Preventing Cold Related Injuries

Just as with my last article on the prevention of heat related injuries there are also practical guidelines which have been prepared by the American College of Sports Medicine (ACSM) when it comes to running activities in a cold environment. The key goal in participating in cold weather is to avoid exposure of skin to the elements and wearing of proper clothing. In looking at the objectives for advising officials and participants about these areas the following categories require attention;

1. To educate athletes and event officials about the most common forms of environmental illness including predisposing conditions, warning signs, susceptibility and incidence reduction.
2. To advise officials of their legal responsibilities and potential liability with regard to event safety and injury prevention.
3. To recommend that officials consult local weather archives and plan games or training at times likely to be of low environmental stress to minimize detrimental effects on athletes.
4. To encourage officials to warn athletes about environmental stress on game or training day and its implications for cold illness.
5. To inform officials of preventive actions that may reduce dehydration, frost bite and other related environmental illnesses.
6. To describe the personnel, equipment, supplies necessary to reduce and treat cases of collapse and environmental illness.

To this end and again after review of the available literature and consultation with various medical authorities and officials familiar with soccer it was felt that the following items are some key guidelines for soccer participation in the cold:

1. Avoid dehydration and make sure you pre-hydrate. I gave the usual hydration guideline in my last article and these will also apply here with exercise in the cold. Remember the body requires fluids to carry out most of its metabolic functions.
2. Drinking carbohydrate and electrolyte fluids may be beneficial in maintaining your glycogen stores in the muscle. In cold weather training, glycogen is used up quicker by the body.
3. Wear appropriate clothing that will cover as much of your body as possible using materials that will trap moisture and sweat away from your skin.
4. Officials should be very cautious in authorizing games and practices in conditions where the temperature is below 0 C and wind conditions are high. They should enquire of the participants to ensure pre-event hydration, medication use and susceptibility to cold injury (prior occurrence).
5. Warning flags:
green - proceed with caution
amber - moderate risk to exposure
red - high risk
Should be posted at locations easily seen by participants, support staff, medical staff and spectators.


The other area to consider is the risk factors which can predispose a soccer player to cold injury. These include but are not limited to :

1. Unacclimatized
2. Unfit
3. Hypohydration
4. Use of a variety of medications
5. Persons with persistent, disabling mental illness
6. Various medical conditions, such as asthma
7. Inappropriate clothing
8. Infection, colds, flu


Identifying cold injury in your soccer player is the next area of concern. Cold injury or hypothermia is a condition that occurs whenever the body heat loss exceeds the body heat production. Persons with mild hypothermia (core body temperature 32 to 35 C ) have the ability to spontaneously rewarm and generally do not present with any physical abnormalities. Those with severe hypothermia ( core body temperature of less than 28 C ) require active rewarming and immediate medical attention. Below is a list of some of the early warning signs to look for and again this is not an exhaustive list:

1. Areas of blanching on the face or other parts of the body
2. Loss in sensation to touch on body surfaces
3. Difficulty getting your breath
4. Headache, dizziness
5. Persistent shivering
6. In coordination
7. Confusion, agitation, uncooperativeness
8. Reduced heart rate and decreased blood pressure


Adequate pre-event conditioning and an 8 - 10 day period of acclimatization, further aids in the reduction of the risk of cold injury. Below is a list of the most common types of cold related injuries:

1. Frostbite - this has been classified into 4 degrees of severity depending on the depth of the injury. Blistering occurs with degrees 2 or greater and permanent tissue damage occurs with degrees 3 or greater. This will usually affect the face, hands and feet first. Initially in a first degree the frozen tissue is cold, hard and bloodless. After thawing, the skin may become wheal-like, red, and painful. It may show signs of edema but there is usually no blistering. Whereas a second degree frostbite is characterized by blister formation.

2. Nonfreezing Injuries - are those injuries where due to skin exposure to lower temperatures the skin is damaged but it does not go through a freezing period such as with frostbite. This is usually due to cold water exposure and this is not characteristic for soccer players.

3. Respiratory and Cardiac Injury - this presents itself in the soccer players inability to breath properly, difficulty getting their breath, general weakness due to poor oxygen exchange and bradycardia ( decreased heart rate ) which could be accompanied by cardiac arrhythmia's ( abnormal hear rate ). This also may spontaneously disappear or require immediate medical attention if it persists.

So to get the most out of the remaining days that will permit outdoor games and for those who train and play through the winter these recommendations should help you to have a safer season. However with the new indoor facilities available now such as The Ontario Soccer Associations new Soccer Centre why would you want to continue to train outdoor as the colder weather arrives.

Acknowledgements:
Dr. Tom Fried, Team Physician, Toronto Lynx Soccer Club
Member, OSA Medical Committee, CSA Medical Committee


Submitted by:
Dr. Robert Gringmuth,
Sports Chiropractic Specialist and Co-ordinator, Toronto Lynx Soccer Club
Chair, OSA Medical Committee

This paper was originally published in Inside Soccer Magazine.