How to avoid a wintertime injury

It's safe to exercise in even the extreme cold, but here's how to keep from getting hurt.

It's safe to exercise in even the extreme cold, but here's how to keep from getting hurt

On Jan. 10, 2004, the temperature at Gillette Stadium just outside Boston was minus-15 Celsius — or minus-23 with the wind chill. It was one of the frostiest games in history. The New England Patriots were scheduled to play the Tennessee Titans in an AFC playoff game, but everyone was wondering: Is it too cold?

Some members of the media consulted Dr. John W. Castellani, a research physiologist for the U.S. Army Research Institute of Environmental Medicine who specializes in cold weather exercise.

His answer was surprising. "It's probably worse for the fans," he said in a recent interview. "They're not doing anything but sitting there."

No players suffered cold-weather injuries and few fans were treated for weather-related ailments, but Castellani has spent the years since frequently dispelling the myths that exercise is ill-advised in extreme cold and that injuries are more frequent during the winter.

While that assessment should come as a relief to the physically active, it also comes with the caveat: Wintertime exercise does have its risks. From weather-induced asthma to ski injuries to slipping on ice, a lack of preparation and a refusal to be honest about your physical limitations can lead to avoidable injuries.

Be prepared

In 2006, Castellani used his extensive research on cold-weather injuries in the Army — hypothermia and frostbite top the list — to help develop a set of winter exercise recommendations for the American College of Sports Medicine. These recommendations emphasize a "risk-management strategy" that considers the temperature and wind chill, clothing protection, pre-existing health conditions, ways to diminish the possibility of cold stress and injury risk, and a contingency plan in case of injury.

But if you're like most weekend warriors eager to hit the slopes while the powder is fresh, prepping for cold-weather exercise probably consists of taking a few pre-emptive ibuprofen. The ACSM approach, however, can be incorporated into a workout regimen with just a simple checklist: Dress appropriately for the elements; choose a distance, time and exertion level based on current health conditions; and have a back-up plan should a sudden injury force you to walk or limp home in the cold.

No studies have been done to prove that the ACSM guidelines prevent injuries, but Castellani considers them a set of best practices designed to keep the physically active from overexertion and prolonged exposure to cold weather, both of which can lead to injuries.

Ski injuries

Dr. Malachy McHugh, director of research at the Nicholas Institute of Sports Medicine and Athletic Trauma at Lenox Hill Hospital in New York City, says that his clinic sees a surge in the number of ski-related injuries in February and that many of them result from poor investment in the fundamental components of fitness like balance, stability, and abdominal strength. His patients most commonly suffer ligament injuries in the ankles and knees.

In 2007, emergency rooms across the U.S. alone treated an estimated 101,000 skiing and snowboarding injuries involving consumer products, according to the National Electronic Injury Surveillance System.

"If you're a downhill skier doing black diamonds and mogul fields you need to do strength training for the quadriceps, hamstrings and core," he says.

McHugh recommends creating a conditioning program with a trainer or expert that focuses on key muscles and ligaments depending on the winter sport.

Know your limits

Sometimes, though, extensive preparation can't change reality.

Shawn Dailey, a physical therapist with Therapeutic Associates, a network of clinics in the Pacific Northwest, says that patients often don't want to address limitations like an aging body or a previous injury.

"It can be a challenging conversation," he says, "to let someone know that they need to scale back on their training or exercises if they don’t have the physical capacity that they feel they do or because they have an injury."

But such resistance can be the quickest path to injury. It can also be a dangerous attitude for people who have a history of asthma or cardiac distress. Both ailments can worsen during cold weather exercise, and while physical activity is still permitted for most, it's essential to be even more vigilant about tightness in the airways or symptoms of angina during the winter.

Though winter injuries don't discriminate when it comes to age, Dailey says he sees a fair number of baby boomers throughout the season. They're increasingly active, pursuing running, cycling and even triathlons despite the cold. But he often has to stress the importance of wearing the right gear, hydrating, warming up properly and conditioning beforehand.

"This is fantastic," Dailey says, "but it takes more than buying a sweet bike or pretty pair of running shoes to participate in these sports without getting injured."