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  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  Archives of Physical Medicine and Rehabilitation  Volume 94, Issue 12, Pages 2315-2328 (December 2013) DOI: 10.1016/j.apmr.2013.05.016 Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 1 KT 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. Archives of Physical Medicine and Rehabilitation 2013 94, 2315-2328DOI: (10.1016/j.apmr.2013.05.016) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 2 KT 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. Archives of Physical Medicine and Rehabilitation 2013 94, 2315-2328DOI: (10.1016/j.apmr.2013.05.016) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 3 Sham 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). Archives of Physical Medicine and Rehabilitation 2013 94, 2315-2328DOI: (10.1016/j.apmr.2013.05.016) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 4 Recording 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. Archives of Physical Medicine and Rehabilitation 2013 94, 2315-2328DOI: (10.1016/j.apmr.2013.05.016) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 5 Design and flow of participants through the trial. Archives of Physical Medicine and Rehabilitation 2013 94, 2315-2328DOI: (10.1016/j.apmr.2013.05.016) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 6 Mean 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. Archives of Physical Medicine and Rehabilitation 2013 94, 2315-2328DOI: (10.1016/j.apmr.2013.05.016) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions

Fig 7 Maximum 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. Archives of Physical Medicine and Rehabilitation 2013 94, 2315-2328DOI: (10.1016/j.apmr.2013.05.016) Copyright © 2013 American Congress of Rehabilitation Medicine Terms and Conditions