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Cold injuries occur in cold, wet or windy (or a combination of these) environments and are classified into three categories: decreased core temperature, freezing injuries of the extremities and non-freezing injuries of the extremities.

Risk factors of cold injury include older age, lean body composition, lower fitness level, presence of comorbidity, exercise-induced bronchospasm, Raynaud's Syndrome, anorexia nervosa, cold urticaria and cardiovascular disease.

Clothing in cold environments should include an internal layer that allows evaporation of sweat with minimal absorption, a middle layer that provides insulation, and a removable external layer that is wind- and water-resistant and allows for evaporation of moisture. Toes, fingers and ears should be well protected.

Athletic trainers should provide an opportunity for athletes to rewarm as needed during or after activity (clothes, heater, blanket, warm beverages, etc.), and encourage them to maintain proper hydration and eat a well-balanced diet.

Hypothermia: Defined as a decrease in core body temperature below 95 degrees. Classified as mild, moderate and severe depending on core temperature.

Symptoms: Vigorous shivering (only in mild, possible cessation of shivering in moderate and severe cases), increased blood pressure, decreased rectal temperature, fine motor skill impairment, lethargy, apathy, impaired mental function, slurred speech and unconsciousness.

Treatment: Includes removing wet clothing, insulating the athlete with a warm, dry blanket or clothes and moving them to a warm environment. When rewarming, apply heat only to the trunk, axilla, chest wall and groin. Provide warm, nonalcoholic fluids and foods containing 6 to 8 percent carbs.

Frostbite: Defined as freezing of body tissue by act of warm blood being shunted from cold peripheral tissues. Classified as superficial or deep.

Symptoms: Edema, redness, mottled gray skin, stiffness, tingling/burning, tissues that feel hard and do not rebound, vesicles and numbness.

Treatment: Includes rewarming slowly in water temperatures of 98 to 104 degrees. Remove any constrictive clothing. Area should be submerged for 15 to 30 minutes. Do not let the area refreeze.

Chilblain: Also known as pernio. Extended exposure to cold environment causes an exaggerated inflammatory response to cold exposure.

Symptoms: Exposure to cold, wet conditions for more than an hour at temperatures less than 50 degrees and the presence of small erythematous papules, with edema, tenderness, itching and pain.

Treatment:  Remove wet or constrictive clothing, wash and dry area gently, elevate area and cover with warm, loose, dry clothing or blankets.

For more information about athletic training, visit the National Athletic Trainers’ Association website. Information provided by the NATA Position Statement: Environmental Cold Injuries.

Travis Turner has been an assistant athletic trainer with the Houston Texans since 2015. Prior to that, he served as a seasonal athletic training intern with the Texans and Los Angeles Rams. He earned his BS from Texas Lutheran University and MS from West Virginia University.