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Both transcutaneous electrical nerve stimulation and superficial heat have been used for pain management. While heat has been shown to have a beneficial effect on pain, transcutaneous electrical nerve stimulation remains controversial. The purpose of the present study was to see if heat, when added to transcutaneous electrical nerve stimulation, would provide more consistent relief. A total of 180 subjects participated in this study and were randomly divided into 12 groups. Low level continuous heat was applied while electrical stimulation was applied at 2 intensities, 2 frequencies and with 2 waveforms for 4 h. Outcome measures were subjective pain scale, range of motion of the back and skin blood flow of the back. The control groups had no significant difference in pain, range of motion or skin blood flow comparing the data at the beginning and 4 h after (p> 0.05). There was a small reduction in pain with transcutaneous electrical nerve stimulation alone while all other groups had a significant improvement in range of motion free of pain, reduction in pain, and increase in skin blood flow from the beginning to the end of the 4-hour period. Since transcutaneous electrical nerve stimulation with low level continuous heat showed better outcomes then transcutaneous electrical nerve stimulation alone or low level continuous heat alone, combining the 2 interventions seems to offer better outcomes for pain management for health care professionals.

BACKGROUND Heating the skin and muscles is a commonly accepted method of pain relief and a modality to increase relaxation in muscles and increase tissue blood flow. OBJECTIVE The purpose of the present study was to examine the effect of local heat applied to trigger points and to determine if there was pain relief in the neck and plantar fascia. METHODS Forty adults were divided into 2 different groups according to their pain; twenty subjects had plantar foot pain and the other 20 had nonspecific neck pain. The 20 subjects in each group were randomly subdivided into a heat and a sham group. Sensitivity to pressure was measured with an algometer. A stopwatch was given to the subject and started when either the heat patch or placebo was applied. Heat cells were applied at trigger points on the pain area. RESULTS Subjective pain significantly decreased in both sham and heat group patients with neck pain (p< 0.05), however, the change was greater in the heat group and there was a significant difference between the heat and sham groups (p= 0.002, d= 0.81). For the plantar pain group, a significant decrease in subjective pain was found in the heat group but not in the sham group. Pressure pain threshold significantly decreased in the heat group patients both with neck and plantar pain but for the sham group there was an increase in the pressure after sham treatment. Pain relief during the intervention was also significantly different between the heat and sham group in both patients with neck and plantar pain. CONCLUSION The effect of local heat on trigger points of the body on pain relief was significantly better in the heat groups than in the sham groups. This finding is significant because using heat on trigger points could be an alternative to dry needling performed by healthcare professionals. This modality can be alternative for home use and avoids opioids.

Background: Intermittent bouts of heavy activity at greater than normal exercise intensity can cause delayed onset muscle soreness (DOMS). Several products are commercially available, all alleging to reduce DOMS. In the present investigation, 40 subjects (average age 27.0+/-4.4 years, average BMI 26.8) were assessed to determine the effect of 4 of these products on skin and muscle temperature and blood flow during 2 hours of application. These included ThermaCare Dry Heat Wraps, ThermaCare Moist Heat Wraps, Icy Hot Patches, and hydrocollator heat packs. Methods; Blood flow was measured (by laser doppler flow meter) over and in the quadriceps muscle and tissue temperature was measured (by thermistors and thermocouples) in these same areas. Results: The results of the study indicated that only ThermaCare Dry and Moist Heat Wraps both heated the muscle and increased muscle blood flow. The menthol and methyl salicylate compounds in Icy Hot cooled muscle. Skin blood flow increased 300% after the moist heat was applied after 45 minutes, low level continuous dry heat almost 256% but it took 105 minutes to reach this flow, hydrocollator heat wraps increased by 201% but only for only first 45 minutes and then back to baseline, a slight reduction in skin blood flow was seen with Icy Hot gel applied to the skin. Moist heat caused muscle temperature to increase by an average of 3.1 Deg C. Dry heat caused muscle temperature to increase by 2.2 Deg C, while hydrocollator packs increased temperature by 0.4 Deg C. Icy hot had no effect on muscle temperature. Conclusion: Continuous low level heat products had better penetration into muscle and increased blood flow the best compared to hydrocollator heat packs and Icy Hot patches.

The purpose of this study was to analyze the rest-activity rhythm of type 2 diabetics mellitus (T2DM) and compare it to healthy controls using the nonparametric analytic approach. Twentyone diabetics and 21 healthy subjects matched for gender and age were recruited to participate in the study. Data were analyzed using the Independent t-test, Mann-Whitney U test, and Spearmans correlation. T2DM subjects demonstrate lower interdaily stability (IS) (p=.03), higher intradaily variability (p=.046) and lower rhythm amplitude (p=.02) when compared to healthy controls. Also, there was a positive correlation between IS and most active 10 hr (M10) in the average of 24 hours pattern (r =.44; p=.046) in the diabetes group and a negative correlation between IV and M10 in the healthy group (r =-.57; p=.007). These data together suggest that T2DM exhibits a dysfunction in the rest-activity rhythm due to alterations in the circadian function as well as in the homeostatic capacity to maintain sleep; mainly characterized by less consistency across days of the daily circadian signal, higher rhythm fragmentation and lower rhythm amplitude. Future approaches may be developed considering the influence of circadian glucose variations throughout the day on the coupling of the rest-activity rhythm to zeitgeber and rhythm fragmentation.

Context: Although much attention has been paid to the effect of estrogen on the knee ligaments, little has been done to examine the ligaments in the foot, such as the plantar fascia, and how they may be altered during the menstrual cycle. Objective: To (1) examine sex differences in plantar fascia thickness and laxity and postural sway and (2) identify any menstrual cycle effects on plantar fascia laxity, postural sway, and neuromuscular tremor between menstruation and the ovulation phase. Design: Case-control study. Setting: Research laboratory. Patients or Other Participants: Fifteen healthy women (age = 25.9 ± 1.8 years) and 15 healthy men (age = 27.3 ± 2.0 years) volunteered to participate in this study. Intervention(s): We asked participants to perform 8 balance tasks on a force platform while we assessed postural sway and tremor. Main Outcome Measure(s): Plantar fascia length and thickness unloaded and loaded with body weight were measured via ultrasound. Postural sway and tremor were measured using a force platform. Results: Plantar fascia length and thickness with pressure were greater in ovulating women compared with men (P < .001), but no differences were found between women during menstruation and men. Postural sway and tremor were greater at ovulation than during menstruation (P < .05), and men had less sway than ovulating women on the 3 most difficult balance tasks (P < .01). Conclusions: Plantar fascia laxity was increased and postural sway and tremor were decreased at ovulation compared with menstruation in women. Postural sway and tremor in men were the same as in women during menstruation. These findings support the need to be aware of the effect of sex hormones on balance to prevent lower extremity injuries during sport activities.

BACKGROUND It has been well documented at heat reduces pain and increases healing by increasing blood flow in tissue. OBJECTIVE The purpose of this study was to see if the use of low level continuous heat (LLCH) and Ibuprofen used as a home therapy between physical therapy sessions at a clinic resulted in better therapy outcomes in people with chronic neck pain. METHODS Ninety-two patients with chronic nonspecific neck pain were randomly divided into 4 groups; LLCH group, LLCH with Ibuprofen (IP) group, sham LLCH with sham IP group, and controls. All subjects underwent 45 minutes of conventional physical therapy twice a week for 2 weeks. the neck disability index (NDI), subjective pain, range of motion (ROM), strength of the neck, and home exercise compliance were measured. RESULTS Both LLCH and IP significantly reduced pain and NDI score, and increased ROM (p< 0.01). Home exercise compliance in LLCH and LLCH with IP group was significantly higher than the placebo and control groups (p < 0.05). CONCUSION The use of LLCH alone and LLCH with IP as an adjunct to conventional physical therapy for chronic neck pain significantly improved pain attenuation and it causes greater compliance for home.

To assess the impact of heat applied for 8 hours immediately after or 24 hours after exercise on delayed-onset muscle soreness (DOMS) in large skeletal muscle groups measured by subjective and objective means.Cross-sectional repeated measure design study.Research laboratory.Three groups of 20 subjects, age range 20 to 40 years.Squats were conducted in three 5-minute bouts to initiate DOMS; 3 minutes of rest separated the bouts. One group had heat applied immediately after exercise, and a second group had heat applied 24 hours after exercise. A third group was the control group where no heat was applied.Visual analog pain scales, muscle strength of quads, range of motion of quads, stiffness of quads (Continuous Passive Motion machine), algometer to measure quadriceps soreness, and blood myoglobin.The most significant outcome was a reduction in soreness in the group that had low-temperature heat wraps applied immediately after exercise (P0.01). There was benefit to applying heat 24 hours after exercise, but to a smaller extent. This was corroborated by myoglobin, algometer, and stiffness data.Low-level continuous heat wraps left for 8 hours just after heavy exercise reduced DOMS in the population tested as assessed by subjective and objective measures.Although cold is commonly used after heavy exercise to reduce soreness, heat applied just after exercise seems very effective in reducing soreness. Unlike cold, it increases flexibility of tissue and tissue blood flow. For joint, it is still probably better to use cold to reduce swelling.

Diabetes is a disease that leads to damage to the peripheral nerves which may eventually cause balance instability. The purpose of this study was to determine the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on soleus H-reflex and nerve conduction velocity (NCV) of the sural and superficial peroneal nerves in people with diabetes.Quasi-experimental, one group pretest-posttest design.Human Research Laboratory.A series of Yang style of Tai Chi classes with mental imagery, one hour, two sessions per week for 8 weeks was done.The Activities-specific Balance Confidence (ABC) Scale, Functional Reach Test (FRT), and One Leg Standing Test (OLS) were measured as functional data. Hoffman reflex (H-reflex), and sural and superficial peroneal NCV were measured as main outcomes.All functional outcomes measures were significantly improved after the intervention (p0.01). In the H-reflex, there was a significant increase in amplitude (μV) after completing 8 weeks of TC exercise (p=0.02). In the sural nerve, the velocity (p=0.01), amplitude (p=0.01), and latency (p=0.01) were significantly improved between pre and post-test. In the superficial peroneal nerve, significant improvements were observed in (p=0.02) and latency (p=0.01), but not in amplitude (μV) (p0.05).Combining TC intervention with MI theory showed an improvement in the H-reflex and NCV tests, which suggests improved balance and walking stability.

BACKGROUND It is well recognized that ageing and diabetes are associated with reduced balance and impaired gait. However, one important factor may be not just balance, but how long it takes to achieve balance equilibrium after a balance challenge. This study examined the relationship between balance, tremor, and time to achieve balance after a challenge to stability in young and old individuals without and without diabetes. METHODS Twenty-four of the subjects were young controls, 22 were older controls, 23 were individuals with diabetes, and 21 were young people with diabetes. Posture sway, tremor, and time to achieve stability were assessed on a force plate during 8 progressively challenging balance tasks. RESULTS For postural sway, tremor and time to reach postural stability, there was a significant difference in all groups with the increased balance challenge of the 8 tests (P

Petrofsky, JS, Laymon, MS, Alshammari, FS, and Lee, H. Use of low level of continuous heat as an adjunct to physical therapy improves knee pain recovery and the compliance for home exercise in patients with chronic knee pain: a randomized controlled trial. J Strength Cond Res 30(11): 3107-3115, 2016-This study examined if the use of low level continuous heat (LLCH) wraps at home between physical therapy sessions at a clinic resulted in better therapy outcomes in patients with chronic knee pain. Fifty individuals with chronic nonspecific knee pain was randomly allocated to 2 groups: the LLCH group and the placebo group. All subjects underwent 1 hour of conventional physical therapy twice per week for 2 weeks at the outpatient clinic and they were asked to accomplish 1 hour of therapeutic exercise at home each day between sessions. The LLCH group applied LLCH knee wraps for 6 hours at home before home exercise while placebo group took a placebo ibuprofen. (This was done since placebo heat is impossible to use since subjects would notice that the wraps were cold) Before, during, and after intervention, pain intensity, active range of motion of the knee (AROM), knee strength, and home exercise compliance were measured. The LLCH group showed pain attenuation after 2 weeks of therapy sessions (p ≤ 0.05). AROM and strength of the knee significantly improved over time compared to the placebo group. Home exercise compliance was significantly higher in the LLCH group than placebo group (p ≤ 0.05). These results indicated that the use of LLCH as an adjunct to conventional physical therapy for chronic knee pain significantly improved pain attenuation and recovery of strength and movement in patients with chronic knee pain.

The purpose of this study was to compare the effects of over-the-counter treatments-ThermaCare HeatWraps (chemical reaction to produce heat above the skin), Icy Hot Patch, and Icy Hot Cream (topically applied menthol)-on skin and deep tissue temperature.This was a longitudinal crossover study. On each of 3 days, a ThermaCare HeatWrap, Icy Hot Cream, or Icy Hot Patch was applied randomly over the quadriceps muscle in 15 healthy volunteers with normal body mass. Skin and muscle temperature and blood flow were measured by laser flowmetry every 15 minutes for 2 hours.After 2 hours, mean temperature decreased by 2.1°C (7.0%; P = .02) in skin and 1.0°C (2.9%; P = .01) in muscle with Icy Hot Cream. Icy Hot Patch decreased skin and muscle temperature by 1.7°C (5.4%; P = .03) and 1.3°C (3.8%; P = .01), respectively. In contrast, ThermaCare raised skin and muscle temperature by 7.8°C (25.8%; P = .001) and 2.7°C (7.7%; P = .002), respectively; both were significantly warmer with ThermaCare vs either Icy Hot product (all P.007). Icy Hot products produced a net decrease in skin blood flow (Cream: 56.7 flux [39.3%; P = .003]; Patch: 19.1 flux [16.7%; P = .045]). Muscle blood flow decreased with the Patch (6.7 flux [7.0%; P = .02]). After a period of fluctuations, Icy Hot Cream produced a net increase vs baseline of 7.0 flux (16.9%; P = .02). ThermaCare more than doubled blood flow in skin (83.3 flux [109.7%; P = .0003]) and muscle (25.1 flux [148.5%; P = .004]).In this group of 15 healthy volunteers, ThermaCare HeatWraps provided the greatest degree of tissue warming and increase in tissue blood flow.

Plantar fasciitis (PF) is a common condition found in men and women and can reoccur throughout life. PF is commonly diagnosed by prolonged foot pain lasting more than 3 months and a plantar fascia over 0.4 mm thick, as measured using ultrasound imaging. This study examined the ability to balance and the occurrence of muscle tremor during different balance tasks in patients with PF compared to their control counterparts. Fifty subjects (25 patients with PF and 25 control subjects) participated in this study. Subjective pain (measured with a visual analog scale (VAS)), pressure pain threshold (PPT), and postural sway and tremor during eight different balance tasks were measured. Postural sway was measured by a balance platform, while tremor was measured as the mechanical movement of the platform in the 8 Hz frequency range. Thickness of plantar fascia, subjective pain, and PPT were significantly greater in the PF group compared to the controls (

The purpose of this study was to investigate the effects of Tai Chi (TC) training combined with mental imagery (MI) on blood pressure and cutaneous microcirculatory function in individuals with diabetes and age-matched healthy subjects. All subjects participated in a one-hour Yang style TC exercise with MI twice per week for 8 weeks. An activities-specific balance confidence (ABC) measurement, a single-leg stance (SLS), a functional reach test (FRT), systolic and diastolic blood pressure, and skin blood flow were assessed. All functional outcomes were significantly improved in both groups, and systolic and diastolic blood pressures were lower in both groups after the TC training (p &lt, 0.05), but there was no significant group effect. Skin blood flow decreased in the age-matched elderly group when heat and occlusion were applied (p &lt, 0.05), but no difference was found in the diabetes group. Combining TC with MI showed an improvement in functional outcomes and blood pressure but cutaneous microcirculatory function did not improve. Combining TC intervention with MI theory showed an improvement in functional outcomes and blood pressure, which showed cardiovascular benefits not only in diabetes but in age-matched healthy subjects. However, cutaneous microcirculatory function was increased only in age-matched healthy subjects.

Plantar fasciitis (PF) is a common condition found in men and women and can reoccur throughout life. PF is commonly diagnosed by prolonged foot pain lasting more than 3 months and a plantar fascia over 0.4 mm thick, as measured using ultrasound imaging. This study examined the ability to balance and the occurrence of muscle tremor during different balance tasks in patients with PF compared to their control counterparts. Fifty subjects (25 patients with PF and 25 control subjects) participated in this study. Subjective pain (measured with a visual analog scale (VAS)), pressure pain threshold (PPT), and postural sway and tremor during eight different balance tasks were measured. Postural sway was measured by a balance platform, while tremor was measured as the mechanical movement of the platform in the 8 Hz frequency range. Thickness of plantar fascia, subjective pain, and PPT were significantly greater in the PF group compared to the controls (p &lt, 0.001). Postural sway and 8 Hz tremor were significantly greater in the PF group compared to the control group for all eight balance tasks (p &lt, 0.01). These results indicate that the lack of plantar fascia elasticity is probably the cause of the reduced balance and increased muscle tremor.

Abstract.Ageing is associated with a loss of balance and mobility. This study was conducted to determine if the use of heat, vitamins alone or heat with vitamins could increase mobility and balance in adults with mobility impairments. Eighty adults in the age range between 55 and 64 were randomly divided into 4 different groups; low level continues heat (LLCH), vitamins (VT) alone, vitamins combined with heat (VT + H), and control group. Subjects were sedentary individuals that were not participating in any balance or walking exercises regularly and were not taking vitamins for at least 1 year. 4000 units vitamin D, 1000 units vitamin E, 300mg CoQ10, 600 mg Calcium, 1 tablet multivitamin were taken each day in the VT and VT + H groups. LLCH was applied with a dry chemical heat wrap, average temperature 42°C for 4 hours per day over the upper leg. The outcome was assessed through postural sway and tremor during standing, tremor, gait speed, symmetry, ground reaction force, and muscle activity during gait. All experimental groups showed significant improvement in balance and walking ability after 4 months of interventions (p < 0.05) but no significant changes were found in the control group. The difference between the control group and all other groups was significant (p < 0.05). The greatest improvements were found in VT + H group after 4 months. This is evidenced by better balance, less muscle tremor and faster and more stable gait, especially with the heat and vitamins used together. Heat and vitamins used together were synergistic.

Because of the differences in the exercise type, temperature, and timing of the use of cold and heat after exercise in different studies, there is no clear conclusion as to the efficacy of either modality on reducing delayed onset muscle soreness. One hundred subjects at similar fitness levels were examined. They accomplished leg squats for 15 minutes and heat and cold were applied after or 24 hours after exercise using ThermaCare heat or cold wraps. Measurements obtained were strength, the force to passively move the knee, analog visual pain scales, and blood myoglobin. Control subjects lost 24% strength after exercise. Subjects with heat or cold just after exercise only lost 4% strength (p < 0.01). For strength recovery, cold applied after 24 hours was better than heat at 24 hours. Heat or cold applied after exercise was significantly better to prevent elastic tissue damage (p < 0.01), whereas heat and cold immediately after exercise caused no loss in muscle myoglobin and heat or cold after 24 hours showed no less muscle damage from myoglobin than in control subjects. Myoglobin in the control and heat and cold 24-hour groups averaged 135.1% of the baseline data but averaged 106.1% of baseline in the immediate heat and cold groups. For reducing pain, control subjects showed a significant amount of pain the days after exercise. But cold immediately after exercise or 24 hours later was superior to heat in reducing pain. In conclusion, both cold and heat appear to be efficacious in reducing muscle damage after exercise.

Many studies have reported that there are changes in sympathetic activity throughout the menstrual cycle as there are oestrogen receptor in the hypothalamus and all other parts of the sympathetic nervous system. The purpose of this study was to see whether there were variations in sympathetic activity, skin vasomotor and sweat gland sudomotor rhythms during the menstrual cycle. Eight young female subjects with a regular menstrual cycle participated in the study. Subjects were tested once during the follicular phase and once during the luteal phase. Skin blood flow and sweat rate were significantly higher in the luteal phase compared with the follicular phase (p < .05), but the frequency and magnitude of sudomotor and vasomotor rhythms were significantly greater in the follicular phase (p < .05). In contrast, spectral data showed less sympathetic activity in the luteal phase. A significant finding here is that the sudomotor rhythm of sweat glands is altered by the menstrual cycle.

Background One of the effects of diabetes mellitus (DM), peripheral neuropathy, affects the sensation in the feet and can increase the chance of falling. The purpose of the study was to investigate the effect of 8 weeks of Tai Chi (TC) training combined with mental imagery (MI) on improving balance in people with diabetes and an age matched control group. Material/Methods Seventeen healthy subjects and 12 diabetic sedentary subjects ranging from 40–80 years of age were recruited. All subjects in both groups attended a Yang style of TC class using MI strategies, 2 sessions a week for 8 weeks. Each session was one hour long. Measures were taken using a balance platform test, an Activities-specific Balance Confidence (ABC) Scale, a one leg standing test (OLS), functional reach test (FRT) and hemoglobin A1C. These measures were taken twice, pre and post-study, for both groups. Results Both groups experienced significant improvements in ABC, OLS, FRT (P

We investigate the effects of 17β-Estradiol across phases of menstrual cycle on the laxness of the anterior cruciate ligament (ACL) and the neuromuscular control patterns around the knee joint in female runners.Twelve healthy female runners who reported normal menstrual cycles for the previous 6 months were tested twice across one complete menstrual cycle for serum levels of 17β-estradiol, and knee joint laxity (KJL). Electromyographic (EMG) activity of the quadriceps and hamstrings muscles was also recorded during running on a treadmill. The changes in the EMG activity, KJL, and hormonal concentrations were recorded for each subject during the follicular and the ovulatory phases across the menstrual cycle.An observed increase in KJL in response to peak estradiol during the ovulatory phase was associated with increased preactivity of the hamstring muscle before foot impact (p0.001). A consistent pattern was also observed in the firing of the quadriceps muscle recruitment pattern throughout the follicular phase associated with decreased hamstring recruitment pattern during weight acceptance phase of running (p=0.02). Additionally, a low ratio of medial to lateral quadriceps recruitment was associated with a significant reduction of the quadriceps to hamstring co-contraction ratio during the follicular phase.Changes in KJL during the menstrual cycle in response to 17β-estradiol fluctuations changes the neuromuscular control around the knee during running. Female runners utilize different neuromuscular control strategies during different phases of the menstrual cycle, which may contribute to increased ACL injury risk.

Background The aim of this study was to examine the effects of a 6-week training program of simulated barefoot running (SBR) on running kinetics in habitually shod (wearing shoes) female recreational runners. Material/Methods Twelve female runners age 25.7±3.4 years gradually increased running distance in Vibram FiveFingers minimal shoes over a 6-week period. The kinetic analysis of treadmill running at 10 Km/h was performed pre- and post-intervention in shod running, non-habituated SBR, and habituated SBR conditions. Spatiotemporal parameters, ground reaction force components, and electromyography (EMG) were measured in all conditions. Results Post-intervention data indicated a significant decrease across time in the habituation SBR for EMG activity of the tibialis anterior (TA) in the pre-activation and absorptive phase of running (P

BACKGROUND Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. MATERIAL AND METHODS Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). RESULTS Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P

Background This study quantified the effects of heat, cold, and pressure on the median nerve and transverse carpal ligament in subjects without carpal tunnel syndrome. Material/Methods Subjects were individuals ages 20–50 who had no symptoms of carpal tunnel disease. Imaging ultrasound was used to measure the clearance around the median nerve, transverse ligament elasticity, nerve conduction velocity, thickness of the carpal ligament, and area of the median nerve. Pressure was applied to the carpal ligament to assess the effects of increasing pressure on these structures. On 3 separate days, 10 subjects had ThermaCare heat or cold packs applied, for either 60 or 120 minutes for heat or 20 minutes for cold, to the palmer surface of the hand. Results Tissue changes were recorded as a response to pressure applied at 0, 5, 10, and 20 N. The size of the nerve and ligaments were not significantly altered by pressure with the hand at room temperature and after cold exposure. After heat, the nerve, ligaments, and tendons showed significantly more elasticity. Conclusions Application of cold to the hand may reduce compression of the carpal ligament and nerve.

Corresponding author: Jerrold S. Petrofsky Department of Physical Therapy, Loma Linda University, 11234 Anderson St., Loma Linda, CA 92350, USA Tel: 1-909-558-7274 Fax: 1-909-558-0481 E-mail: jpetrofsky@llu.edu This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licens es/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Copyright © 2014 Korean Academy of Physical Therapy Rehabilitation Science http://dx.doi.org/10.14474/ptrs.2014.3.2.86 Phys Ther Rehabil Sci pISSN 2287-7576 2014, 3 (2), 86-92 eISSN 2287-7584 www.jptrs.org

Aims: To find out if the use of heat at home between physical therapy sessions results in better therapy outcomes in people with acute, non-specific back pain. Setting: Longitudinal, single-blind study at physical therapy outpatient rehabilitation centres. Methods: A total of 144 people with acute, non-specific back pain underwent 45 minutes to 1 hour of therapy, twice a week for 2 weeks. Participants were instructed to accomplish 30 minutes of therapeutic exercise at home daily. Half of the participants used ThermaCare heat wraps for 6 hours before home therapy. The measures were the OSWESTRY, Roland-Morris and Visual Analogue Pain scales, range of motion of the lower back, strength of the lower back and home exercise compliance. Results: In the heat group, compared to the non-heat group, the OSWESTRY reduced (3 times), strength increased (twice), range of motion increased (3 times), pain reduced (twice) and compliance for home exercise doubled. All differences were significant (p=Conclusions: Using heat at home before home exercise sessions and between therapy sessions was associated with faster recovery from acute, non-specific back pain and better home exercise compliance than was seen in the non-heat group.

Objective: Low level laser treatment (LLLT) is widely used in physical therapy practice. It is combined with physical therapy or LLLT alone. The purpose of this study is to evaluate the effectiveness of LLLT on patients` perception of general wrist pain. Design: Longitudinal study. Methods: Forty-eight subjects with wrist pain who were in the age range of 18-70 years old were examined. The subjects were asked, via an interview and a visual analog scale, to grade their wrist pain. They were asked to rotate their wrists through full range of motion and the angle at which any pain occurred was assessed. Each subject was then exposed to one of the following: 1) treatment with an infrared laser with the power turned off (placebo), 2) treatment with an infrared therapeutic laser, 3) treatment with a red therapeutic laser, 4) treatment with an ultraviolet laser, 5) treatment with a blue laser, 6) treatment with a Mickey Mouse flashlight. The duration of the treatment was 3 sessions in 3 days. Results: The results of the experiments showed that while pain was reduced both immediately after and the next day after laser therapy (p

Objective: The low level lasers currently in the market vary in wavelength, dosage, and frequency. These devices are used with much different clinical pathology. Most notably, some studies claim that wounds heal faster with low level laser therapy due to the fact that bacteria commonly found in wounds are killed by laser light. Systemic and meta-analysis studies found the difficulty of comparison of numerous research studies because of differences in the intensities and frequencies of low level laser treatment (LLLT). The purpose of this study was to determine the effectiveness of LLLT on controlling bacterial growth. Design: Cross-sectional study. Methods: Variables included LLLT dosage and wavelength on 3 bacteria commonly seen in wounds, strains of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa were used on commercially available 5.0-cm agar plates. Blue, green, and red, ultraviolet (UV) and infrared laser light sources were adjusted to either low or high intensity settings. Five Petri dishes at a time were placed directly beneath laser light sources with the exception of UV which was placed six inches below the suspended light and infrared which was placed directly on top of the Petri dish lid. Each group of five Petri dishes was irradiated for 15 minutes. Results: The results showed no effect of any of 9 different LLLT intensities or colors on bacteria growth compared to sham light. Conclusions: At least for claims of bacterial growth inhibition with LLLT, no support for this claim can be found here.

Purpose/Hypothesis: To determine if agreement exists between microcurrent conductance through the skin over an injury, myoglobin levels in the serum, and diagnostic ultrasound measurements of swelling. Number of Subjects: 140. Materials/Methods: Subject underwent microcurrent conductance, serum myoglobin, diagnostic ultrasound, and strength testing before and after delayed onset muscle soreness (DOMS) was induced. Non-control subjects were also given a therapy wrap, dry heat, moist heat, or cold, either applied immediately or delayed 24 hours. Results: After induction of DOMS, there was agreement between significant 37% decreases in microcurrent conductance, significant 37% serum myoglobin increases, and significant 20% increases in quadriceps size, measured by diagnostic ultrasound. When either dry heat or cold was applied immediately, changes in these measurements were insignificant and less than 10%. Agreement was weaker when treatment was delayed 24 hours. Also, cold packs showed less than a 5% decrease in microcurrent conductance for covered areas compared to a 22% decrease for uncovered areas around the knee with 24 hour delay. Moist heat packs showed an insignificant change overall, but a significant 11% decrease for the covered center of the quadriceps with immediate treatment. Strength decreased 25% after DOMS, and all immediate treatments, along with 24 hour delayed cold and moist heat showed significantly smaller decreases. Conclusions: Changes in microcurrent conductance through the skin over injured tissue appear to be indicative of initial injury and recovery, and also for detecting the specific area of the injury. Clinical Relevance: Microcurrent through the skin over injured tissue appears to be a promising objective measurement of tissue injury as well as recovery from injury.

Background Falling can lead to severe health issues in the elderly and importantly contributes to morbidity, death, immobility, hospitalization, and early entry to long-term care facilities. The aim of this study was to devise a recurrent fall prevention program for elderly women in rural areas. Material/Methods This study adopted an assessor-blinded, randomized, controlled trial methodology. Subjects were enrolled in a 12-week recurrent fall prevention program, which comprised strength training, balance training, and patient education. Muscle strength and endurance of the ankles and the lower extremities, static balance, dynamic balance, depression, compliance with preventive behavior related to falls, fear of falling, and fall self-efficacy at baseline and immediately after the program were assessed. Sixty-two subjects (mean age 69.2±4.3 years old) completed the program – 31 subjects in the experimental group and 31 subjects in the control group. Results When the results of the program in the 2 groups were compared, significant differences were found in ankle heel rise test, lower extremity heel rise test, dynamic balance, depression, compliance with fall preventative behavior, fear of falling, and fall self-efficacy (p

Michael.Laymon@tun.touro.edu This is an Open-Access article distributed under the terms of t he Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright © 2013 Korean Academy of Physical Therapy Rehabilitation Science

Objective: To assess the effect of vitamin D administration on the skin blood flow response to occlusion and heat. Design: Cross-sectional study. Methods: Twenty age matched subjects; 10 who had diabetes and 10 who were controls were administered 4,000 IU of vitamin D3 for 3 weeks at breakfast. The function of the endothelial cells was evaluated in 2 ways; first, the response to 4 minutes of vascular occlusion of the skin was measured with a laser Doppler flow meter. Second, the skin blood flow response to local heat at 42 degrees C for 6 minutes was examined. Results: The results of the experiments showed that the blood flow response to heat was reduced after 3 weeks administration of vitamin D in the subjects with diabetes and in the control subjects (p

Eighty-two percent of sexually active women aged 15-44 have used oral contraceptive pills (OCP) in the United States. The OCP, an exogenous source of synthetic forms of steroid hormones, prevents ovulation. Hormone changes during the menstrual cycle (MC) are believed to have an impact on anterior cruciate ligament (ACL) laxity due to estrogen. Because the estrogen receptor β resides on human connective tissue, OCP may have potential impact on tendon and ligament synthesis, structure, and biomechanical properties. Temperature has also been known to have an effect on tissue elasticity. Therefore, the purpose of this study was to investigate the differences in ACL elasticity, force to flex the knee (FFK), and knee flexion-extension hysteresis (KFEH) between OCP users and non-OCP users. To investigate these changes, two different knee temperatures were measured. Nineteen young females were divided into two groups: OCP users and non-OCP users. Blood for estradiol serum concentration (E2) was taken before beginning the tests. ACL elasticity, FFK, and KFEH were assessed both at ambient temperature (22 °C) and after 38 °C warming of the leg to stabilize tissue temperature. Assessments were performed four times during the MC. Throughout the MC, ACL elasticity, FFK, and KFEH fluctuated in non-OCP users, but not in OCP users. At ambient temperature, ACL elasticity was significantly lower and FFK and KFEH were significantly higher in OCP users than non-OCP users (p < 0.05). But, no significant differences in FFK and KFEH between the two groups were found after warming to 38 °C.

Background A high occurrence of knee injuries have been observed in women during the menstrual cycle (MC). As a result, numerous studies have been conducted regarding knee ligament elasticity during the MC. Some researchers believe that since estrogen receptor b exists in ligaments and tendons in the knee, estrogen may modulate towards a state of laxity. However, increased tissue temperature also observed during the MC can predispose ligament and tendon laxness. Therefore, the purpose of this study was to assess in women the relationship between Estradiol (E2) serum concentrations and tissue temperature during the MC and their combined effect on knee laxity. Material/Methods Ten non-athletic young healthy females, 18 to 30 years of age participated in the study. E2 serum concentrations, anterior cruciate ligament (ACL) elasticity, and force to flex the knee (FFK), knee flexion-extension hysteresis (KFEH) were assessed both at ambient temperature (22°C) and after 38°C warming. Testing was performed multiple times during the participant’s MC, for one full MC. Results ACL elasticity was significantly higher (P

Aims: This study examined how vision, base of support (BOS) and surface compliance affected postural sway and electromyography (EMG) activity of hip and ankle muscles during eight balance training tasks in young adults. Methods: Postural sway and EMG activity of gluteus maximus (GMAX), gluteus medius (GMED), tibialis anterior (TA), and medial gastrocnemius (GAST) were measured during eight balance tasks with eyes open or closed, feet in tandem or apart, and on foam or a firm surface. Results: Postural sway and EMG activity of hip and ankle muscles were significantly affected by the alteration of vision, surface compliance or BOS during eight balance tasks (PConclusions: Balance exercises may be progressed according to the rank of the task’s difficulty by increasing the number of sensory factors altered in a balance task. There was significant recruitment of hip and ankle muscles in the balance tasks indicating the importance of these muscles in postural control.

Background The purpose of this study was to investigate the changes in the Power Spectrum Density (PSD) of the electroencephalography (EEG) in common sensorimotor balance training tasks of varying difficulty. Sensorimotor balance exercises including alteration of vision, base of support or surface compliance are used to improve postural control. These exercises are presumed to induce supraspinal adaptation, however, there were no studies that investigated the power changes of the cortical activity in these static balance tasks. Our objective was to provide evidence in the cortical involvement with the static balance tasks frequently used in sensorimotor training. Material/Methods Postural sway and EEG changes of alpha, beta and sigma wave bands were measured in seventeen participants during eight balance tasks of varying difficulty with eyes open and closed, feet in tandem or apart and on foam or a firm surface. Results The power of beta and sigma bands increased significantly at the parietal and central area of the brain in tasks with eyes open together with one sensory factor (base of support or surface compliance) or two sensory factors (base of support and surface compliance) altered, and in task with three sensory factors (vision, base of support and surface compliance) altered from the control task. Conclusions This study demonstrated the cortical involvement in the sensorimotor balance tasks, suggesting that these exercises may induce cortical adaptation for postural control. The results support subcortical control with increased task difficulty and the increase in cortical processing when task became extremely challenging.

BACKGROUND The vascular endothelium is the interface between the blood and vascular smooth muscle in arteries. It is easily damaged by oxidative stress. Recent studies show that Asians are more susceptible than Caucasians to impairment of endothelial function. This study examined endothelial function in US-born Caucasians, Asians from Korea, and US-born Asians (almost all Korean decent) and examined the effect of coenzyme Q10 (CoQ10) on endothelial function. MATERIAL AND METHODS Twenty Caucasians and 30 Asians participated (

Background It is commonly believed in medicine that using heat will increase the distensability and flexibility of soft tissue. If true, increased flexibility would be a positive factor to reduce injuries in sports. However, cold should have the opposite effect and is often used to treat sports injuries. This study was accomplished to quantify the effect of heat and cold on the force needed to flex the knee and laxness of the anterior and posterior cruciate ligaments. Material and Methods The present study examined 20 male and female subjects to determine if heat would increase extensibility of the anterior and posterior cruciate ligaments of the knee and reduce the force needed to flex the knee. Cold exposure was examined to see if it would have the opposite effect. There were 4 experiments in the series: The first was a room temperature series; the second was a series where cold was applied with an ice pack for 20 minutes; in the third, hydrocollator heat packs were applied for 20 minutes; and in the fourth, ThermaCare heat wraps were applied for 4 hours on the quadriceps and knee. Tendon extensibility was measured with a KT2000. The force for flexing the knee was measured by passive movement being applied (CPM) to the knee through 30° and the force required to move the leg was measured. Results The results show that the anterior and posterior cruciate ligament flexibility increased and the force needed to move the knee decreased with heat by about 25% compared to cold application. Conclusions Heat is beneficial in increasing muscle and ligament flexibility and may help reduce athletic injuries, but cold treatment may have the opposite effect. Language: en

Background: Endothelial dysfunction due to diabetes may be one reason why at least 15% of people with diabetes will eventually develop a lower extremity ulcer with delayed healing and risk of amputation. Recent evidence shows that skin blood flow may be increased with electrical stimulation if treatment is done in a warm room. However, optimal stimulation waveform is unknown. Optimizing the stimulation waveform may increase healing even more. The purpose of this investigation was to compare two electrical waveforms to determine which increased blood flow blood flow and wound healing more in chronic stage III or IV pressure ulcers and in Wagner stage II neuropathic ulcers when using a warm room. Materials and Methods: Forty subjects with chronic pressure or neuropathic ulcers were treated at an outpatient wound center. Twenty were people with neuropathic ulcers and twenty with pressure ulcers. Treatment consisted of biphasic or monophasic electrical stimulation up to 20 mA for 30 minutes, 3x/ week for 4 weeks in a 32°C room. Skin blood flow was measured by a Laser Doppler imager. Results: Subjects with neuropathic ulcers receiving biphasic current had significantly higher healing rate (70.0% ± 32.3%) than those receiving. monophasic current (42% ± 22.3%; p Conclusion: Both patients with neuropathic and pressure ulcers receiving biphasic current demonstrated greater blood flow and healing rates compared with patients receiving monophasic current when treated in a 32°C room.

Background Vitamin D is a modulator of the immune system. There is some limited evidence that it also increases local blood flow in response to stress. Material and methods In the present study, we examined 20 age matched subjects; 10 whom were from India and 10 Caucasians from the United States. Subjects were administered 4000 IU of Vitamin D3 for 3 weeks at breakfast. The function of the endothelial cells was evaluated in 2 ways; first, the response to 4 minutes of vascular occlusion was measured with a laser Doppler flow meter and second, the blood flow response to local heat at 42°C for 6 minutes. Results The results of the experiments showed that, as reported previously, the endothelial function in people from India was less than their Caucasian counterparts. The blood flow response to heat was reduced after 3 weeks administration of vitamin D in both groups and the response to vascular occlusion in the Caucasian group. But there was only a 20% reduction in the blood flow response to heat in the Caucasian group and a 50% reduction in the group from India. Conclusions Thus acute doses of vitamin D may increase vascular tone and reduce blood flow to tissue during stressors. Dosages administered for a longer duration may have beneficial effects on endothelial function but this was not examined here.

To examine if the use of heat at home can result in better quality and safer mobility in the elderly with gait and balance impairments. Setting: Randomized longitudinal cross over study design in a clinical setting. Methods: 20 people with impaired mobility (assessed as a score of more than 4 on the Stepping On questionnaire) were tested with a multi-camera gait analysis system, a treadmill with pressure sensors, a balance platform and the timed up and go and walking speed tests before and after using ThermaCare continuous heat wraps on their legs and knees for 6 days at 4 hours per day. The loss in mobility could not be due to pain killers or other drugs that reduced mobility. Results: Muscle tremor was reduced, mobility of the joints was improved, balance was significantly improved, and gait was improved after 6 sessions of heat application on the legs. As per the literature, this should reduce the chance of falls in this population. Conclusion: Using continuous heat wraps may be an important adjunct for improving gait in the elderly with gait impairments.

Balance is sensed through peripheral and central receptors and mediated by central control through the brain and spinal cord. Although some evidence exists as to the areas of the brain involved and how processing of data occurs in young individuals, nothing has been published on people with diabetes. The purpose of this study was to examine the electroencephalogram (EEG) during common sensorimotor and balance training tasks and to relate these to task difficulty.Postural sway and EEG change of alpha, beta, and sigma wave bands were measured in 17 young subjects, 10 older subjects, and 10 subjects with diabetes during eight progressively more difficult balance tasks with eyes open and closed, feet in tandem or apart, and on foam or a firm surface.EEG power of beta and sigma wave bands showed significant increases on the cortical and parietal areas of the brain relative to the control tasks when eyes were open (P0.05). The cortical involvement decreased as the task became more difficult with vision and somatosensory information reduced, whereas that of the parietal area increased with task difficulty. The greatest increase was in subjects with diabetes, and the least was in younger people. Individuals with diabetes had increased sigma and beta EEG power in all regions of the brain examined with increased complexity of the balance task.This study demonstrated cortical and parietal involvement in static balance tasks commonly used in sensorimotor training. The results support the proposal that there was increased subcortical control with increase in task difficulty in the young subjects, but in subjects with diabetes, there was a major increase in activity across the brain.

SUMMARY: Aim: To determine if heat applied after strenuous exercise reduces soreness and/or muscle damage. Methods: Self-reported soreness and blood biomarkers were measured in 20 subjects over 72 h after biceps exercise. Heat was applied both immediately and 24 h after exercise, or never (control). Results: Muscle soreness was lower in groups with more heat applied. Skin temperature and some biomarker analytes (granulocytes and mid-size white cells) support a hypothesis of less pain and faster healing in muscles when heat is applied after exercise. Ultrasound data showed less fascial swelling in groups with heat applied compared with controls. Conclusion: Data suggest that heat applied immediately and/or 24 h after exercise reduces muscle soreness and accelerates the healing process. A larger group of subjects is needed to draw better conclusions.

Measurement of resting blood flow to the skin and other organs is an important indicator of health and disease and a way to assess the reaction to various stimuli and pharmaceutical interventions. However, unlike plasma ions such as sodium or potassium, it is difficult to determine what the proper value for resting blood flow really is. Part of the problem is in the measurement of blood flow; various techniques yield very different measures of skin blood flow even in the same area. Even if there were common techniques, resting blood flow to tissue, such as the skin, is determined by the interaction of a plurality of factors, including the sympathetic nervous system, temperature, pressure, shear forces on blood vessels, tissue osmolality, and a variety of other stimuli. Compounding this variability, the blood flow response to any stressor is reduced by free radicals in the blood and diminished by aging and diabetes. Race also has an effect on resting blood flow to the skin. All these factors interact to make the exact resting blood flow difficult to determine in any one individual and at any one time. This review examines the main techniques to assess blood flow, the factors that alter blood flow in the skin, and how aging and diabetes affect blood flow. Recommendations for the measurement of resting blood flow are presented.

Endothelial function is known to be impaired in response to heat in people with diabetes, but little has been done to see how air humidity alters the skin blood flow response to heat.Seventeen male and female subjects were divided in two groups, one with type 2 diabetes and the other the control subjects without diabetes, age-matched to the diabetes group. All subjects participated in a series of experiments to determine the effect of the warming of the skin by air on skin temperature and skin blood flow. On different days, skin temperature was warmed with air that was 38°C, 40°C, or 42°C for 20 min. Also, on different days, at each temperature, the air humidity was adjusted to 0%, 25%, 50%, 75%, or 100% humidity. Skin blood flow and temperature were measured throughout the exposure period. This allowed the interactions between air humidity and temperature to be assessed.For the control subjects, the moisture in the air had no different effect on skin blood flow at air temperatures of 38°C and 40°C (analysis of variance, P0.05), although skin blood flow progressively increased at each air temperature that was applied. But for the warmest air temperature, 42°C, although the four lower humidities had the same effect on skin blood flow, air at 100% humidity caused the largest increase in skin blood flow. In contrast, in the subjects with diabetes, blood flow was always significantly less at any air temperature applied to the skin than was observed in the control subjects (P0.05), and skin blood flow was significantly higher for the two higher humidities for the two higher air temperatures. Skin temperature paralleled these findings.These data show that individuals with diabetes do not tolerate moist, warm air above 50% humidity as well as controls without diabetes.

Summary Background The vascular endothelium plays an integral role in maintaining vascular homeostasis, including the regulation of blood flow, vascular tone, and platelet aggregation. The aim of this study was to see if there were any differences in endothelial function between Koreans and Caucasians. Material/Methods This was accomplished by 2 measures of endothelial function – the response to local heat and the response to vascular occlusion. Ten Caucasian and 10 Korean male and female subjects participated (

Summary Background Most studies of the skin and how it responds to local heat have been conducted with either water, thermodes, or dry heat packs. Very little has been accomplished to look at the interaction between air humidity and temperature on skin temperature and blood flow. With variable air temperatures and humidity’s around the world, this, in many ways, is a more realistic assessment of environmental impact than previous water bath studies. Material/Methods Eight young and 8 older subjects were examined in an extensive series of experiments where on different days, air temperature was 38, 40, or 42°C. and at each temperature, humidity was either 0%, 25%, 50%, 75%, or 100% humidity. Over a 20 minute period of exposure, the response of the skin in terms of its temperature and blood flow was assessed. Results For both younger and older subjects, for air temperatures of 38 and 40°C., the humidity of the air had no effect on the blood flow response of the skin, while skin temperature at the highest humidity was elevated slightly. However, for air temperatures of 42°C., at 100% humidity, there was a significant elevation in skin blood flow and skin temperature above the other four air humidity’s (p

Diabetes is the most common cause of peripheral neuropathies. No definitive treatment for diabetic neuropathies has been reported, and very few studies have been published on the role of exercise in reducing either the symptoms or incidence of diabetic neuropathies.This study assessed the effects of an exercise program on balance and trunk proprioception in older adults with diabetic neuropathies. Thirty-eight patients with diabetes having peripheral neuropathies were enrolled, randomized, and subdivided in two groups: an experimental group of 19 participants with diabetes (72.9 ± 5.6 years old) and a control group of 19 participants with diabetes (73.2 ± 5.4 years old). Both groups received health education on diabetes for 50 min/week for 8 weeks. The experimental group practiced an additional balance exercise program for 60 min, two times a week. The exercise training was performed two times per week for 8 weeks. Results were evaluated by both static and dynamic balance and trunk proprioception.Postural sway significantly decreased (P0.05), the one-leg stance test significantly increased (P0.05), and dynamic balance from the Berg Balance Scale, Functional Reach Test, Timed Up and Go test, and 10-m walking time improved significantly after balance exercise (P0.05). Trunk repositioning errors also decreased with training (P0.05).The balance exercise program improved balance and trunk proprioception. These results suggested that a balance exercise is suitable for individuals with diabetic neuropathy.

A common factor contributing to organ damage in type 2 diabetes mellitus (T2DM) is impaired tissue blood flow caused by damage to vascular endothelial cells (VECs). Damage can occur even before the clinical diagnosis of diabetes. It can be caused by both a high average blood glucose concentration and/or large daily spikes in blood glucose. While much of the present literature focuses on the damage to VECs and organs from these large glucose excursions, this review will focus on the consequence of this damage, that is, how endothelial cell damage in diabetes affects normal daily activities (e.g., exercise, reaction to typical stimuli) and various treatment modalities (e.g.. contrast baths and electrical stimulation therapy). It is important to understand the effects of VEC damage such as poor skin blood flow, compromised thermoregulation, and altered response to skin pressure in designing diabetes technologies as simple as heating pads and as complex as continuous glucose monitors. At the simplest level, people with diabetes have poor circulation to the skin and other organs. In the skin, even the blood flow response to locally applied pressure, such as during standing, is different than for people who do not have T2DM. Simple weight bearing on the foot can occlude the skin circulation. This makes the skin more susceptible to damage. In addition, endothelial damage has far-reaching effects on the whole body during normal activities of daily living, including an impaired response to local heat, such as hot packs and contrast baths, and higher body temperatures during whole body heating due to impaired blood flow and a reduced ability to sweat. Finally, because of multiple organ damage, people with T2DM have poor balance and gait and impaired exercise performance.

Summary Background Circulation plays an essential role in tissue healing. Moist heat and warm water immersion have been shown to increase skin circulation; however, these heating modalities can cause burns. Recent research has shown that passive vibration can also increase circulation but without the risk of burns. Material/Methods The aim of this study is to compare the effects of short-duration vibration, moist heat, and a combination of the two on skin blood flow (SBF) and skin temperature (ST). Ten (10) subjects, 5 female and 5 male, aged 20–30 years of age, received two interventions a day for 3 consecutive days: Intervention 1 – Active vibration only (vibration exercise), Intervention 2 – passive vibration only, Intervention 3 – moist heat only, Intervention 4 – passive vibration combined with moist heat, Intervention 5 – a commercial massaging heating pad, and Intervention 6 – no intervention, resting in supine only (control). SBF and ST were measured using a laser Doppler imager during the 10 minute intervention and then throughout the nine minute recovery period. Results The mean skin blood flow following a ten-minute intervention of the combination of passive vibration and moist heat was significantly different from the control, active vibration, and the commercial massaging heating pad. Skin temperature following the ten-minute interventions of moist heat alone and passive vibration alone were both significantly different from the commercial massaging heating pad and active vibration interventions. Conclusions The combination of passive vibration and moist heat produced the greatest increase in skin blood flow and the second highest increase in skin blood flow nine minutes post application.