Medical: Cold Weather Injuries


Riding in the cold can be a miserable experience, but when things go wrong you can be putting your life at risk. Here Dr Alex Bamford tells you how to avoid and treat the most common cold-weather injuries.

Cold environments represent a significant hazard to the unprepared rider. From negotiating patches of ice to developing hypothermia and even frostbite, there are several ways that the cold can catch you out.

Bryn Davies wrote about the effects of the cold and methods of protecting against it in his online article ‘The Life-Threatening Dangers of Riding in the Cold’ and this is well worth a read for some top advice on preventative measures and types of kit that will help protect against freezing temperatures.

This article will talk in a bit more detail about the cold and methods of treating hypothermia and frostbite. 

What causes cold injuries? 

Cold injuries can be caused by a combination of either cold/wet or cold/dry conditions on the body. This is important because an understanding of the weather conditions will dictate your risk factors and protective measures that will need to be taken. Broadly speaking, the effects of the cold can be categorised as generalised (hypothermia) and localised (frostbite and frostnip).

The key to preventing cold-weather injuries is having an awareness of the risk factors and how to counteract them. Consideration should be given to the environmental temperature, clothing and equipment, physical demands of where you are riding as well as individual risk factors such as nutrition, hydration status, age and experience.

Extra care should always be considered when the still air temperature is less than 5C. 

When riding through extreme conditions or cold environments it is important to be able to obtain accurate weather forecasts so that you can plan ahead for worsening riding conditions for the coming days. 

Clothing and Equipment 

Inappropriate clothing and equipment is a sure-fire way of increasing the risk of cold-related injuries. Specific considerations should be given to headwear, layered clothing, footwear, hand protection and sleeping system. 

Individual Factors 

It is worth noting the increased nutritional requirement at colder temperatures. When temperatures reach as low as minus 20C the nutritional requirement for an adult male increase from 2,500 to 5,000+ kcal a day. Again, this needs to be incorporated into the planning process so that deterioration in health and fitness is not seen during the trip.

Dehydration can occur just as easily in cold weather environments as in hot environments. I’m sure some people will have experienced the inconvenience of the increased urinary fluid loss associated with the cold.

Signs and symptoms of Hypothermia

Mild Hypothermia – The casualty may say that they feel cold and are cold to touch. They may be having problems with manual dexterity and maybe starting to deny that they are having any problems. Their symptoms can include uncontrolled shivering, cold pale hands and feet, mild confusion and maybe rejecting help or becoming inappropriately difficult. 

Moderate Hypothermia – At this stage, the casualty may have slurred speech, their lips may have turned blue and their pulse might feel slow and irregular. They may appear to be mentally impaired and will have stopped shivering. 

Severe Hypothermia – The casualty will be unresponsive, breathing and pulse will be faint or even undetectable and they may look dead. 

What next?

If you’re riding in a group and you’ve identified someone as having hypothermia, there’s a good chance that others will be at risk too. Where possible the casualty needs to be removed from immediate danger and assessed using basic first aid principles and an Airway, Breathing and Circulation approach. 

Are they conscious?

If the casualty is conscious then give them a warm drink or some high energy food such as chocolate. If they’re unconscious then you will need to place them in the recovery position. 

Handling the Casualty

It is really important that the casualty is handled gently and carefully. If possible, they need to be moved indoors or somewhere warm. If they can’t be moved indoors then try to find something to lay them on that will insulate them from the ground. If their clothes are wet then they need to be changed into dry clothes as soon as possible.

If you have a sleeping bag available then put the casualty inside and cover with any extra clothing or blankets. The casualty should be encouraged to shiver if they are capable of doing so as this is the body’s natural mechanism for warming. 

Evacuation to Medical care 

The casualty then needs to be evacuated to medical care as quickly as possible. 



Frostbite follows a period of freezing of exposed tissue. Any part of the body can be affected but the areas that are most prone are the face, hands, feet and genitalia (make sure you’ve not left your flies undone!). Prevention is the key here and relies upon the correct use of clothing and constant awareness of the environmental conditions. 


There are varying degrees of frostbite that range from mild to severe. At the mild end of the scale, there is superficial freezing of the tissue that fully recovers within 30 minutes of re-warming (frostnip); at the severe end, there is full-thickness freezing of the tissue down to the bone which causes deep necrosis and can lead to amputation. 

At first, the skin may feel cold with a prickling feeling that then turns to numbness. There will also be skin changes to white or bluish-white colours to greyish-yellow skin that is hard and waxy looking with a clear demarcation line with non-frozen tissue.

This is associated with loss of function and clumsiness due to muscle stiffness. Eventually (usually after rewarming) the skin may become bruised in appearance with blisters. 


If you suspect anything more than frostnip, then seek urgent medical attention. If frozen tissue is allowed to thaw and then refreeze, the outcome is considerably worse, so re-warming should only be initiated if there is no risk of refreezing. 

Re-warming should occur as soon as possible but brisk rubbing, direct heat from flames, steam or exhaust fumes should not be used as you don’t want to add burns to your list of problems, particularly as there may be limited sensation in the affected body part. Armpits are a great source of warmth and can be used to initiate the warming process while you are waiting for help.

The mainstay of initial treatment is re-warming by immersion in stirred water at 38-41C, ideally with a topical antibacterial agent added. Pain relief, antibiotics and surgery will need to be considered by a medical professional if the frostbite is severe, so always consider this in your medical planning. 


Respect should always be given to the conditions you are riding through and the cold is perhaps the most dangerous. Recognising when the temperature is below 5 degrees Celsius and studying weather forecasts will help ensure you are adequately prepared and protected.

Once you have suffered a cold-weather injury you will be far more prone to developing one again in the future and it is often recommended to avoid further cold exposure for at least 12 months.

This is perhaps a good excuse to plan your next trip to a more temperate climate.