Nonfreezing Cold Injury and Cold Intolerance in Paddlesport

Abstract

Introduction-Nonfreezing cold injury (NFCI) occurs when tissues are subjected to prolonged cooling that causes tissue damage, but not freezing. Long-term effects include cold intolerance, with allodynia, pain, or numbness of the affected limb. Those who participate in outdoor paddlesports are at particular risk.Methods-This is an epidemiological study that aimed to determine the risk factors for paddlesport athletes developing NFCI and chronic cold intolerance in their hands. Secondary outcomes were to correlate cumulative cold exposure with the development of cold intolerance and to identify risk factors for developing NFCI or cold intolerance. Six hundred nine athletes responded to a survey distributed by their national governing body obtaining demographic and activity details, symptoms of NFCI, and a cold intolerance severity score (CISS).Results-Twenty-three percent reported symptoms consistent with acute NFCI. The median CISS was 31 y (interquartile range 25-43), and 15% had a pathological CISS defined as >50. Females and individuals with Raynaud's phenomenon or migraines had a significantly higher CISS (P<0.05). Regression analysis found that females, smokers, and those with Raynaud's phenomenon or a previous nerve injury had a significantly higher risk of developing pathological cold intolerance (CISS >50). There was no correlation between cumulative cold exposure and CISS.Conclusions-A large proportion of paddlesport athletes undertaking activity in cold conditions have a pathological CISS or episodes consistent with NFCI. Cumulative cold exposure was not associated with a pathologically high CISS. The risk factors were female sex, smokers, and those suffering from either Raynaud's phenomenon or nerve injury.

The peripheral vascular responses in non‐freezing cold injury and matched controls

“…Although less reported in civilian populations, exposure to cold in occupations such as farming, fishing, construction, cold storage and food preparation may lead to NFCI. In addition, the increased popularity of outdoor recreational activities also increases the risk of cold injuries and NFCI has been reported in paddle sports (Oakley et al., 2022 ), ice skaters (Tlougan et al., 2011 ), cyclists (Fraser et al., 1979 ), divers (Laden et al., 2007 ), long distance Polar rowers (Longman et al., 2020 ), and hikers who become incapacitated (Paal et al., 2013 ).…”

Elucidation of the Role of TRPV1, VEGF-A, TXA2, Redox Homeostasis, and Inflammatory Cascades in Protection against Cold Injuries by Herbosomal-Loaded PEG-Poloxamer Topical Formulation

“…Exposure to extreme cold environments invokes several physiological and behavioral changes to prevent the induction of hypothermia, most notable responses include heat generation through shivering and nonshivering thermogenesis. , Local response to heat conservation is elicited through vasoconstriction and activation of nociceptors to cold, which helps evade cold exposure temporarily . Prolonged and repeated exposure to extremely cold environments in people living/working in subzero environments leads to desensitization of peripheral sensory nerves and loss of painful stimuli to cold, which accentuates the ischemic damage caused due to local vasoconstriction, direct damage due to ice crystal formation and inflammatory response, leading to further tissue damage and delayed healing. Furthermore, the restriction of blood flow due to extreme cold weather exposure leads to less oxygen at the injured location, which makes it more prone to bacterial and fungal infections, thereby limiting the ability of new tissue to grow around the frostbitten site.…”

Plasma biomarkers of endothelial function, inflammation and oxidative stress in individuals with non‐freezing cold injury

“…Historically, NFCI has been a major problem for the military; for example, 64% of the UK 3 Commando Brigade experienced symptoms of NFCI during the Falklands Conflict, although the conflict lasted only 25 days (Golden et al., 2013 ). The increased popularity of outdoor activities means that civilians are also at risk of NFCI (Longman et al., 2020 ; Oakley et al., 2022 ; Paal et al., 2013 ), as are those who are homeless (Parsons et al., 1993 ) or immobilized (Williams et al., 2005 ). Although the current phenotype is thought to be less severe than historical cases (Kuht et al., 2019 ), chronic symptoms can have a profound effect on an individual's quality of life and employability.…”