Critique of Discussion/Conclusion? 1. Did this section

Critique of Discussion/Conclusion? 1. Did this section compare the results with the results of others in the literature? how do they compare? 2. Do the conclusions seem reasonable and warranted based on the results of the study? see below for the article portion. Discussion In this study, we have compared the effects of local heat therapy and cold rub gel on pain and joint function in patients with knee OA. The results showed that local heat therapy and cold rub gel improved pain and joint symptoms in patients with knee OA. This finding is in agreement with the findings of similar studies which have reported soft tissue thermodynamics improvement (Hunter et al., 2018) and pain relief (Castro & Dent, 2017) following menthol gel, as well as physical function, pain relief, joint stiffness, and patients’ QOL with knee OA (Yildirim et al., 2010), pain relief in patients with acute back pain (Dehghan & Farahbod, 2014), and increased range of knee joint motion (Ananias et al., 2017) following local heat therapy. Moreover, it has been found that cold rub gel and local heat therapy have a similar effect on pain and symptoms in patients with knee OA. This finding is also in line with reported studies about the cumulative effect of cold and heat therapy on symptoms and pain in patients with knee OA (Denegar et al., 2010), and their synergic effects with stretching exercise on a range of motion for the burned patients’ knee joint (Ahmed & Abdelkarim, 2013). However, our results are inconsistent with the studies by Garra et al. (Garra et al., 2010) and Gergorio et al. (Gregorio et al., 2016). Specifically, Arankalle et al. showed improved heel pain and function with alternating bewteen heat and cold applications (Arankalle et al., 2016). The usefulness of non-pharmacological interventions have well been documented for acute musculoskeletal disorders such as arthralgia or joint swelling (Caes et al., 2018). Moreover, a few studies confirm the effectiveness of local heat and cold therapy in chronic musculoskeletal injuries (Malanga et al., 2015). Therefore, the effectiveness of cold and heat therapy for knee OA requires further investigations (Brosseau et al., 2003). To explain the observed changes in the pain severity and joint function in patients with knee OA following hot and cold application, it could be referred to this fact that both local heat and cold stimulate thermoreceptors which play a major role to relief pain, decrease joint stiffness, improve ROM of joint, and increase muscle strength (Adams & Arminio, 2008; Malanga et al., 2015). Thermoreceptors are activated by temperature changes. Moreover, some thermoreceptors are polymodal. This means that they can respond to both hot and cold stimuli, as well as to certain chemicals, such as menthol which initiate sensations similar to hot and cold (Noël et al., 2009). Furthermore, there are some channels or receptors in humans such as transient receptor potential cation channel subfamily V member 2 (TRVP2). This channel allows the cell to communicate with its extracellular environment and responds to noxious temperatures greater than 52°C. In addition, there is the transient receptor potential cation channel subfamily V member 1 (TRVP1) or the capsaicin receptor. This receptor responds to temperatures greater than 42°C, as well as chemical such as capsaicin. Regulation of body temperature and providing a sensation of scalding heat and pain are the functions of TRVP1. The function of transient receptor potential cation channel subfamily V member 3 (TRPV3) or camphor receptor—responds to temperatures at 34°C-38°C- is temperature sensation and vasoregulation. Transient receptor potential melastatin 8 (TRPM8) or the cold and menthol receptor 1 is a major receptor of cold environment and is activated by temperatures at 25°C-28°C or chemical substances such as menthol and eucalyptus. (Palkar et al., 2015; Vriens et al., 2014; Zhang, 2015). Therefore, according to the above can be said that in the present study, heat therapy and cold rub gel cause a change in local temperature, and these changes stimulate the thermoreceptors. Heat therapy stimulates the thermal receptors TRPV1, TRPV2 and cold rub gel due to its compounds (menthol, camphor and Eucalyptus) stimulates TRPV 3, TRPM8, and TRPA1. Stimulation of thermoreceptors can reduce the severity of pain and improve knee joint function in patients with osteoarthritis.

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