Is Kinesio taping an effective approach for acute ankle sprains? A systematic review and meta-analysis

Abstract

Purpose

• To examine the effect of Kinesio taping (KT) on patients with acute ankle sprains (AAS).

Methods

• We searched MEDLINE (via PubMed), Cochrane Library, Embase, Web of Science, SPORTDiscus, CINAHL, and Google Scholar for all relevant publications from database inception to January 2025, without language restriction. Randomized controlled trials on KT for AAS were selected according to the participant, intervention, comparison, and outcome measures. A meta-analysis was conducted using R software. Heterogeneity investigation involved sensitivity, subgroup, and meta-regression analysis. Two independent reviewers assessed the quality of the literature using the Cochrane risk of bias tool 2, and the GRADE framework was applied to grade the certainty of the evidence.

Results

• Eight trials containing 582 participants were selected in this review. Moderate-certainty evidence indicated that KT was more effective than controls in relieving pain (standard mean difference (SMD) = −0.63; 95% CI: −1.25 to −0.01; I² = 94.1%, P = 0.047) and improving function (SMD = 0.72; 95% CI: 0.10–1.34; I² = 94.5%, P = 0.023). Low-certainty evidence was found for its effect on reducing swelling (SMD = −0.29; 95% CI: −0.48 to −0.10; I² = 77.5%, P = 0.002). Subgroup analysis revealed that KT significantly improved pain, swelling, and function following 3–5 days of intervention. ‘I’-shaped KT was found to significantly improve pain, swelling, and function.

Conclusion

• KT can significantly alleviate pain, reduce swelling, and improve function in patients with AAS. However, significant effects are only observed short-term, and the ‘I’-shaped KT method may be the most effective recommendation for AAS.

Introduction

Acute ankle sprains (AAS) are among the most common musculoskeletal injuries, with a high incidence in both athletic and non-athletic populations (1). The primary clinical manifestations of AAS include pain and swelling in the early stages. Without appropriate management during the acute phase, these symptoms can lead to secondary complications such as synovitis, tendinopathy, joint stiffness, muscular weakness, joint instability, and persistent pain and swelling (2, 3). Furthermore, the recurrence rate of ankle sprains can reach up to 70% (1), and this high recurrence rate is closely associated with the development of chronic ankle instability (CAI) (4, 5). A prospective cohort study found that the incidence of CAI can reach 40% one year after an initial lateral ankle sprain (6). In the Netherlands, the incidence rates of sports and daily activities over 10–25 years were reported as 37.5 and 17.5 per 1,000 person-years, respectively (7). Additionally, early management and rehabilitation of AAS have significant socioeconomic implications, including reduced labor productivity (8, 9). Given these considerations, research on early management of AAS is essential for advancing clinical practices in musculoskeletal injury treatment.

Current evidence-based clinical guidelines for the management of AAS symptoms primarily recommend nonsteroidal anti-inflammatory drugs (NSAIDs), cryotherapy, elevation, compression, immobilization, and early functional activity (10, 11, 12, 13). Although some studies show that NSAIDs alleviate pain and swelling in AAS, they may also cause complications and delay tissue healing (10, 12). Furthermore, excessive immobilization may impair early ankle joint function, delaying recovery (10, 11). Recently, Kinesio taping (KT) has emerged as a non-invasive, convenient therapy widely used in musculoskeletal injury rehabilitation. KT, introduced by Dr Kenzo Kase in the 1970s, involves applying elastic, adhesive tape to soft tissues in specific patterns (14). KT stimulates sensory pathways in the nervous system to enhance afferent feedback and reduce pressure on subcutaneous nociceptors, providing analgesic effects (15). It also increases the space between the skin and underlying connective tissues, facilitating improved circulation of blood and lymphatic fluid and alleviating tissue swelling (16). Moreover, the pressure and stretching effects exerted by KT on the skin are thought to stimulate mechanoreceptors, enhancing proprioception and muscle strength, thus supporting and optimizing musculoskeletal function (17, 18). Previous studies have demonstrated the efficacy of KT in treating conditions such as lateral epicondylitis and knee osteoarthritis (14, 19). Given its potential to alleviate pain, reduce swelling, and preserve early ankle joint function, KT may be an effective treatment for the acute management of AAS.

Despite several randomized controlled trials (RCTs) investigating the effects of KT on AAS, current findings remain controversial. Some studies have reported that KT significantly reduces pain and swelling in patients with AAS (20), whereas others have found no significant effect on swelling reduction (3). To date, only one systematic review has addressed the therapeutic effects of KT on AAS. Gabriel et al. (21) concluded in this review that KT did not significantly reduce swelling in AAS. However, this study included only three RCTs, and the interventions were not standardized, which may undermine the reliability of the conclusions. This study aimed to assess the efficacy of KT in treating AAS and provide a theoretical basis for clinical practice using various methodologies. Consequently, we conducted a comprehensive search of RCTs evaluating the use of KT in AAS and performed a meta-analysis based on systematic reviews.

Methods

Protocol and registration

This review adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (22) (Supplemental Appendix 1 (see section on Supplementary materials given at the end of the article)) and was preregistered and publicly accessible via the Open Science Framework Registries (https://doi.org/10.17605/OSF.IO/SFW6Y). As this study only involved a review and synthesis of the existing literature, it was exempt from requiring approval by an institutional review board.

Search strategy

From the establishment of the databases to January 2025, we conducted a systematic search and identification across Medline (via PubMed), Embase (via Scopus), Web of Science, CINAHL, SPORTDiscus, and the Cochrane Library, with no restrictions on publication date or language. The search strategy employed Medical Subject Headings (MeSH) or Emtree terms, along with text words for ‘athletic tape,’ ‘ankle joint,’ ‘lateral ligament, ankle,’ ‘sprains and strains,’ ‘wounds and injuries,’ and ‘randomized controlled trials’ (Supplemental Appendix 2). Additionally, we searched Google Scholar using the same terms and retrieved relevant references from the full-text articles and prior systematic reviews.

Eligibility criteria

Studies were considered eligible if they adhered to the PICOS criteria outlined below:

1. Population: participants with AAS were included in this study, regardless of the diagnostic method used.

2. Intervention: KT treatment with or without standardized co-interventions (such as supervised or home exercises), provided that both the experimental and control groups received the same co-interventions.

3. Comparison: the control group received either sham KT treatment or other conservative interventions (e.g., conventional treatment, elastic bandages, splints, neuromuscular electrical stimulation, or other therapeutic measures).

4. Outcomes: studies that included outcomes related to pain, swelling, and function.

5. Study design: RCTs.

Study selection and data extraction

The retrieved studies were imported into Endnote X9 (Clarivate, USA), and duplicate trials were removed. Two independent authors (HWZ and MZ) reviewed the titles and abstracts of all the potential citations based on the inclusion criteria. The extracted data encompassed study characteristics, participant characteristics, outcomes, and study protocols. If data were unavailable, we contacted the corresponding author of the article three times within six weeks. In case of any discrepancies, a discussion with a third independent author (LZ) was conducted to reach a consensus.

Quality appraisal

The included trials were evaluated in accordance with the revised Cochrane risk-of-bias tool 2 for RCTs (23). The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology was employed to assess the certainty of evidence in this systematic review (24) (Supplemental Appendix 3). The certainty of evidence is best regarded as the confidence in the true effect within a specified range (25). If there are significant deficiencies in the domains of risk of bias, inconsistency, imprecision, or publication bias, the quality of evidence is downgraded. All assessments of the studies were conducted by two independent authors (HWZ and MZ). In the event of any discrepancies, a discussion with a third independent author (LZ) was conducted to reach a consensus.

Statistical analysis

All data were subjected to statistical analysis and presentation using R software (version 4.3.2) (26). For studies meeting the inclusion criteria, as the outcomes were continuous variables, we extracted the means and standard deviations (SDs) for both baseline and endpoint measurements in the intervention and control groups. In cases where standard errors were reported, these were converted to SDs (27). If such data were not provided, we derived the means and SDs from the sample size, median, interquartile range, minimum, and maximum values (28). For studies that presented data solely in graphical form, we estimated the means and SDs by using the Y-axis and histogram length (29). The mean and SD values of the baseline and endpoint differences between the intervention and control groups were used to calculate the relevant outcomes for each study. A correlation coefficient of 0.5 was employed, as recommended by the Cochrane collaboration’s tool for assessing the risk of bias in RCTs (23). The weight of each study was determined by the precision of its effect estimate, which was calculated as the inverse of the variance. We obtained the combined effect sizes for KT interventions on pain, swelling, and function, expressed as standard mean differences (SMDs) with 95% confidence intervals (CIs), using a random-effects model (30, 31). The SMD was classified into three categories: large (0.8), moderate (0.5), and small (0.2) effects (32). The percentage of variability in the combined estimates attributable to heterogeneity beyond chance was assessed using the I² statistic (33). Statistical heterogeneity across trials was examined using the Cochran Q statistic, which tests the null hypothesis that there is no difference in effect sizes between studies (31). The potential for publication bias was assessed using funnel plots (34) and Egger’s regression test (35, 36).

Additional analysis

We conducted sensitivity analyses for each outcome by sequentially removing the individual studies. Additionally, we performed a meta-regression analysis based on potential covariates to explore the sources of heterogeneity and to examine the moderating effect of these variables on the efficacy of KT interventions. Effect size estimates were derived using a random-effects meta-regression model and restricted maximum likelihood estimation (37). Subgroup analyses were performed according to potential covariates with the aim of providing insights and guidance for future research.

Results

Search results

The overall search of seven databases yielded 808 studies. Following the removal of duplicates, 555 potentially eligible studies remained for which the abstracts were screened. At the full-text stage, 22 studies were reviewed, and 14 studies were excluded because they failed to meet the inclusion criteria, leaving eight trials for analysis (3, 20, 38, 39, 40, 41, 42, 43). Reasons for exclusion after the full-text review for the remaining studies can be found in Supplemental Appendix 4. The remaining eight studies associated with KT and control interventions in patients with AAS were included in the review and quantitative synthesis (Fig. 1).

Figure 1.

PRISMA flow diagram of study selection.

Study characteristics

A total of 582 participants were included in the meta-analytical calculations: 291 in the intervention group and 291 in the control group. The trials were originated from Turkey (n = 3) (20, 38, 39), Korea (n = 2) (40, 43), Iran (n = 1) (41), India (n = 1) (42), and Brazil (n = 1) (3), and all of them were published between 2015 and 2024. The participants in the eight included trials ranged in age from 14 to 40 years. The intervention time was from 3 to 28 days, and the follow-up duration was from 1 day to 8 weeks. For outcome measures in the eight included trials, six reported pain severity (e.g. VAS, NPRS) (20, 38, 39, 40, 42, 43), five reported swelling (e.g. girth of ankle and volumetry of swelling) (3, 20, 38, 41, 43), and four reported functions (e.g. Karlsson score, Foot Function Index, EQ-5D-5L, or FAOS) (20, 38, 40, 43) (Supplemental Appendix 5).

Results of quality appraisal

Risk of bias assessment revealed five trials to be rated with a low risk of bias (3, 20, 38, 43), three were rated with some concerns (39, 40, 41), and one was rated with a high risk of bias (42) in the ‘randomization process’ because of inappropriate randomization or lack of allocation concealment. Owing to insufficient information, two trials were rated of some concern in ‘deviation from the intended intervention’ (Supplemental Appendix 6). The GRADE assessment of the evidence certainty for the meta-analysis results indicated moderate-certainty evidence for pain and function outcomes, whereas the evidence for swelling outcomes was rated as low-certainty (Table 1).

Table 1.

Grading of Recommendations, Assessment, Development and Evaluation (GRADE) rating justifications.

Outcome	Para-meters, n	Sample size		SMD (95% CI)	I 2	GRADE
		KT	Control			RoB	Inconsistency	Indirectness	Imprecision	PUB bias	Overall
Pain	13	458	458	−0.63 (−1.25, 0.01)	94.10%	Not serious	Serious	Not serious	Not serious	Undetected	⨁⨁⨁◯
										(P = 0.525)	Moderate
Swelling	29	988	933	−0.29 (−0.48, −0.10)	77.50%	Not serious	Serious	Not serious	Not serious	Serious	⨁⨁◯◯
										(P < 0.001)	Low
Function	11	420	422	0.72 (0.10, 1.34)	94.50%	Not serious	Serious	Not serious	Not serious	Undetected	⨁⨁⨁◯
										(P = 0.660)	Moderate

SMD, standard mean difference; CI, confidence interval; PUB, publication; RoB, risk of bias.

Outcome of meta-analysis: pain

Thirteen comparisons with a total of 916 patients presented pain levels in the results. The results of the meta-analysis indicated that KT significantly relieved pain levels in AAS (SMD = −0.63; 95% CI: −1.25 to −0.01; I² = 94.1%, P = 0.047) (Supplemental Appendix 5). The results of the univariate regression analysis showed no significant correlation for most variables except for the follow-up time of the single intervention (P = 0.036) (Supplemental Appendix 5). Further subgroup analyses based on different intervention durations showed that significant responses existed only when the duration was three days. Subgroup analyses based on the applied types of KT showed that significant responses existed in ‘I’-shaped and ‘8’-shaped types (Supplemental Appendix 5). There was symmetry in the funnel plot, suggesting no potential publication bias (P_egger = 0.525) (Supplemental Appendix 7).

Outcome of meta-analysis: swelling

Twenty-nine comparisons with a total of 1,921 patients presented swelling in the results. The results of the meta-analysis indicated that KT significantly reduced swelling in AAS (SMD = −0.29; 95% CI: −0.48 to −0.10; I² = 77.5%, P = 0.002) (Supplemental Appendix 5). The results of the univariate regression analysis showed that region (P = 0.002), age (P < 0.001), applied types of KT (P = 0.008), intervention during (P = 0.032), and outcome measures (P = 0.034) may be the sources of heterogeneity (Supplemental Appendix 5). Further subgroup analyses based on different intervention durations showed that significant responses existed only when the duration was five days. Subgroup analyses based on the applied types of KT showed that significant responses existed only in ‘I’-shaped types (Supplemental Appendix 5). There was asymmetry in the funnel plot, suggesting potential publication bias (P_egger < 0.001) (Supplemental Appendix 7).

Outcome of meta-analysis: function

Twenty-one comparisons with a total of 842 patients presented function in the results. The results of the meta-analysis indicated that KT significantly improved function in AAS (SMD = 0.72; 95% CI: 0.10–1.34; I² = 94.5%, P = 0.023) (Supplemental Appendix 5). The results of the univariate regression analysis showed no significant correlation for most variables except for age (P < 0.001) and the follow-up time (P = 0.030) (Supplemental Appendix 5). Further subgroup analyses based on different intervention durations showed that significant responses existed only when the time was at three days. Subgroup analyses based on the applied types of KT showed that significant responses existed in ‘I’-shaped and ‘8’-shaped types (Supplemental Appendix 5). There was symmetry in the funnel plot, suggesting no potential publication bias (P_egger = 0.660) (Supplemental Appendix 7).

Sensitivity analysis

For results with high heterogeneity, sensitivity analyses were conducted by systematically excluding individual studies to assess the impact of heterogeneity on overall outcomes. If the removal of a study resulted in a reduction in heterogeneity, this study could be identified as a potential source of the high heterogeneity observed. After excluding studies that contributed to heterogeneity, we compared the weighted mean differences before and after the sensitivity analysis. The sensitivity analysis revealed that the weighted mean differences for all outcomes demonstrated no directional change (e.g., from statistically significant to not statistically significant). Therefore, despite the substantial heterogeneity in the study results, the exclusion of heterogeneous studies did not significantly alter the findings, suggesting that the meta-analysis results were reliable (Supplemental Appendix 8).

Discussion

To our knowledge, this is the first systematic review and meta-analysis to assess the clinical efficacy of KT in patients with AAS. The results indicate that, compared to the control group, KT significantly alleviated pain, reduced swelling, and improved ankle joint function in patients with AAS. However, these effects were significant only during the short-term intervention period of three to five days. Furthermore, we conclude that the ‘I’-shaped KT application may be the most effective treatment for AAS patients.

Local pain, swelling, and reduced functional capacity (e.g., weight-bearing, balance, ankle range of motion, jumping ability) in patients with AAS significantly impair the rehabilitation process and consequently affect their quality of life (44, 45). When functional recovery in the acute phase is restricted, it may lead to long-term adverse consequences (46). Recent studies indicate that KT alleviates pain and swelling in musculoskeletal injuries and improves functional status (47, 48). In ankle musculoskeletal injuries, KT has been reported to provide effective lateral support and improve muscle activation in patients with CAI, thereby enhancing stability (49). However, evidence on the clinical application of KT in AAS is currently insufficient to guide clinical practitioners. Our systematic review and meta-analysis, which included RCTs evaluating KT for the treatment of AAS, reported positive effects. KT may alleviate pain by stimulating sensory pathways in the nervous system, thereby indirectly reducing nociceptive input to nerve fibers or by providing support to the skin surface, directly reducing pressure on subcutaneous pain receptors, ultimately decreasing pain perception (17, 50). Additionally, KT increases the space between the skin and underlying muscles, promoting blood circulation and lymphatic drainage, which enhances tissue metabolism and reduces inflammatory substance accumulation. This process improves the nutritional status of nerves and muscles, alleviates joint swelling, and mitigates aseptic inflammation (51, 52). Moreover, while most existing KT research has primarily focused on chronic pain conditions, such as chronic low back pain (53) and neck pain (54), limited attention has been paid to its efficacy in the acute phase. Our study broadens the scope of KT research by applying it to acute inflammatory stages.

Over the past two decades, KT has gained increasing attention as a novel therapeutic approach. Despite its reported positive effects in musculoskeletal practice, several systematic reviews indicate that current evidence does not support the widespread use of KT (55, 56). However, previous systematic reviews included patients with diverse musculoskeletal conditions, and research has demonstrated that pain and inflammation characteristics in musculoskeletal disorders can vary based on the site of injury, injured tissue, and stage of the disease (57, 58). Additionally, variations in intervention duration and KT application methods may explain discrepancies in outcomes across studies. Therefore, we suggested that these factors may significantly account for the ongoing controversy surrounding KT efficacy. Accordingly, we specifically focused on the effects of KT in the acute phase of ankle sprains and performed subgroup analyses to further investigate the potential influence of different intervention protocols on efficacy, thus validating our hypotheses. Subgroup analysis of KT intervention duration showed significant improvements in pain and function after 3 days and in swelling after 5 days. This suggests that patients with AAS may only benefit from short-term KT interventions, which supports our earlier hypothesis. A potential explanation is that skin or tissues may adapt to KT stimulation after prolonged use, thus limiting its positive effects. This finding aligns with a previous review, which found no significant improvement after a 4-week intervention in chronic musculoskeletal conditions compared to the control group (59). Additionally, we performed a subgroup analysis of KT application techniques, which showed that both ‘I’-shaped and ‘8’-shaped KT significantly improved pain and function, with ‘I’-shaped KT notably reducing swelling. In other words, the ‘I’-shaped KT method showed the best therapeutic effect in AAS. This may result from the different mechanical stimuli applied by various KT techniques, affecting sensory input, blood circulation, and lymphatic drainage, which leads to varying effects on pain, swelling, and functional recovery. However, research on the efficacy differences between KT application methods is limited. Given the limitations of the included RCTs, further studies are needed to confirm their effects on AAS. It is also worth noting that Nunes et al. (3) suggested that factors such as the patient’s physical activity level may influence the effectiveness of KT in reducing swelling. Athletes, with faster metabolic rates, may have sufficient tissue circulation and lymphatic stimulation, masking KT’s positive effects. This may explain the positive effects of KT in non-athletes (60, 61) compared to athletes (3). However, due to the demographic limitations of the included RCTs, further subgroup analysis was not possible, and this hypothesis requires further investigation. Interestingly, the subgroup analysis based on ankle volume measurements showed significant improvement in swelling, while ankle circumference measurements showed no positive results. This suggests that more objective and reliable methods are needed to assess swelling.

Limitations

This study has several limitations. First, the RCTs included in this review did not strictly control NSAID use, so whether KT can effectively replace NSAIDs to avoid adverse effects requires further high-quality RCTs for validation. Second, we acknowledge the substantial heterogeneity in our study. To address this, we conducted the most comprehensive regression and subgroup analyses possible, and we recommend that future research carefully consider factors such as patient demographics (e.g. age, activity level), follow-up duration, and outcome measurement methods to minimize potential heterogeneity and more comprehensively evaluate the clinical efficacy of KT. Third, the RCTs included in this study used different assessment tools to measure pain, swelling, and functional improvement in patients with AAS, which may have introduced bias and hindered the reproducibility of the results. Fourth, some RCTs in this study lacked appropriate randomization and blinding, which may have introduced selection bias. Finally, the small sample size and the limited number of studies may have reduced the reliability of our findings. Sixth, regarding the grading of acute ankle sprain severity, available evidence is insufficient to allow subgroup analyses, warranting further high-quality studies to substantiate this area.

Clinical implications

Management strategies for pain and swelling during the acute phase of AAS have long been a focus in musculoskeletal clinical practice. Furthermore, previous clinical guidelines have raised concerns regarding the use of NSAIDs and excessive immobilization in the management of AAS. Our study reported the positive effects of KT on AAS, highlighting its side-effect-free nature and ability to avoid restricting activity. This contributes to effective symptom management during the acute inflammatory phase, promoting tissue repair. Additionally, through subgroup analyses, we identified the optimal intervention durations and KT application methods, offering practical clinical guidance for musculoskeletal practitioners. In this way, AAS patients may effectively alleviate health and economic burdens through the direct benefits of KT, while also reducing strain on medical resources and healthcare professionals. Moreover, our findings offer new clinical recommendations for early-stage AAS management. Existing clinical management guidelines for AAS recommend the use of functional braces to prevent early tissue adhesion and range-of-motion restrictions, replacing rigid immobilization to facilitate early functional activity (12, 62). Based on these clinical guidelines, we propose that, although KT can alleviate pain and reduce swelling during the early 3–5 days without affecting functional activity, its inadequate protective support for the joint suggests that functional ankle braces should be used in later stages to ensure joint support and maintain essential early functional activity. Such recommendations further expand the therapeutic options available to both healthcare professionals and patients, offering a novel perspective on the early management of AAS. High-quality RCTs are needed to further validate the practical clinical effects.

Future research

Our study supports the clinical efficacy of KT in AAS; however, high-quality RCTs evaluating its use in AAS treatment are still lacking. Future research should further confirm KT as an effective alternative to NSAIDs by strictly controlling NSAIDs use. Additionally, efficacy observations based on demographic characteristics, such as age and physical activity level, may provide valuable guidance for personalized interventions for both clinicians and patients. Given the current limitations in the number of RCTs, future studies should investigate various KT application methods in greater depth. Finally, given the reported efficacy of KT in the early phase of AAS, future studies should explore its long-term rehabilitation effects when combined with other therapeutic modalities to better guide clinical practice.

Conclusion

Low to moderate-quality evidence indicates that KT can significantly alleviate pain, reduce swelling, and improve function in patients with AAS. However, significant effects are observed only after a short-term intervention period of 3–5 days, and the ‘I’-shaped KT method may be the most effective recommendation for patients with AAS. Owing to the current limitations in study quantity and design, further high-quality RCTs are necessary to refine KT intervention methods for AAS.

ICMJE Statement of Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding Statement

This work was supported by the National Key R&D Program of China (Grant No. 2023YFC3603502) and the China General Administration of Sports research project (W 23-28).

Author contribution statement

HZ and MZ had full access to all the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. HZ and MZ contributed equally to this work as co-first authors. HZ, MZ, and LZ contributed to the concept and design. HZ, MZ, and PC helped in data acquisition and interpretation. HZ, MZ, LW, and LD drafted the original manuscript. LZ revised the original manuscript and approved the final version of the manuscript.

Data availability

Since all analyses were performed based on previously published studies, no ethical approval or patient consent was required.