Everything you need to know about preventing environmental cold illnesses and injuries

This post is for athletes, coaches, event coordinators, etc.

*Disclaimer: The information provided here is for general informational purposes only. It should not be considered as, or a substitute for, professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of information provided here. Reliance on any information provided by me is solely at your own risk.

There are many people, including myself, who believe sport is an important part of their lives and participate in at least one sport if not more. Some people take these sports very seriously and compete for a living, and others just enjoy them for the health and social benefit. Obviously, we are all very aware of the health benefits participating in regular physical activity has. If not, head over to the American Heart Association website, or any health governing agency website. The majority of diseases and illnesses have the usual recommendation of proper nutrition and a healthy amount of movement and exercise habits.

Now some athletes even take it as far as to participate in their sports no matter the weather! And then there are exclusively winter sports which all occur in colder temperatures such as skiing, snowboarding, etc. But with these types of sports come the increased exposure to injury and illness risks associated with environmental conditions. That’s right, cold temperatures are associated with a plethora of negative outcomes if not properly prepared. Even moreso, extreme cold, wet, and/or windy conditions may even hamper physical activity disturbing outdoor and indoor events (2).

While we unfortunately do not have much control of earth’s happenings in regards to weather (climate change, totally, but another topic indeed), we do however, have control of our exposure to it. When we spend time outside in the winter, the body adapts by trying to maintain core temperature, which causes decreased blood flow to the extremities. Additionally, the body responds by slowing the body’s chemical processes, including the nervous system which is responsible for generating muscle contractions (2). This physiological phenomenon can lead to cold injuries such as hypothermia, frostbite and frostnip, or even chilblain (1). Signs and symptoms of each of these are in Table 1 at the end of this article, retrieved from Cappaert et. al (2008).

Hypothermia occurs when there is a decrease in body temperature below 35 degrees Celsius (95 degrees F). Severities in hypothermia range from mild (35 degrees Celsius), moderate (32 degrees Celsius), and severe (<32 degrees Celsius) (1). As you can see in the table each severity is associated with their own set of signs and symptoms. If you are like me and are a regular cold sport enthusiast it is important to be familiar with these signs and symptoms so that you may be able to prevent worsening for you or your adventure/sporting partners.

Frostbite and frostnip are localized responses to a cold and dry environment but with moisture from sweating which causes the increase of tissue cooling to protect the core temperature but can result in actual freezing of the tissue. Frostnip is the beginning of frostbite.

Chilblain is an unusual inflammatory response to prolonged exposure to cold and wet conditions (1). The blood vessels constrict in response to the cold as mentioned earlier, but if constricted for too long, it can result in what’s called hypoxemia, or decreased oxygen in the blood, and inflammation of the blood vessel walls (1). Sounds serious right? This cold illness can occur with or without the presentation of freezing tissue (1).

An additional and important consideration when exposed to cold temperatures for long periods of time is dehydration. I know most of you are thinking “why would I need to hydrate as much if it’s cold. I don’t drink water in the cold.” Well in the beginning I mentioned that the blood in the body is pulled from the extremities to keep the core temperature regulated. Well by this happening, the kidney actually produces more urine (2). Secondly, breathing cold, dry air causes more rapid fluid loss through evaporation. It’s important to stay hydrated.

So now that we know some of the primary risks associated with winter or cold-temperature sports, wouldn’t you like to know the proper strategies to stay safe and healthy? Great!

So for the hydration bit, that one is simple enough, drink water and electrolytes, to replace fluid loss. I always recommend carrying water on you if you are on the mountain skiing, boarding, hiking, touring, snowshoeing, cross country skiing, or whatever. Even if you don’t have a backpack on you, a collapsible silicone water bottle is the niftiest (Like this). Electrolytes come in packet or pill form that you can easily stash them in a pocket and toss in the bottle. My favorite are the Nuun instant pouches or the tabs (but those are tricky alone in a sweaty pocket).

It is extremely important to warm up your core temperature preluding physical activity outdoors. This will help redistribute blood flow back to extremities and allow for better dexterity and increased capacity for muscular contractions. Having a movement routine geared towards your sport and requirements is not just important in normal environmental conditions but especially in cold temperatures. A warm up should always include some dynamic flexibility, activation of the muscles required in your physical activity/sport, and then build up of pace to match the level of intensity of the sporting event. If you are sweating after your warm up, that’s a sign it worked. However, there are certain sports where sweating too much could provide a more problematic scenario if the gear is not appropriate.

Which brings me to my next strategy is the type of gear you are wearing during your sport. Obviously, competitions of different sports may have a required kit. There are many blogs and articles about appropriate layering and the best recommended brands of each. But layering is an important piece. For the layers closest to the skin, make sure it is a breathable fabric which provides a wicking mechanism to keep your sweat off your skin but isn’t just absorbed into the fabric. The fabric should be able to dry quickly. This is called your base layer. Afterwards would be a midlayer, something to keep you warm. This could be an insulated jacket, a ¾ zip pullover layer, etc. Again depends on activity, and sometimes I wear two or three midlayers (like a long sleeve over my base layer, then a pullover, then a jacket). Then the outer layer will be something to block the elements, wind, rain, snow. My outer layer will always have openings in the armpit to allow some breathability when I am overheating. The layering will work the same for the legs. But normally a base layer tight with either a wind pant, or insulated pants works well. For running specifically, layers can get a bit bulky, so sometimes they make insulated/lined tights with a protective outer layer all-in-one. This article lists some of the top ones out there which can actually work across numerous other sports as well. Utility for me is really important as a conscious consumer.

Alright I could talk about gear forever. But our next prevention strategy is going to be alertness of weather changes. Drastic increases or decreases in temperature can change the conditions of the surface you are on. With snow sports, increases in temperature slush up the snow which can make it harder for maneuvering, so staying alert and not going on trails that look a bit out of reach for your skill level with the added technicality. I have known many who have thought the slushy snow would be fun then their ski gets stuck, they catch a bump and can’t turn etc. and wind up with a broken leg, concussion, etc. On the other end, a drastic decrease in temperature can make for some icy conditions especially following a rain or wet snow. Needless to say, always check the weather, check the ski conditions or snow conditions, investigate your surface, stay vigilant, and this could prevent unnecessary injuries or even deaths.

Last but certainly not least, if you have any previous injuries which you know colder temperatures will increase the aches and pains, please get those addressed before participating in your sport. Let’s make sure we are taking the necessary steps to strengthen and reinforce those areas along with the rest of your body to reduce re-injury or secondary injury from compensatory patterns. Please visit your nearest athletic therapist or sports medicine practitioner (me!).

Thank you so much for reading, and I hope this information was helpful. This information only covered a fraction of all injuries and illnesses related to cold environments. I did not talk about at-risk populations. Please refer to Caepert et. al (2008) for more specific information in these areas and more in depth explanation of topics covered in this article. Please share this with everyone who you know lives in a place with cold temperatures or people who plan to visit somewhere with cold temps and/or snow.

Additionally, if you are a coach, event coordinator, athlete, and there is a sporting event without a Certified Athletic Trainer, or Athletic Therapist present, please look at Table 3 below at what services and value we can provide to your event ensuring best practices of safety and care of all event participants.

Please email me at performrx.sportsmed@gmail.com for recommendations on how to go about treating previous injuries, or getting prepared for this upcoming winter season of sport and adventure!

Tables of interest

Services an Athletic Therapist/Trainer can provide at events

References

1. Cappaert, T.A., Stone, J.A., Castellani, J.W., Krause, B.A., Smith, D., Stephens, B.A. (2008). National athletic trainers’ association position statement: environmental cold injuries. Journal of Athletic Training, 43(6), 640-658.

2. Rao, V.L., Mohan, N.V. (2021). Impact of weather on sports and sports injuries. International Journal of Physical Education, Sports, and Health, 8(3), 9-13.