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Questions about Moist Hot Packs

Good afternoon,

You will find below an email I sent to Dr Watson before I was aware of this forum. I post my questions here as per his automatic reply. I searched and could not find any similar subject.

First of all, I would like to apologise for my english as it is not my first language (I am French). I am a fourth year Physiotherapy student and my final dissertation subject is called "Investigating the Optimal Duration of Hot Pack Application at the Shoulder Joint".

I read with interest your book "Electrophysical Agents" especially Chapter 6 about Superficial Heating. However, I still do not understand some of the logic behind it.

If I did understand what you said (and different other sources), Moist Hot Packs (MHP) heat transfer calculation is based on the PBHTE Pennes model from 1948 that does not take into consideration body fat content nor skin moisture. I was not able to find a more recent model except maybe Vendrik and Vos in 1957. Is there no other updated theoretical model that would fill the gap?

Talking more specifically about MHP, I have not been able to find a single study showing what happens after 30 minutes of application. However, in some studies, skin temperature is not back to baseline after 30 minutes. Do you know what is the rationale behind?

Another point that I do not understand (and is probably in Chapter 2 of your book but I do not have access to this Chapter) is that studies about MHP use a different amount of layers to act as an interface between skin and the MHP. But no one measured the thickness except maybe Fyfe (1982) that said it was roughly 1.5cm. Is it because of that point that I found so many disparities between max skin temperature? 45.4°C for Greenberg (1972), 40°C for Tomaszewski, Dandorph and Manning (1992), 38°C for Fuentes-León et al. (2016); 40.7°C for Fyfe (1982).

Thanks in advance.

Antoine Martinez

2 months ago

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Dr Ethne Nussbaum
Dr Ethne Nussbaum

Hi Antoine, Your interesting observations point to the need for more rigorous research in this area. I agree that results in the literature show inconsistency for skin temperature following HMP application. You raise the question about use of different interfaces between MHP & the skin. This is certainly one factor. Other factors influencing the skin temp rise are the initial gradient between skin & HP, the surface area of body, body locale, skin moisture, time of application, and, of course body composition is very important. Skin cooling post MHP application depends on how much skin temp was raised during application as well as surface area, body locale and body composition, etc., as well as environmental temperature. Skin cooling is partly due to conduction from cooler surrounding air. So the answer is that unless a study is performed measuring all these variables in a controlled manner, you can expect to encounter contradictory results. Good luck with your studies. Hope you will be the one to examine this topic when you qualify.

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