It may or may not be a consequence of our globe’s climate change, but the winter of 2010-2011 proved to be particularly brutal. Evidenced by a continual string of storms, unprecedented precipitation and record breaking low temperatures, an increasing number of people encountered the dangers of frigid weather. Will 2012 be just as cold?
Some massage therapists may remember learning about a massage contraindication for frostbitten extremities during their initial schooling. However, few have been required to recall the details of that warning for their clinical practice. Because the elements can be harsh during winter, massage therapists are urged to review who is at highest risk and what the warning signs are for frostbite.
Occurring when the skin and other tissues are exposed to very cold temperatures, frostbite can cause permanent tissue damage. Usually affecting the hands, feet, nose, cheeks and ears, frostbite can happen within minutes of exposure to extreme cold, or even in above-freezing temperatures if there is a strong wind chill or if the person is at high altitude or wet.
When exposed to cold, the body strives to preserve heat. By constricting the blood vessels near the skin’s surface, blood is forced into the body’s core to keep the vital organs warm. This is exactly the mechanism that prevents the extremities (such as hands and feet) from receiving enough blood, which causes them to become cold and makes them vulnerable to frostbite. The following sequence of events can lead to frostbite:
- Initially, the blood vessels alternate between narrowing and widening to keep the extremities as warm as possible.
- Under extremely cold conditions the vessels stop widening.
- When the skin’s temperature drops low enough, ice crystals form around and within the cells, freezing tissue and possibly rupturing cells.
- The lack of circulation that occurs when the body directs blood flow away from the extremities can cause damage to the cells.
While a massage therapist is most likely to encounter just the first stage, there are four degrees of frostbite severity, each with their own symptoms:
- First Degree – Known as frostnip, this affects only the skin’s surface. Initial symptoms are itching and pain, and some numbness may exist. These symptoms are usually not permanent.
- Second Degree – This level involves freezing of the skin, but not deep tissue. The affected area usually will develop blisters one to two days after cold exposure.
- Third Degree – Possibly causing a temporary loss of use of the affected area, this level is deep enough to involve tissue, muscle and tendons. The skin turns hard and waxy and purplish, and blood-filled blisters may be present.
- Fourth Degree – Freezing tissue, muscle and tendon, this is the most severe stage of frostbite. The affected area suffers permanent loss of function and is at risk for possible amputation due to infection.
In general, the indications of frostbite are:
- Itching, pain or prickling progressing to numbness
- Pale, hard, cold skin with a waxy appearance
- Flushing from blood rushing to the area after being re-warmed
- Burning sensation and swelling from collected fluid that can last for weeks
For Massage Therapists
Particularly in the coldest of months, people may come in for a massage appointment from an extended foray in the elements. Although it is not always obvious, frostbite must be recognized by a practitioner, because massaging the affected area can cause serious tissue damage. To help recognize frostbite, it is helpful to know who is most vulnerable. Frostbite can occur more quickly or be harder to recognize in those who:
- smoke or are under the influence of alcohol or another substance
- have cardiovascular disease
- have peripheral vascular disease or poor circulation
- take beta-blockers
- have diabetes
- do winter sports at high altitudes
- work outdoors
If frostbite is suspected, a therapist should never apply any massage techniques to the affected area.
Medical help should be sought right away to prevent permanent tissue damage, as the extent of the injury may not be apparent until the area is re-warmed. If medical care is not available immediately, a mildly frostbitten area can be warmed in warm water (101 – 104° F), or by repeatedly applying warm cloths to the area for 30 minutes. Never use hot water, fire, a heating pad, or other dry heat because these methods may burn the skin before the feeling returns. Because the affected area may swell, remove any jewelry before re-warming. You can also give the person with frostbite something warm to drink (no alcohol or caffeine). If the toes are the frostbite culprit, help the person ambulate without them putting pressure on their feet. If there is any danger of refreezing, wait to thaw the area out until warm shelter is guaranteed. Thawing and refreezing can cause even more serious damage to tissue.
Massage therapists are not expected to serve as emergency medical technicians. However, this winter could easily bring a client into your practice complaining of frozen toes. Because massaging said toes could do significant damage to a client with an unsuspected case of frostbite, massage therapists need to have a firm understanding of this frigid condition.