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STaar ready instruction is. Baseline skin temperature The skin temperature in experimental and control group was measured before application of the contrast bath of which no significant difference on PA control Variation of skin temperature during and after contrast bath. Variation of skin temperature after contrast bath Analysis of thermal variation of skin after the CWT was performed, in other words, observing the ability of the CWT to maintain the temperature reached.

The Student t test was used to compare the average temperatures between the intervals of both control and experimental PA and PB at 3, 6, 9 and 12 minutes after CWT table 2, fig. For PB, no significant differences were found between any conditions or intervals table 2, fig. Discussion CWT has been shown to be an effective tool in athletic recovery after strenuous exercise and its use has been suggested by several textbooks for various other maladies.

Several studies have thus suggested that CWT holds benefits such as reduced muscle soreness11, decreased tissue damage9 and increased blood flow We suggest that the use of the alternating hot and cold water temperatures provides variability in the use of this treatment which could be more particularly entailed for the ailment.

Water temperature in CWT must be controlled, since it needs to promote significant changes in temperature without causing tissue damage. Current work by Pournot et al20 illuminates that the mechanism that functions in both cold and CWT involves a suppression in the inflammation and damage markers in the plasma concentrations decreasing plasma leakage of the skeletal muscle.

Moreover, Higgins et al9 whose research implies that damage to the tissue is caused by ice therapy suggests that CWT is an actually more effective treatment for athletic recovery than cryotherapy. Studies have demonstrated that the temperature changes of tissue during CWT remain at a very superficial level - not reaching 1 cm, therefore maintaining heat on muscle tissue Van't Hoff's law is clearly not the therapeutic mechanism being utilized.

Fiscus et al21 identified that heat or warm water therapy as well as CWT has been implicated with increased blood flow, where cold water had no effect on blood flow. One possible explanation of this comes from Petrovsky et al25 who found an improved reaction of diabetic patients to CWT when global warming was implemented suggesting that sympathetic vasoconstriction plays a role in their responsiveness to CWT as an effective therapeutic tool.

This implies that the heating phase of CWT may contribute to increased blood flow, although not measured in diabetic patients, the improvement to treatment after global warming would suggest that in diabetic patients where the blood flow is reduced a possible longer heating time may be required for the treatment to show effective measures.

Our study, which measured the skin temperature after CWT in both protocols at intervals of 3, 6, 9 and 12 minutes supports this idea. A possible explanation for this phenomenon is that the final temperature or exposure time of the heated water or even both were not enough to re-warm the tissues after immersion in cold water. Rodrigues3 attributes this phenomenon to the thermodynamics of heat exchange in tissues, since the cold tissue takes a "long" time to re-warm. This may explain why a form of global warming where the circulation may already be increased can counteract the effects of the reduced blood circulation we find in some conditions, most notably diabetes.

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Several studies13,15, corroborate that the depth of penetration of heat also increases the caliber of blood vessels, in turn blood flow. Thus we suspect that the function of heat in CWT is either a type of protective measure against cryotherapy or increases blood flow or both.

In the present study, ambient temperature and relative humidity were measured and verified to be constant throughout the trials, thus the amount of heat transferred or received by the skin came from CWT, using warm and cold water according to PA and PB.

We utilized water with a non constant temperature to replicate clinical practice conditions.

The pre and post treatment water temperatures showed a significant change with the hot water dropping close to 5 degrees and the cold water rising approximately 4 degrees. This change in extreme temperatures was clearly seen in our measurements of skin temperature throughout CWT, PB at minute 5, skin temperature reached On the other hand, in PA the cold condition maintained efficiency throughout CWT, minute 5 decreasing skin temperature to These results should be considered in clinical practice as one of the key functions of CWT is the alternating temperature extremes which diminishes as CWT is performed.

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The present study utilized infrared thermometry as it is a cheap, rapid and non-invasive means of monitoring superficial and core temperature34, with the exception of heat exhaustion The choice for use of the infrared thermometry in this research was based on previous studies that showed efficacy in evaluating superficial temperature in cool and hot environments35, In both protocols A and B there were significant variations in skin temperature.

The skin, however is an organ that performs heat exchange with ease37 does not imply that this skin variation is heating any of the superficial tissues.

Vasomotor stimuli, presumably promoted by CWT, occur in the dermal skin layer, which is highly vascularized16,18,21, Fiscus et al21 , suspects that the respective vasodilatation and vasoconstriction of the peripheral blood vessels cause these significant differences between the warm and cold transitions in CWT.

However, careful consideration must be made about these results and that these are two distinctly different physiological processes and that further investigation is needed to elucidate their relationship and that by no means measuring one implies that we are measuring the other. As to whether CWT should end with warm water or cold water we agree with Rodrigues3 , that the choice should be based on the kind and stage of injury, as well as therapeutic targets and metabolic conditions of the tissues.

Typically authors,21,29 have conducted research with CWT always beginning with heat and ending with cool devices, as it is the most commonly seen.

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Our results concur that beginning with warm water and ending with cold water in each set, as shown in PA, is the best form of treatment in cases of sub-acute musculoskeletal injuries - where the objective is to reduce the surface temperature of the skin and reduce the local metabolism.

However, in other conditions where there is a compromised blood flow to the lower limb for example, alterations in temperatures, as well as whether the treatment should end with cold or heat should be reexamined for the particulars of the ailment and its effectiveness for the pre-existing conditions. Although limited in its scope, our study would suggest different therapeutic mechanism thus different concerns and considerations should be taken into account with not only injured populations but also those who have conditions affecting blood flow.

Despite our small sample, we consider that our results support other current research being conducted in the area and offers further evidence towards the therapeutic mechanisms of CWT.

We suggest that further studies involving CWT to the lower leg in injured populations be carried out to determine whether our findings are clinically relevant and to increase the scientific evidence for the use of CWT, its effects and parameters.Enter your activation code and click the activate button. Currently, the interaction between the heating and cooling phases of CWT remains difficult to deduce its therapeutic application in clinical uses outside of athletic recovery.

Our results concur that beginning with warm water and ending with cold water in each set, as shown in PA, is the best form of treatment in cases of sub-acute musculoskeletal injuries - where the objective is to reduce the surface temperature of the skin and reduce the local metabolism. X elite universal patch here june aneesa latest version. A team approach to chronic conditions is emphasized to coordinate care of patients.

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Water temperature in CWT must be controlled, since it needs to promote significant changes in temperature without causing tissue damage.

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