Harsh cold doesn't cause injuries, but can make them more painful

By Bill Bradley, contributing editor

With temperatures predicted to drop below freezing for two of this weekend's four NFL Divisional Playoff Games, the conditions could become harrowing for players and fans.

NFL Evolution conducted email interviews with Dr. Matthew Matava, the president of the NFL Physicians Society, this week as well as last year at this time. We have combined those interviews to provide a broader picture of what health issues the players face in the extreme cold conditions.

The St. Louis Rams' lead physician discussed the injury factor for players in these conditions, treating injuries in the extreme cold and what they might do to prevent getting hurt in the severe cold.

Does the extreme cold cause any problems in immediate treatment of injuries, including cuts or wounds?

Extreme cold does not cause any problems in the immediate treatment of injuries. Any significant injury would likely necessitate transfer off the field or sideline back into the locker room for further evaluation. Cold weather, however, does make injuries to the skin and extremities more painful because of the cold's effect on the sensory nerves of the extremities.

How does the extreme cold affect the concussion protocol? Will the temperature affect the athlete's orientation?

The concussion protocol will not be affected by the extreme cold. The only way the temperature will affect the athlete's orientation is if he experiences hypothermia, which is uncommon given the precautions in place by the teams' medical staffs.

Is there a risk of hypothermia on NFL fields?

Hypothermia is not a common problem in football as the players have multiple safeguards in place (i.e., equipment, clothing, heaters, warm liquids) to protect them from hypothermia during the game. However, each team's medical staff will be observing for signs of hypothermia in not only the players but also in the coaches and the other team's personnel on the sideline.

For team trainers and physicians, is it tougher to detect injuries in such conditions?

NFL athletic trainers are very adept at planning for, recognizing and treating cold-related injuries and medical conditions. In general, most musculoskeletal injuries will be detected despite the cold. There are no specific diagnostic methods used specifically in cold weather.

What are the biggest health issues players might face by playing in below-freezing temperatures during playoff games this weekend?

Cold weather may present a challenge to players, coaches, medical staff and other sideline personnel if any one of the following is present: 1.) Temperature of 40 degrees and below or 2.) Wet (rain, snow, ice, high humidity) or wet clothes at temperatures below 60 degrees. In addition, winds with speed above 5 mph in combination with wet conditions and temperature 40 degrees or below increase the risk of cold injury. The most common medical conditions facing football players in sub-freezing temperatures are hypothermia, frostbite and cold-induced asthma.

Are there any injuries they might suffer that they might not face otherwise?

There are no musculoskeletal injuries unique to the cold, however, players will be at an increased risk for muscle strains and tears, usually to the hamstrings, quadriceps and calf muscles. Since the ball is harder, there is a risk for fractures of the hand and fingers when trying to catch or receive the ball. Those players who participate in a game only intermittently (i.e. punters, kickers, special teams players) are at a heightened risk as they are expected to go "all out," such as on a punt or kickoff, without a significant "warm up".

What do players do to prepare for such cold weather? Is it true they undergo "Vaseline baths"?

Players will dress in multiple layers of modern synthetic clothes that maintain body heat while wicking sweat away from the body. They will often coat exposed skin with either a petroleum-based ointment or other like-agents to maintain body heat as well as protect the skin from cold wind. Many players will put tight-fitting surgical gloves under their playing gloves to help retain heat. Chemical hand warmers are often placed within the players' gloves and shoes to provide local heat to the extremities. Hydration also should be maintained. To do so, players will often drink warm chicken broth in addition to water and sports drinks during a game as a means of warming the body. The soup not only replenishes body fluids but also electrolytes such as sodium, potassium, and chlorine that may be dissipated from sweat and elevated metabolism needed to stay warm.

How do players keep muscles warm and stretched in such conditions?

They will begin stretching in the locker room while they are still warm, and then gradually increase their muscular activity in cold weather. There are space heaters on the sidelines and warming benches that work very well to warm multiple players at one time. Each sideline will also have a stationary bicycle for the players in order to allow prolonged muscle activity to reduce the risk of muscle strains and tears.

What role does a frozen or harder field play in these conditions?

A frozen surface is harder, which means that any direct contact with the ground may increase the risk of fractures, contusions and/or head injuries.

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