Cold-Related Injuries

This article is currently under review and may not be up to date. Please come back soon to see the finished work! (11/11/2020)

Original Editor - Puja Gaikwad

Top Contributors - Puja Gaikwad, Kim Jackson, Reem Ramadan, Vidya Acharya and Wanda van Niekerk  

Introduction

Cold injuries are a result of exposure to cold environments during physical activity. Many athletes participate in fitness pursuits and physical activity year-round in environments with cold, wet, or windy conditions or a combination of these, thereby putting themselves in danger of cold-related injuries. Cold exposure can be uncomfortable, can impair performance and can be life-threatening. Cold injuries and illnesses usually affect military personnel, traditional winter-sport athletes, and outdoor-sport athletes, like those involved in running, cycling, mountaineering, and swimming etc. Traditional team sports like football, baseball, softball, soccer, lacrosse, and track and field have seasons that stretch into late fall or early winter or begin in early spring when weather conditions may rise vulnerability to cold injuries.

The NATA position statement states that the occurrence of these injuries depends on Low air or water temperatures (or both) and The influence of wind on the body's ability to take care of a normothermic core temperature, due to localized exposure of the extremities to cold air or surfaces.

Alpine Environments

Cold conditions are often expected in alpine environments. Furthermore, open exposed areas, like mountain peaks, mean that windy conditions are also commonplace in these environments and may contribute significantly to cold temperatures (also referred to as the 'wind chill factor'). The collective effect of those conditions is heat loss, which places extra demands on the body. For instance, a decrease in core body temperature of just 1°C causes the muscles to shiver, which in turn can lead to low blood glucose levels (hypoglycaemia) and thereby reduced sporting performance.

Types

Cold injuries are classified into three broad categories:

1. Decreased core temperature (Hypothermia)
2. Freezing-tissue injuries of the extremities
3. Non-freezing injuries of the extremities

Hypothermia

Hypothermia is a significant drop in body temperature [below 95°F (35°C)] as the body’s heat loss exceeds its production. thereby the body is not able to maintain a normal core body temperature. This can occur quickly within a couple of hours or gradually over days and weeks. Conditions which will cause hypothermia are cold temperatures, insufficient clothing and equipment, wetness, poor nutrition, duration of the event and exposed/uncovered skin.

Wind-Chill temperature index (WCT) demonstrates how cold an individual feels when exposed to a combination of cold air and wind. This index is a very useful and necessary tool to monitor the conditions individuals are exposed to during events held in colder weather calculated through a formula but multiple graphs and apps are available for quick reference. As the WCEI indicates, wind speed interacts with ambient temperature to significantly increase body cooling. If the body and clothing are wet because of sweat, rain, snow or immersion, the cooling is even more pronounced due to evaporation of the water held close to the skin by wet clothing.

The signs and symptoms of hypothermia can vary with each individual, depending upon previous cold weather injury (CWI), race, geological origin, ambient temperature, medications, clothing, fatigue, hydration, age, activity levels and others. Hypothermia is typically classified as mild, moderate, or severe, depending upon measured core temperature. Initially, the athlete may feel cold, begin to shiver and be not able to perform motor function leading to impaired athletic and mental performance. Early recognition of these symptoms is key to preventing more severe hypothermia. If early symptoms of hypothermia are not recognized or treated, the core body temperature will continue to decrease.

Freezing Injuries of the Extremities

These type of injuries include Frostbite and Frostnip

Risk Factors

• Non-environmental: Athletes are often predisposed to cold-weather injuries before going outside. Risk factors for increased susceptibility to cold-weather injuries include Nutrition and hydration, age, medications, body size and composition, fitness level, and clothing. Certain medical conditions can predispose athletes to cold injuries, including exercise-induced bronchospasm (EIB), Raynaud syndrome and cardiovascular disease.
• Environmental: Environmental conditions like cold temperatures and weather conditions may put added stress on the body. Before training or competing outside, review various environmental conditions such as air temperature, humidity, rain, snow and wind to determine if it is safe for athletes.

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