Conquering Cold Injuries

Added by Katie Boushie on December 7, 2012.

The northeast is no stranger to playing sports in cold weather.

Winters in the northeast can be tough, but so are its athletes. Whether you are a year-long runner or biker, skier, snowboarder, or heading into post-season, these upcoming cold months can be a challenge both mentally and physically. Having grown up in Vermont, I love to ski and snowshoe and know outdoor activities like these are some of the best parts of the season. For us outdoor athletes cold injuries are a very real concern, but with awareness and preparation can be avoided. In the following paragraphs I will cover the most common injuries, the proper treatment, and discuss prevention.

Hypothermia is most likely the first to come to mind when thinking of cold injuries. By definition a hypothermic person has a core body temperature below 95 degrees, and can be categorized as mild, moderate or severe depending on their temperature. With the exception of the sports sideline, it isn’t reasonable to think you would be able to get the core body temperature of a hypothermic person. You must be able to recognize the signs and symptoms, a very good reason why any activity should be done in a group.

Signs of mild hypothermia (beside a temperature lower than average) include; shivering, acting lethargic, possible amnesia, and fine motor skill impairment.  For all types the athlete should be moved to a warm, dry area as quickly as possible, and any wet clothes should be removed immediately and replaced with dry clothes or blankets. Someone with mild hypothermia should be coherent and may have warm (not hot) liquids. Moderate and severe will present with depressed vital signs, cessation of shivering, gross motor skills impairment, mental impairment and possibly unconsciousness. Emergency personnel should be contacted to treat anyone with severe hypothermia and vital signs must be monitored while waiting for help to arrive.  Rewarming must be done carefully; hypothermic skin is very fragile and shouldn’t be vigorously rubbed. Heat should only be applied to the trunk and areas of increased blood flow, such as the groin and underarms. Applying heat to the extremities will cause the colder blood to circulate back to the heart and cause complications.

In sports you hear, “the best offense is a good defense,” in the case of cold injuries the same applies; protection is key. It is not so much the quantity of layers keeping you warm, but the quality. Your outermost layer should be wind and waterproof and your innermost breathable and designed to wick moisture away from the body. Always be aware of how you are feeling and reacting to the cold, and stay with a group (plus it’s more fun than riding the chairlift alone).

Frostbite is body tissue freezing, and occurs to temporarily ward off hypothermia. The body “traps” the warm blood close to the core to maintain temperature and the extremities are then left with a change in electrolyte concentration, resulting in water in the tissue freezing.  Similar to hypothermia, there are different stages, each categorized by the quantity of tissue damage. In mild frostbite the area will be swollen, red or gray in appearance, stiff, and they may feel burning or tingling. Severe frostbite has significantly more tissue damage and will appear more mottled or gray, skin will not rebound to the touch and will be numb. Mild frostbite may be rewarmed by holding the damaged area against another person’s warm skin. Severe frostbite is best rewarmed in warm (not hot) water. For both types it is essential that the tissue be fully rewarmed and not allowed to refreeze. As with hypothermia, efforts can be made to prevent frost bite by being aware and dressing properly.

Less commonly known and seen than the previously discussed injuries are chilblain and immersion foot. Chilblain is the result of exposure to cold and wet conditions for over an hour and most commonly affects the feet. It will present with swelling, itching and pain and must be dried and rewarmed gently. Immersion foot, also known as “trench foot” after soldiers standing in flooded trenches for hours on end during World War I, is caused by cold and wet conditions for twelve hours or more.  Feet will be swollen, blistered, painful, itching, and the integrity of the skin may be affected. Treatment is similar; feet must be dried and warmed, making sure not to use any friction while drying as the skin is incredibly delicate. As previously mentioned, prevention is key. Ideally, shoes and boots should keep out water, but if feet are exposed to wet conditions for an extended period of time socks should be frequently changed.

Injuries that take you out of the game can be largely unpredictable, but cold injuries don’t have to be. By dressing properly and being aware of how you are feeling often these can be prevented altogether or halted in the mild stages. With awareness and clear thinking, no matter if you are tuning up your skis or gearing up for the postseason, the cold shouldn’t be your biggest opponent.