With winter on its way, and the temperatures dropping nationwide, the National Athletic Trainers’ Association (NATA) has issued recommendations that people of all ages can follow to reduce the risk of injuries and illnesses that may occur from cold-weather activity. Cold-weather injuries are classified into three categories: decreased core temperature (e.g., hypothermia), freezing injuries of the extremities (e.g., frostbite) and nonfreezing injuries of the extremities (e.g., chilblains). The recommendations are included in a newly released position statement published in the November/December issue of the Journal of Athletic Training, the scientific publication of NATA.
“Many cases of cold-related injuries are preventable and can be successfully treated if such conditions are properly recognized and appropriate care is provided in a timely manner,” said the study’s lead author, Thomas A. Cappaert, PhD, ATC, CSCS, CES, associate professor of athletic training/sports medicine, Central Michigan University. “We’re hoping to educate parents, coaches, school administrators, employers, athletic trainers and other health care professionals and those who exercise or work in the cold about what can be done to prevent these types of serious injuries.”
According to NATA’s position statement, many people engage in fitness pursuits and physical activity year-round in environments with cold, wet or windy conditions (or a combination of these), thereby placing themselves at risk of cold injury. In fact, cold injuries and illnesses can affect any physically active individual, including military personnel, traditional winter-sport athletes and outdoor-sport athletes. Traditional team sports like football, baseball, softball, soccer, lacrosse and track and field also have seasons that extend into late fall or early winter or begin in early spring, when weather conditions can increase susceptibility to cold injury.
To guard against illness and injury caused by outdoor activity in cold weather, NATA recommends implementing a risk management process that includes strategies for preventing, recognizing and treating cold injuries. In addition, when getting ready to exercise in cold weather, one should follow the following preventive guidelines:

  • Wear insulating clothing that allows adjustment to changing weather conditions and also allows evaporation – and minimal absorption – of perspiration;
  • Re-warm your body as needed during outdoor activities. Use external heaters, wear additional clothing or layer clothing, or take regular breaks in a warm indoor environment;
  • Make sure to eat a well-balanced diet and stay hydrated with water or sports drinks. Avoid alcohol.

Cold-related Ailments: Identification and Treatment
Following is a summary of the cold-related ailments, as well as their prevention and preferred treatment, as outlined in the Journal of Athletic Training article:
1. Hypothermia: The signs and symptoms of mild hypothermia include vigorous shivering, increased blood pressure, core body temperature less than 98.6F(37.6C) but greater than 95.6F (35.6C), fine motor skill impairment, lethargy, apathy and mild amnesia. Signs of moderate and severe hypothermia include cessation of shivering, very cold skin, depressed vital signs, core body temperature between 90.6F (32.6C) and 95.6F (35.6C) for moderate hypothermia or below 90.6F (32.6C) for severe hypothermia, impaired mental function, slurred speech, unconsciousness and gross motor skill impairment.
What to do: Begin by removing wet or damp clothing; insulating the subject with warm, dry clothing or blankets (including covering the head); and moving him or her to a warm environment with shelter from the wind and rain. When re-warming, apply heat only to the trunk and other areas of heat transfer, including the armpit, chest wall and groin. Re-warming the extremities can send cold blood from the body’s periphery to its core, which leads to a drop in core temperature, and may result in cardiac arrhythmias and death. Provide warm, nonalcoholic fluids and foods to help sustain shivering and maintain metabolic heat production. Avoid applying friction massage to tissues, which may increase damage if frostbite is present.
2. Frostbite: Be aware of signs and symptoms of superficial frostbite, which include swelling, redness or mottled gray skin appearance, stiffness and transient tingling or burning. Be aware of signs and symptoms of deep frostbite, which include edema, mottled or gray skin appearance, tissue that feels hard and does not rebound, blisters, and numbness or loss of sensation.
What to do: The decision to re-warm a subject is contingent upon resources available and likelihood of re-freezing. Re-warming can occur at room temperature or by placing the affected tissue against another person’s warm skin. Re-warming should be performed slowly, and water temperatures greater than 98.6F to 104.6F (36.6C–40.6C) should be avoided. To re-warm, the affected tissue should be immersed in a warm (98.6F–104.6F [36.6C–40.6C]) water bath. The water will need to be gently circulated, and the area should be immersed for 15 to 30 minutes. Thawing is complete when the tissue is pliable and color and sensation have returned. In addition, re-warming can result in significant pain, so a physician may prescribe pain medication.
3. Chillblain: Occurs with exposure to cold, wet conditions for more than 60 minutes at temperatures less than 50.6F (16.6C). It can be identified by the presence of small red bumps, swelling, tenderness, itching and pain.
What to do: Remove wet or constrictive clothing, wash and dry the area gently, elevate the area, and cover with warm, loose, dry clothing or blankets. Do not disturb blisters, and refrain from applying friction massage, creams or lotions or high levels of heat. Do not allow any weight bearing on the affected area.
4. Immersion (Trench) Foot: Occurs with exposure to cold, wet environments for 12 hours to three or four days. Symptoms include burning, tingling or itching, loss of sensation, bluish or blotchy skin, swelling, pain or sensitivity, blisters and skin fissures or maceration.
What to do: For treatment, thoroughly clean and dry the feet, then treat the affected area by applying warm packs or soaking in warm water (102.6F–110.6F [38.8C– 43.3C]) for approximately five minutes. Replace wet socks with a clean, dry pair, and rotate footwear or allow footwear to dry before reusing.
Children should take similar preventive measures as those suggested for adults, but they should also be encouraged to take more frequent breaks from a cold environment, especially water immersion. Similarly, as adults reach the age of 50, the ability to tolerate cold decreases and risk of hypothermia increases. Older athletes are also more likely to have chronic health concerns, such as diabetes, hypothyroidism, hypopituitarism or hypertension, which can increase the likelihood of cold injury; therefore, older athletes should carefully and conservatively follow all prevention and recognition recommendations.
“We are not invincible when it comes to exercise in the cold,” Cappaert, said. “In extreme cases, if medical care is not provided in a timely manner, serious long-term damage can occur.”
To read “National Athletic Trainers’ Association Position Statement: Environmental Cold Injuries,” visithttp://www.nata.org/statements/position/environmentalcoldinjuries.pdf.

Athletic trainers are unique health care professionals who specialize in the prevention, diagnosis, treatment and rehabilitation of injuries and illnesses. The National Athletic Trainers' Association (www.nata.org) represents and supports 30,000 members of the athletic training profession. NATA advocates for equal access to athletic trainers for patients and clients of all ages and supports H.R. 1846.