The late fall is upon us and in some places signs of winter have arrived with snow and cold temperatures. While environmental cold injuries can happen any time of year in the right conditions the likelihood of these injuries increases as the ambient temperature drops, the snow falls and the ski or snowboarding trips are planned. While those competing in traditional winter sports or wildernesses activities can be particularly at risk for environmental cold injuries, so can athletes who are participating in traditional fall sports in cold conditions. Participation in a football or soccer game or even a cross country race in cold weather can potentially lead to frostbite or hypothermia with the right combination of conditions. The important thing to understand is that these types of injuries can be prevented with appropriate precautions.

In order to understand how to prevent environmental cold injuries you must first understand cold stress and your body’s response. As an equation, cold stress can be described as follows:


As the temperatures become lower and wind speeds rise the likelihood of environmental cold injuries increase. The likelihood increases even further if a person is outside in cold temperatures with high wind speeds and is wet (perhaps from sweating or even immersion in cold water). Heat transfer in the water is 70 times greater than in the air. Heat loss increases two times when someone is wet and cold as compared to dry and cold. Additionally, the insulating properties of clothing are decreased up to 90% when wet. The NOAA windchill chart can give you an idea of the increasing injury potential as temperatures drop and wind speeds increase.

 Windchill Chart

Several non-environmental risk factors or certain medical conditions can increase the potential for environmental cold injuries. Those who have suffered previous environmental cold injuries are 2 – 4 times more likely to suffer another injury. Females are also 2 times more likely to suffer from environmental cold injuries. Wearing the appropriate clothing (check insulation rating) is a particular focus on prevention, being unprepared increases injury risk. Youth athletes are at increased risk of injury because of higher surface area to mass ratio and lower adipose deposits. This means young athletes can suffer from an injury in conditions that would not normally impact adults. Also, if your child suffers from exercise-induced bronchospasm or asthma, Raynaud’s syndrome or cold urticaria the risk of environmental cold injury increases.

The National Athletic Trainers’ Association Position Statement: Environmental Cold Injuries (2008) delineates several recommendations in order to prevent cold injuries. Those recommendations are as follows:
Have trained personnel available that are specifically trained in cold injury prevention, recognition, and treatment; athletic trainers are among these.
Identify those participants that are increased risk and monitor them closely; in certain situations they may need to be withheld from participation.
Have a clear event or practice guideline on assessing weather conditions and making decisions about event postponement or cancellation.
Know how to properly layer clothing with an inner wicking layer, middle insulation layer and wind and water resistant external layer; click HERE for a video and HERE for an article on how to layer properly.
For young athletes more frequent breaks and opportunities to warm are necessary.

Cappaert, T.A., Stone, J.A., Castellani, J.W., Krause, B.A., Smith, D., and Stephens, B.A. (2008). National Athletic Trainers’ Association position statement: Environmental cold injuries. Journal of Athletic Training; 43(6): 640–658. Available at

National Weather Service. Windchill Chart. Accessed at

Occupational Safety and Health Administration. Cold Stress Accessed at

Submitted by Heather L. Clemons, MS, MBA, ATC