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Inside, an insulated liner (typically expanded polystyrene foam or insulated panels) creates a thermal barrier that slows heat transfer from the outside environment

The authors sincerely thank Professor Graham Rook (University College London, United Kingdom) for discussions on his Old Friends Hypothesis and critical reading of the manuscript, and Professor Hanna Kmita (Adam Mickiewicz University, Poznan, Poland) for a critical reading of the manuscript and helpful suggestions for its improvement

ClinicalTrials.gov also lists a 2026 acute hamstring muscle strain repair study record, which may help future evidence review but does not by itself prove safety or efficacy 24

Initial injections may be weekly or monthly to rapidly raise levels, followed by maintenance injections as needed