Abstract
BackgroundOne of the chronic symptoms of non-freezing cold injury (NFCI) is cold sensitivity. This study examined the effects of prior exercise on the response to a cold sensitivity test (CST) in NFCI patients with the aim of improving diagnostic accuracy.MethodsTwenty three participants, previously diagnosed with NFCI by a Cold Injuries Clinic, undertook two CSTs. Participants either rested (air temperature 31°C) for approximately 80 min (prior rest condition (REST)) or rested for 30 min before exercising gently for 12 min (prior exercise condition (EX)). Following REST and EX, the participants placed their injured foot, covered in a plastic bag, into 15°C water for 2 min; this was followed by spontaneous rewarming in 31°C air for 10 min.ResultsThe great toe skin temperature (Tsk) before immersion averaged 32.5 (3.4)°C in both conditions. Following immersion, the rate of rewarming of the great toe Tsk was faster in EX compared to REST and was higher 5 min (31.7 (3.4)°C vs. 29.8 (3.4)°C) and 10 min (33.8 (4.0)°C vs. 32.0 (4.0)°C) post-immersion. Over the first 5 min of rewarming, changes in the great toe Tsk correlated with the changes in skin blood flow (SkBF) in EX but not the REST condition. No relationship was observed between Tsk in either CST and the severity of NFCI as independently clinically assessed.ConclusionsExercise prior to the CST increased the rate of the toe Tsk rewarming, and this correlated with the changes in SkBF. However, the CST cannot be used in isolation in the diagnosis of NFCI, although the EX CST may prove useful in assessing the severity of post-injury cold sensitivity for prognostic and medico-legal purposes.
Highlights
One of the chronic symptoms of non-freezing cold injury (NFCI) is cold sensitivity
No differences were found in the great toe (TGt) or Tt2–5 between the first and second cold sensitivity test (CST) for either rest condition (REST) or exercise condition (EX) conditions before immersion or at 5 min, indicating that the order of testing did not influence the Skin temperature (Tsk) observed
Tsk before immersion was similar in both conditions (Figure 1) as was the Tsk at 63% of pre-immersion values (TGt: REST 28.7 (2.5)°C, EX 29.4 (3.0)°C; Tt2–5: REST 28.0 (2.4)°C, EX 28.1 (2.8)°C, P > 0.05)
Summary
One of the chronic symptoms of non-freezing cold injury (NFCI) is cold sensitivity. This study examined the effects of prior exercise on the response to a cold sensitivity test (CST) in NFCI patients with the aim of improving diagnostic accuracy. Stage 4, the chronic state, is characterised by cold sensitivity, numbness, hyperhidrosis and persistent pain that may last for many years These chronic effects of NFCI may produce debilitating neurological problems including pain, paraesthesia, and even impaired neuromuscular function in severe cases that may have life-changing consequences for the individual. The cold sensitivity, which is an exaggerated vasoconstrictor response (in intensity and duration) to a cold stimulus, alone may cause protracted peripheral vasoconstriction leading to an increase in peripheral cooling and associated pain and numbness Such consequences may affect employability status, increase living costs due to the requirement of specialised clothing and increased domestic heating, as well as restrict the individual’s participation in normal outdoor sporting or social activities. Accurate identification of the severity of these long-term symptoms and the efficacy of their treatment is of importance in deciding future employability and treatment regimes in both military and civilian populations
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