Appraisal Correspondence Research requires deep knowledge of the modality to be tested As associates of Dr Kenzo Kase, Founder and Chairman of the Kinesio Taping Association International, we feel called upon to respond to published research and correspondence with regard to ‘Kinesio Taping does not decrease swelling in acute, lateral ankle sprain of athletes: a randomised trial[5_TD$DIFF]’ by Nunes and colleagues. 1 [4_TD$DIFF] Nunes claims that the taping application used was drawn from Dr Kase’s book, 2 but they only ‘partially’ followed the book’s instructions. They tested two pieces of tape; they did not test the Kinesio Taping Method. As Kinesio Taping educators we found both the study itself and the follow-up communication puzzling. It is evident to anyone who is trained and experienced in the assessment and application protocols for lymphatic Kinesio Taping that the process used was simply wrong. The team does not appear to include anyone certified or extensively trained in the Kinesio Taping Method. Both the contents of the initial article 1 and the subsequent published correspondence 3,4 with Dr Lee indicate significant weaknesses. We share Lee’s skepticism as to whether these researchers possess a solid understanding of the principles behind lymphatic Kinesio Taping. Their reply to him reinforces these doubts. The study is replete with troubling details. The subjects were varied in activity and condition. The applications were not blinded. Twenty minutes of icing and exercise with the Kinesio Taping treatment could have affected compliance and caused additional trauma. Many subjects did not complete the study. The technique used 1 suggests a formation of crisscross patterns around the lateral malleolus for lateral ankle sprain and around the medial malleolus for medial ankle sprain. However, with Kinesio Taping the pressure decreases due to lifting of the superficial skin, and blood and lymphatic circulation increase due to an increase in subcutaneous space. The ‘control’ taping was not inert but had 20% tension, and was applied on the anterior pathway of the lymphatics. As a control they had no no-treatment group. Multiple different investigators may have applied tape with no specifics on their training in Kinesio Taping. Voltmeter for the lower extremity is from foot to knee, so swelling at the ankle may not have been properly measured. 5 We do not know whether these people continued to participate in the sport that caused the injury in the first place. Tape measurement can have huge variability depending on who is measuring, and consistent tension is extremely difficult. We are not talking about litres of fluid in these patients, but something more like tablespoons of fluid that are sufficient to cause pain and change biomechanics of a joint. As for placement, the appropriate question to ask is: do you want direct or indirect draw of fluid? For many years, any Kinesio Taping research at all was valued for providing guidelines for further study. We have now gone past that point, and we expect to see studies performed in a responsible and informed manner. This study does not meet the lowest standard of responsible scientific research[1_TD$DIFF]. Kim Rock Stockheimer a, *, Gu ¨ l Baltacı b [2_TD$DIFF], Graceann G. Forrester c , Stefano Frassine d and Andrea Wolkenberg c a Kinesio Taping Association International, Wisconsin, USA b Kinesio Taping Association International, Ankara, Turkey c Kinesio Taping Association International, New York, USA d Kinesio Taping Association International, Legnano, Italy *Corresponding author E-mail address: info@kinesiotaping.com (K.R. Stockheimer). References 1. Nunes GS, et al. J Physiother. 2015;61:28–33. 2. Kase K, et al. Clinical Therapeutic Applications of the Kinesio Taping1 Method. Tokyo, Japan: Kenı ´-Kai information; 2003. 3. Lee J-H. J Physiother. 2015;61:231. 4. Nunes GS, et al. J Physiother. 2015;61:231–232. 5. Kase K, et al. Kinesio Taping for Lymphoedema and Chronic Swelling. Tokyo, Japan: Kenı ´-Kai Ltd; 2006. http://dx.doi.org/10.1016/j.jphys.2016.02.003 Knowledge of the modality comes from rigorous research [3_TD$DIFF]We are grateful for the opportunity, once again, to discuss science and further explain our trial of Kinesio Taping for ankle sprain. 1 [2_TD$DIFF] We understand the disappointment shown by Stock- heimer and colleagues that the results did not favour Kinesio Taping; however, we feel that it is important to show our study to the physiotherapy community and let them judge whether the Kinesio Taping method should be used or not. As correctly identified by Stockheimer and colleagues, and as mentioned in our previous correspondence, 2 we partially followed the figure from the book Clinical Therapeutic Applications of the Kinesio Taping1 Method to be consistent with the descrip- tion on how the lymphatic correction (channelling) should be applied. 3 Stockheimer and colleagues’ letter states, in accordance with Dr Kenzo Kase’s book, 3 that ‘with Kinesio Taping the pressure decreases due to lifting of the superficial skin, and blood and lymphatic circulation increase due to an increase in subcutaneous space’. We really would like to have a reference to a published study demonstrating that this in fact occurs; however, we are yet to find such a study. Stockheimer and colleagues seem to be ‘troubled’ by the fact that our sample was drawn from athletes from varied sports modalities, giving the impression that they expect Kinesio Taping to be effective for sprained ankles that occur in some sports but not in others. We would need further clarification before any further comments could be made about this. Journal of Physiotherapy 62 (2016) 118–119 Journal of PHYSIOTHERAPY journal homepage: www.elsevier.com/locate/jphys 1836-9553/ß 2016 Australian Physiotherapy Association. Published by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).