders, geriatric and pediatric care, as well as sports injuries and related issues. This article introduces the topic of the trauma theme group.

Background

Ankle sprains belong to one of the most common sport injuries/traumas. They often result in pain, swelling, and restricted movement, which can delay return to activity and increase the risk of chronic instability. Swelling management during the acute phase of rehabilitation is essential, as persistent edema may impede muscle activation and joint mobility.

Physiotherapists frequently use Kinesio Taping (KT) and Neuromuscular Electrical Stimulation (NMES) to support edema reduction and recovery. KT is an elastic therapeutic tape designed to gently lift the skin, theoretically improving lymphatic and venous drainage and reducing pressure on pain receptors. In contrast, NMES produces rhythmic muscle contractions through electrical impulses, stimulating the muscle pump mechanism to enhance venous and lymphatic flow.

Although both methods are widely used in clinical practice, the evidence for their effectiveness in reducing acute ankle swelling remains inconsistent. Some studies report small benefits, while others find no significant changes compared to standard care. Therefore, it is crucial to examine and compare these interventions based on current research to guide evidence-based physiotherapy practice.

We have conducted a structured literature review, applied the PEDro Scale for critical appraisal, and summarized the findings in the form of a mini systematic review. The aim of this review was to compare the effectiveness of Kinesio Taping and Neuromuscular Electrical Stimulation in reducing ankle swelling following lateral ankle sprain.

Methods

The PICO criteria from our goal is the following: P: Patients with an ankle sprain (acute phase), I: Kinesio Taping (KT) applied over medial and lateral ankle surfaces, C: Neuromuscular electrical stimulation (NMES) and O: Reduction in ankle swelling. We conducted a literature review of randomized controlled trials found in the PubMed database using keywords like “ankle sprain,” “kinesio taping,” “neuromuscular electrical stimulation,” “edema,” and “ankle sprain rehabilitation”. The aim was to determine whether kinesio taping has a greater effect on reducing swelling in ankle sprains than neuromuscular electrical stimulation. The inclusion criteria required participants to be adults aged from 18 to 60 with an acute ankle sprain. The outcomes of interest were swelling reduction during the acute phase of the injury. We included RCTs about Kinesio taping, neuromuscular electrical stimulation and standard care in the acute stage of ankle sprain to evaluate the effectiveness of kinesio taping and neuromuscular electrical stimulation in reducing oedema. We aimed to extract all relevant information from each included study to compare the effectiveness of the treatments. From every article, we collected data on study design, sample size, characteristics of participants (such as age, sex and type of trauma) and details of how each treatment was applied. We also recorded information on the comparison groups and the outcome measures used to assess swelling reduction. The results from all studies were compiled and compared to evaluate the overall effectiveness of the interventions. The methodological quality of the studies was assessed using the PEDro Scale.

Results

According to the PEDro Scale, the scores ranged from 5 to 6, indicating moderate methodological quality with minor limitations such as lack of blinding and small sample sizes. Across the four studies, results were consistent: neither Kinesio taping nor neuromuscular electrical stimulation (NMES) produced a statistically significant reduction in ankle swelling compared with control or standard care. Nunes et al. (2015) study showed that KT, despite being applied with the intent to stimulate lymphatic flow, did not reduce swelling at 3 or 15 days post-application when compared to control taping. Man et al. (2007) directly compared KT and NMES in 31 semi-professional athletes. Both interventions led to small, non-significant decreases in ankle volume over five days, but no difference between groups was detected. Mazloum et al. (2023) evaluated the effect of NMES on ankle swelling in 34 adults within five days after a sprain. Authors concluded that NMES, as applied in this study, did not effectively reduce edema or improve function in the early phase after ankle sprain. Wainwright et al. (2019) reported that NMES used alongside conventional therapy produced a minor, short-term reduction in edema measured by fluid displacement, but this did not result in better pain or functional outcomes.

Collectively, these studies indicate that while both Kinesio taping and NMES may produce subtle physiological changes, their impact on clinically relevant swelling reduction remains minimal.

Discussion

Despite their widespread use in sports and rehabilitation settings, Kinesio Taping (KT) and Neuromuscular Electrical Stimulation (NMES) appear to offer limited additional benefits over conventional management methods such as rest, compression, elevation and active mobilization in the treatment of acute ankle sprains.

Evidence from randomized controlled trials consistently shows that both interventions produce only minimal, non-significant reductions in ankle edema, with outcomes comparable to the natural healing process or standard care alone. While both KT and NMES are safe and well-tolerated, their short-term effects on swelling are not clinically meaningful.

Kinesio Taping may be more effective in chronic, low-protein edema, such as that associated with venous insufficiency, rather than for acute inflammatory swelling after injury (Mazloum et al., 2023). Similarly, NMES may offer greater benefit for imobilized or post-surgical patients, where muscle activity is reduced, but seems less effective in active athletes, who already generate sufficient muscle pumping through voluntary movement (Wainwright et al., 2019).

The methodological limitations of current studies, such as short treatment duration, small sample sizes, baseline differences between groups, and absence of long-term follow-up, may also contribute to the absence of statistically or clinically significant findings. Additionally, none of the existing trials have explored combined intervention protocols, which could potentially yield synergistic effects and improve clinical outcomes.

Conclusions

Current evidence indicates that Kinesio Taping and Neuromuscular Electrical Stimulation are not significantly effective in reducing ankle swelling after an acute lateral sprain. Their effects appear comparable to those achieved through standard rehabilitation or the natural resolution of edema.

For evidence-based physiotherapy practice, these methods are useless and not recommended. Clinicians should continue to prioritize active movement, elevation, compression, and early mobilization as the primary strategies for edema management.

Future research should investigate longer intervention periods, different stimulation paramenters, and combined treatment protocols withing larger, well-controlled studies to clarify the pontential role of these modalities in comprehensive rehabilitation programs.

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Authors:

Kateřina Josefusová, physiotherapy student, Charles university

Lukáš Rylich, physiotherapy student, Charles university

Dayen M’Zebla, physiotherapy student, l’institut de formation en Masso Kinésithérapie (IFMK) de référence Ile de France

Emma González González, physiotherapy student, University A Coruna

Dagmar Pavlu, PT. Assoc. Prof. Charles University, Czech Republic.

Ivana Vláčilová, PhD., PT. Charles University, Czech Republic.

Marja Äijö, PT, PhD Principal Lecturer of gerontology and rehabilitation, Savonia, University of Applied Sciences, Kuopio, Finland.

Veronica Robles García, PhD. PT. OT. Associate Professor, University of A Coruña, A Coruña, Spain.

Zeltia Naia Entonado, PhD. PT. University of A Coruña, A Coruña, Spain.

María Vilanova Pereira, PhD., PT. University of A Coruña, A Coruña, Spain.

Adrien Pallot, PT, MSc, Lecturer at École D´Assas, France.

Aurel Bellaïche, PT, Lecturer at CEERRF, France.

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References:

1. Mazloum, V., Akbari, H., & Gholampour, A. (2023). The comparison of the effects of neuromuscular electrical stimulation and Kinesio Taping on ankle swelling in athletes with lateral ankle sprain. Journal of experimental orthopaedics, 10(1), 63. https://doi.org/10.1186/s40634-023-00624-w

2. Wainwright, T. W., Burgess, L. C., & Middleton, R. G. (2019). Does Neuromuscular Electrical Stimulation Improve Recovery Following Acute Ankle Sprain? A Pilot Randomised Controlled Trial. Clinical medicine insights. Arthritis and musculoskeletal disorders, 12, 1179544119849024. https://doi.org/10.1177/1179544119849024

3. Man, I. O., Morrissey, M. C., & Cywinski, J. K. (2007). Effect of neuromuscular electrical stimulation on ankle swelling in the early period after ankle sprain. Physical therapy, 87(1), 53–65. https://doi.org/10.2522/ptj.20050244

4. Nunes, G. S., Vargas, V. Z., Wageck, B., Hauphental, D. P., da Luz, C. M., & de Noronha, M. (2015). Kinesio Taping does not decrease swelling in acute, lateral ankle sprain of athletes: A randomised trial. Journal of Physiotherapy, 61(1), 28-33. https://doi.org/10.1016/j.jphys.2014.11.002