SPORTS MEDICINE – OPTION 3 HOW ARE SPORTS INJURIES CLASSIFIED AND MANAGED? WAYS TO CLASSIFY SPORTS INJURIES DIRECT AND INDIRECT: Direct: Injury is caused by an external blow or force generated outside the body • Causes of direct injuries: collisions (e.g. a tackle), being struck (e.g. a cricketball) • Injuries that could result include: haematomas, bruises, joint damage, ligament damage, dislocations, fractures. Indirect: Injury caused by an intrinsic force within the body • Injury can occur distance from impact site e.g. fall on outstretched arm and dislocate shoulder • Injury occurs as a result of internal forces, built up by actions of performer e.g. overstretching due to fatigue, poor technique, lack of fitness. HARD AND SOFT TISSUE: Soft: Includes all injuries apart from bones and teeth. Includes damage to muscles, tendons, ligaments, cartilage, skin, nerves, organs. • Most common type sports injury • Treated through RICER --> in order to limit scar tissue build up, very stiff and rigid and therefore hard to get rid of/ go back to how it was. • Examples include: skin injuries (abrasions and lacerations), muscle injuries (tears, strains, contusions), tendon injuries (tears, strains, inflammation), Ligament injuries (tears and strains). Hard: injuries that involve damage to bones of skeleton and teeth. • Includes fractures, dislocations, bruising. • Internal bleeding can result. Secondary Injuries: Injuries that occur as a result of a previous injury. • Return to play before fully recovered • Full ROM and strength gained prior to returning to play. OVERUSE: Injury is a result of intense or unreasonable use of joints or body areas. • Change in training practices (increased intensity) and body unable to deal with the increased stress. • Due to incorrect technique • Repetitive force • e.g. shin splints, tennis elbow, stress fractures. SOFT TISSUE INJURIES TEARS, SPRAINS, CONTUSIONS TEARS: Disruption of the fibres of a muscle or a tendon.
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SPORTS MEDICINE OPTION 3 HOW ARE SPORTS INJURIES CLASSIFIED AND MANAGED?€¦ · to get rid of/ go back to how it was. • Examples include: skin injuries (abrasions and lacerations),
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SPORTS MEDICINE – OPTION 3
HOW ARE SPORTS INJURIES CLASSIFIED AND MANAGED?
WAYS TO CLASSIFY SPORTS INJURIES
DIRECT AND INDIRECT:
Direct: Injury is caused by an external blow or force generated outside the body
• Causes of direct injuries: collisions (e.g. a tackle), being struck (e.g. a cricketball)
• Injuries that could result include: haematomas, bruises, joint damage, ligament damage, dislocations, fractures.
Indirect: Injury caused by an intrinsic force within the body
• Injury can occur distance from impact site e.g. fall on outstretched arm and dislocate shoulder
• Injury occurs as a result of internal forces, built up by actions of performer e.g. overstretching due to fatigue, poor technique, lack of fitness.
HARD AND SOFT TISSUE:
Soft: Includes all injuries apart from bones and teeth. Includes damage to muscles, tendons, ligaments, cartilage, skin, nerves, organs.
• Most common type sports injury
• Treated through RICER --> in order to limit scar tissue build up, very stiff and rigid and therefore hard to get rid of/ go back to how it was.
Hard: injuries that involve damage to bones of skeleton and teeth.
• Includes fractures, dislocations, bruising.
• Internal bleeding can result.
Secondary Injuries: Injuries that occur as a result of a previous injury.
• Return to play before fully recovered
• Full ROM and strength gained prior to returning to play.
OVERUSE: Injury is a result of intense or unreasonable use of joints or body areas.
• Change in training practices (increased intensity) and body unable to deal with the increased stress.
• Due to incorrect technique
• Repetitive force
• e.g. shin splints, tennis elbow, stress fractures.
SOFT TISSUE INJURIES
TEARS, SPRAINS, CONTUSIONS
TEARS: Disruption of the fibres of a muscle or a tendon.
• Tiny tears are known as strains or sprains.
• A tear can be classified as mild to severe
• Strains occur when muscles or tendons are overstretched or contract too quickly
SPRAINS: A tear of the ligament, supporting the joint.
• A sprain results when a joint is extended beyond its normal range of movement.
• Limited blood supply healing slow.
CONTUSIONS: Caused by bleeding into the soft tissue.
• Also known as a bruise
• Often caused by direct blows or collisions.
• Severe can form a haematoma – blood clot.
SKIN ABRASIONS, LACERATIONS, BLISTERS
SKIN ABRASIONS: involves skin being scraped and shallow bleeding occurring
• needs to be cleared with warm soapy water.
LACERATIONS: A wound where the flesh is irregularly torn or cut.
BLISTERS: Caused by a collection of fluid below or within the epidermal layer of the skin.
• May contain clear fluid or blood
• Occur due to new equipment, old equipment, friction.
• Calluses are increased thickness of the skin caused by constant pressure e.g. gripping a bat.
INFLAMMATORY RESPONSE
• Without RICER the inflammatory response is much worse resulting in a longer time injured.
•
3 phases to the Inflammatory response:
1. The Inflammatory Stage:
• Pain, redness, swelling
• Loss of movement and function
• Damage to cells and surrounding tissue
• Increased blood flow to the area
• Leakage of fluid causing swelling (oedema) – excess of watery fluid collecting in cavities or tissue – protective mechanism
• Formation of blood cells to promote healing. 2. Repair and Regenerative Stage (3-6 days)
• Elimination of debris
• Formation of new fibres
• Production of scar tissue – sticky substance almost like glue – collagen type of protein in the body.
3. Remodelling Stage (6 weeks – many months)
• Increased production of scar tissue
• Replacement tissue that needs to strengthen and develop in the direction that the force is applied. Type of remodelling varies according to the time and degree of mobilisation of the injury
• Excessive exercise too early will cause further damage
• Too little = large amounts scar tissue build up, lack strength and flexibility
Immediate treatment of soft tissue injuries:
• Reduce swelling
• Prevent further damage
• Ease pain
Long term treatment aims to:
• Restore flexibility
• Regain full function
• Prevent recurrence
• Return to play ASAP
No HARM principle:
First 48-72 hours to ensure quickest recovery
HEAT: avoid any type of heat to injured area increase blood flow to the site and increase bleeding and swelling
ALCOHOL: alcohol will dilate blood vessels and increases blood flow to injured site increased swelling. Can also numb the area and may make person believe not as bad as it is distorts pain response.
RUNNING: Any vigorous form of physical activity will increase blood flow to the injured site and further damage the injured part
MASSAGE: An increase in blood flow occurs when the body part is massaged and therefore will contribute to increased swelling and bleeding.
MANAGING SOFT TISSUE INJURIES:
Ricer:
REST: depends on severity. Remain inactive for 24-72 hours. Used to reduce bleeding and prevent further damage.
ICE: used to reduce pain, blood flow, swelling enzyme activity, spasm and tissue demand for oxygen. Ice causes blood vessels to constrict and thus decrease circulation. Apply crushed ice in a wet towel to injury and surrounding area for 20-30mins every 2hours for the first 48-72 hours.
COMPRESSION: reduces swelling by limiting the fluid build up. Uses an elastic bandage around the injury and surrounding site. Compression needs to be applied for a minimum of 24 hours.
ELEVATION: helps to decrease bleeding, reduce swelling and throbbing. Elevate the injured site above heart level (or pressure point) for the next 48-72 hours.
REFERRAL: Seeking medical advice will help to understand the nature and extent of the injury and can help provide a rehabilitation program.
HARD TISSUE INJURIES
FRACTURES: Result of a simple break in the bone
• Direct, indirect or repetitive impact
• Simple/ closed: bone is fractured but skin is intact
• Compound/ open: a jaggered end of the bone cuts through the skin and protrudes, or there is a cut at the site of the fracture. Visible bleeding and risk of infection is high.
• Complicated: fractured bone damages the local tissues (e.g organ)
• Stress fractures: small incomplete bone breaks caused by repeated pounding.
Signs and symptoms:
• Pain at site
• Inability to move injured part/ unnatural
• Deformity
• Swelling/ bruising
• Grating sound from bones when moving
Management:
• Minimise movement
• Immobilisation of joints above and below useful
• Should be supported by a splint 1. DRSABCD 2. Control bleeding, treat shock 3. Immobilise area/ use splint and bandage 4. Obtain medical help 5. Serious help needed if obvious deformity, uncontrolled bleeding, can’t complete TOTAPS
DISLOCATION: displacement of the bone at the joint
• Never attempt to relocate displaced bone – medical professional
• Apply ice and seek medical aid
• Finger dislocations common
• Subluxation: occurs when bone pops out and then back in again – ligament damage – rehab
ASSESSMENT OF INJURIES
TOTAPS (TALK, OBSERVE, TOUCH, ACTIVE AND PASSIVE MOVEMENT, SKILLS TEST)
T TALK Questions:
• How did injury happen
• Where does it hurt
• Hear snaps/ cracks
• Pins and needles
• Sharp or dull pain If you cannot obtain information or a concussion is possible seek immediate medical aid.
O OBSERVE Visually examine the injure and compare to non-injured side if possible.
• Deformity
• Swelling
• Redness If there is an obvious deformity seek immediate medical assistance
T TOUCH Gently feel the injured area for sign of deformity. Determine the area of tenderness/ pain. Compare with opposite side of body and determine if there is:
• Temperature change
• Change in bone shape Observe the players response to determine the extent of pain. If there is evidence of a fracture or dislocation stop and seek immediate medical aid and immobilise the injured area.
A ACTIVE MOVEMENT Ask the player to attempt to move the injured part. Observe degree of pain and ROM. Check for clicking or grating when moving. If there is minimal or non-existent movement apply RICER and seek immediate medical assistance.
P PASSIVE MOVEMENT At this stage unlikely to be serious. Move injured limb to determine how much movement is pain free and possibility of returning to play.
If movement causes pain apply RICER
S SKILLS TEST Once standing have the player place pressure on the injured site by performing movements similar to the game. Only when these actions can be completed can the player return to the game.
HOW DOES SPORTS MEDICINE ADDRESS THE DEMANDS OF SPECIFIC ATHLETES?
CHILDREN AND YOUNG ATHLETES
MEDICAL CONDITIONS:
ASTHMA EPILEPSY DIABETES
Nature of condition
• A condition characterized by breathing difficulty where there is a reduction in the width of the airways leading to the lungs, resulting in less air being available to them.
• 1/10 people have asthma.
• Symptoms are breathlessness, wheezing, chest tightness and coughing.
• Causes are genetics, eczema, hay fever and external chemicals/smoke.
• Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.
• Type 1 diabetes is an auto-immune condition occurs when the pancreas does not produce insulin.
• The most common type is type 2 diabetes
• Caused by bodies inability to produce sufficient insulin or use it efficiently
• This condition leads to high blood glucose levels
How can exercise affect this condition?
• Should not be an excuse to avoid participation
• Exercise-induced bronchospasm or EIB:
• When you exercise air that comes through your mouth has not been filtered air that gets to your airways is cooler and drier than usual.
• If you have asthma, your extra-sensitive airways don't like cool dry air. airways react Tighter airways mean there is less space for the air to pass through.
• It is extremely rare for a person to have a seizure while exercising.
• Rather than triggering seizures, your epilepsy may improve with exercise.
• abnormalities on EEG (a test that measures the electrical activity of the brain) decrease during exercise.
• Overall fitness and a feeling of wellbeing help reduce seizure frequency.
• Most sports activities are safe as long as people avoid overexertion, dehydration and hypoglycaemia (low blood sugar). If a seizure occurs, it is most likely to be after the exercise (15 minutes to three hours later).
• Physical activity causes blood glucose to drop and if the child’s blood glucose level falls too low this can cause hypoglycemia
Precautions in engaging in exercise
• Keep asthma medications with you when exercising
• Check your asthma is under control before partaking,
• Make sure you understand how to use a puffer
• Warm up and cool down properly
• Protect yourself from asthma triggers, e.g. air quality, allergies, temperature, humidity
• Know steps to take when asthma triggers occur
• take medication according to your doctor’s directions
• Drink plenty of water before, during and after exercise
• Don’t push yourself to the point of physical exhaustion
• If you are feeling very hot and tired, slow down or stop
• Make sure you have at least two rest days every week
• Make sure your diet is nutritionally adequate
• Get plenty of rest and good quality sleep
• Limit or abstain from alcohol
• Collision sports avoided.
• supervisors present and know what to do if a seizure occurs.
• swimming alone, scuba diving and rock climbing completely avoided
• Therefore extra carbohydrates e.g. Gatorade before activity, check blood glucose before, during and after and have a prepared kit of snacks, glucose tablets, fruit juice, water and any medication
• Good meal beforehand - pregame meal to raise blood sugar levels and hourly glucose supplementation
How is this condition managed?
• • Type 1 diabetes managed with insulin injections/ insulin pump
• Diabetes check ups
OVERUSE INJURIES:
• until age 11/12 boys and girls similar levels of strength and body proportions
• during period of growth bones grow significantly, muscle mass increases
• injuries in adolescents related to growth imbalances
• bones can grow quicker than muscles and tendons (painful)
• growth plate never damaged – can cause severe growth problems later on
• How to prevent: o Do not overtrain o Play a number of sports o Exercise in variety of positions o Appropriate conditioning o Appropriate stretching
• E.g. stress fractures, runners knee, Achilles tendonitis, and shin splints.
THERMOREGULATION: the process that allows the body to maintain temperature. “Action of the hypothalamus in the brain in responding to changes in body temperature and initiating appropriate mechanisms (ie sweating)”.
• Children less metabolically efficient than adults.
• Children have larger surface area to body sixe
• Less fluid
• Sweat glands less developed
• Less muscular development than adults
• Do not have mental alertness – just don’t think about it
• 3-5x more likely to suffer overheat/ heat exhaustion
• more prone to dehydration and extremes in temperatures
• Hyperthermia- too cold.
• Hypothermia – too hot.
• How to avoid: o Not exercise for long periods of time in extreme weather conditions o Encouraged to drink water frequently o Wear appropriate clothing
APPROPRIATENESS OF RESISTANCE TRAINING:
• Can participate in some
• Strength is an important component if all sports, the growth plate is an important consideration so as to not damage this area.
• Maximum lifting avoided
• Must be supervised
• Correct technique
• Overall muscle groups
• Using own body weight e.g. pull ups, push ups
• Light weight, high reps, correct technique.
ADULTS AND AGED ATHLETES:
• Exercise programs should aim to develop strength, flexibility, aerobic capacity and coordination – all can improve functional capacity
HEART CONDITIONS
• Can include high BP, weak heart, narrow arteries, heart disease, heart attack
• Lungs also affected
• Decreasing
• Decreased ability to carry oxygen – breathing harder during exercise
• Exercise benefit if implemented correctly – reduce BP by average 11 systolic and 9 diastolic points
• Needs to be combined with low fat and low salt diet
• Need to get medical clearance prior – stress test
• Supervision at an early stage
• 60-75% max
• Adequate time and rest – older fatigued more quickly
• Aerobic exercise best e.g. swim, walk, cycle
• Modified strength programs – no heavy weights, more reps, light loads, major muscle groups.
• Key considerations: medical clearance, progress gradual, mod intensity only, tailored individual tastes, sustainable program, never exercise to point of pain, don’t exercise when too hot.
FRACTURES/ BONE DENSITY
• Bones that are more brittle and less dense fracture more easily as a result of falls, impact from other players, or sudden muscle contractions.
• Stress fractures – reduced calcium
• Osteoporosis – females (loss of minerals during menopause)
• Osteoporosis- deterioration of bones due to lack of mineral content
• Exercise will increase bone mass and make bones stronger
• Inactivity encourages depletion of calcium from the bone, making it weaker.
• Decreases with age because of loss of elasticity in tendons, ligaments, and muscles.
• Effort needs to be made to keep joints supple so full ROM is possible and tasks performed efficiently
• Regular gentle and slow stretching
• Swimming
• Can get arthritis, tight muscles, aching as a result of lack of
• Programs need to be low impact, specific to person’s limitations, consider existing medical conditions that may limit movement.
• Goals to improve QOL by increasing aerobic endurance, increasing strength, increasing energy levels, increasing balance and coordination, increasing flexibility, maintaining weight.
FEMALE ATHLETES
• Special dietary needs: increased iron (periods), increased calcium (due to loss of bone density as age increases)
Menstruation (not on syllabus but still important to note)
• Affect will differ for some athletes
• Some will have trouble performing at best
• Exercise often causes disruptions
• LINKS TO IRON DEFICIENCY – menstruating athletes need 18mg iron/ day to replace (normal 12-16)
• Some athletes stop menstruating (amenorrhoea- usually reversible) caused by intense training, nutritional problems, and psychological factors.
• Osteoporosis
EATING DISORDERS: characterised by behaviours such as purging, binge eating and starving.
• Most common anorexia and bulimia
• Often linked to sport – weight control, food intake, physical inactivity
• Affect more than half athletes in events which require low body fat
• Female athletes 2x risk eating disorders due to exposure to peer influence, exposure to social expectations, pressures within athletic subculture
• Risks include: o Loss of energy o Irregular periods o Weak bones o Abnormal heart rhythm o Dehydration o Starvation
• Prevented by a multi disciplinary approach o Participation focus > winning o Nutritional education + counselors o Able to detect signs o Educate parents on reasonable pressure o Observe training and eating and take action when behaviour is suspicious
BONE DENSITY
• Quantity of calcium in bones
• Needed for bone strength and muscle and nerve functions
• Calcium deficiency associated wit osteoporosis and bone fractures
• Required for bone strength and in the blood to allow muscles and bones to function correctly
• Bones that lack calcium susceptible to fractures and weakening
• Causes: hormonal changes in menopause, decreased exercise, inadequate amounts of calcium
• Supplementation benefits people below recommended levels
• Indiscriminate use of iron tablets can cause iron levels to reach toxic amounts and contribute to liver disease, diabetes, heart problems, and joint damage.
PREGNANCY
• Mild – moderate exercise
• Dangerous in high risk pregnancies
• Don’t start new program
• Avoid vigorous activity
• No contact sports/ scuba
• No heat stress/ saunas
• Good warm up/ cool down
• Advise doctor of intention to exercise
• Be aware of signs to stop
• Adequate hydration
• Self regulated rather than competitive sports
• Benefits: o Maintain fitness and general well being o Weight control in later stages o Improved muscle tone o Reduce risk f CVD o Reduce risk of gestational diabetes o Improve self esteem and wellbeing.
ASSESS THE DEGREE TO WHICH IRON DEFICIENCY AND BONE DENSITY AFFECT PARTICIPATION IN SPORT:
IRON DEFICIENCY:
• Tired, weak fatigues hard to train at required intensity
• Performance will suffer so will concentration
• E.g. female hockey player
• Poorer performance and limited participation due to a lack of haemoglobin lack of O2 to working muscles
• Affect aerobic
BONE DENSITY:
• Bones more at risk of fracture/ stress fractures
• No high impact sports
• Athletes with no periods at risk and may have to consider ceasing or changing intensity of periods.
HOW ARE SPORTS INJURIES CLASSIFIED AND MANAGED?
PHYSICAL PREPARATION:
• Helps body cope with demands of sport
• Reduces rate of injuries
• Improve overall performance
PRE SCREENING:
• To assess the health status of a person before they become involved in a training program
• Subjects at risk must be screened e.g. males 40+, females 50+, asthmatics, smokers, obese, family
history heart conditions
• Age, gender, health status, previous experience must be considered
• Promoted sports med Australia tool for identifying people risk of acute CVD, identifying low/ mod risk.
• Encourage people through exercise prescription – specifies what to do to achieve desired level of
fitness
• FITT principle
• Athletes pre screened at start of season
SKILL AND TECHNIQUE
• Efficiency in which we perform required activities
• Skillful players – high degree temporal patterning, pacing, and control
• Essential to prevent injury
• Improved performance
• E.g. soccer player unsure about correct tackling technique at risk every time go in to tackle.
PHYSICAL FITNESS
• Ensure level of physical fitness required by sport attained before full competition begins
• Dependent on sport/ activity
• Lack of is major contributor to injury
• Level of physical fitness fitting to the sport ensures that energy supplies are adequate and body
systems are able to meet demands of what is required in activity.
WARM UP, STRETCHING, AND COOL DOWN
WARM UP:
• Geared to demands of sport
• Explosive events warm up longer – increased stress on muscle.
• Redistribution of blood flow
• Higher muscle temp allows ability of muscle to stretch without tearing and improve time muscle takes
to respond to stimulus.
• Positive psychological feelings
• General body warm up increases blood flow and raises muscle temp
• Stretching increases elasticity and increased muscle extensibility
• Calisthenics strengthens muscle and draws blood from internal organs to skeletal muscle
• Skill rehearsal increases agility, promotes game readiness, and maintains body temp.
STRETCHING
• General stretching 4/5 times per week
• Stretching program
• Specific to needs
• Muscle groups placed on demands require specific attention
COOL DOWN
• Maintain stretch in muscle groups that may have been shortened during activity
• Disperse lactic acid that has built up -- active recovery
• Prevent blood pooling
• Not as intense of as long as warm up
SPORTS POLICY AND SPORTS ENVIRONMENT:
RULES OF SPORTS AND ACTIVITIES
• Assist flow of play
• Protect from injuries
• Break rules put themselves and others at risk
• rules enforced by referee and punishment decided by referee and possibly official panel (rugby league)
• responsibility on officials and coaches to ensure players under control do not intentionally break the
rules
• e.g. hockey goal keeper must wear set equip
• heat rules aus open will stop playing outdoor courts/ give more breaks when too hot.
MODIFIED RULES FOR CHILDREN
• Rules modified for children to reduce risk of injury and accommodate their needs
• Include design of modified games e.g. walla rugby/ netta
• Changed rules within competition e.g. u19 bowlers in cricket restricted to amount of overs they are
allowed to bowl
• Rules to address specific needs e.g. lowering of ring in basketball/ netball, modifying equipment/
distances in little athletics
• Field dimensions, rules, equipment adjusted to promote enjoyment and safety to avoid failure
MATCHING OF OPPONENTS
• Promote safety – match children/ players with those of the same size, gender, age, strength, skill level
and physiological development
• When competitions are even skills are matched and interest is heightened
• Risk of mismatched opponents in some sports is height e.g. rugby league/ union
• Hard to match skill level in younger ages
• When comp is even, interest is high
USE OF PROTECTIVE EQUIPMENT
• Purpose:
o Absorb energy from direct blow
o Deflect blow and protect
o Limit excessive movement
• Equipment must allow freedom of movement, air flow as requires, and be comfortable.
• Helmets: worn when rules dictate, must protect but continue to allow full movement and vision
• Mouthguards: can prevent most dental injuries, absorbs force and protects teeth and jaw, absorbs
shock of blows to chin and decreases chance of concussion.
• Shoulder/ shin pads: protect against bruising and soft tissue injuries by absorbing impact of direct blow
• Footwear: supportive and protective, adequate support and traction to minimize injury, sport shoes
specific to each individual sport, studs to prevent foot from losing traction
• Joint harnesses and braces: prevent joints extending past normal range
• EXPENSIVE – EQUIPMENT TESTED THOROUGHLY.
SAFE GROUNDS, EQUIPMENT, FACILITIES
• Must always ensure grounds meet safety standards
• Risk assessment
• Ensure playing surface is in reasonable condition
• Clear away all rubbish
• Check corner posts
• Pad all goal posts
• Ensure perimeter fences well back from sideline
• Adequate lighting at night
• Matting where needed
• Equipment must be checked each time before being used
• Equipment must be suited to size and ability of child, sufficient in number, padded appropriately
• Properly erected and constructed
• Actual field/ court design must contribute to player safety e.g. enough room on sidelines of courts/
fields to avoid contact with walls/ fences.
ENVIRONMENTAL CONSIDERATIONS
TEMPERATURE REGULATION (CONVECTION, RADIATION, CONDUCTION, EVAPORATION)
• Thermoregulation: the ability of body to regulate temperature and maintenance of core temp within 1
degree of 37 degrees
• Body temp controlled through hypothalamus in brain
• Reacts to changes in atmospheric temp by triggering devices such as sweat mechanism
• Involuntary
CONVECTION
• Refers to flow of air across skin
• If air cool body will lose heat and visa versa
• 12% heat lost at rest
• WIND OR WATER
RADIATION
• Heat gain or loss to the surrounding atmosphere
• Accounts for 60% heat lost
• Temp and humidity
CONDUCTION
• Involves skin contact with an object of a different temperature
• Rest accounts for only 3% heat loss
EVAPORATION
• Sweat evaporates from the skin and a cooling effect is achieved, thus heat is released