Cooling athletes with a spinal cord injury
Sweating and vasomotor control are lost below the lesion, impairment scales with lesion level, and site-specific cooling (ice vests) is what has been shown to work
Key Findings
Individuals with an SCI have reduced afferent input to the thermoregulatory centre and a loss of both sweating capacity and vasomotor control below the lesion; the impairment is proportional to the level of the lesion — high-level lesions (tetraplegia) carry a greater heat-illness risk than lower-level lesions (paraplegia) at a given exercise intensity.
Cooling may therefore be highly beneficial in this group even in moderate ambient conditions (~21 °C).
Site-specific cooling suits an SCI athlete better than whole-body water immersion (practical difficulties of immersion in this population). From the studies reviewed, wearing an ice vest during intermittent sprint exercise decreased thermal strain and improved performance; ice vests are also effective in able-bodied athletes.
Drawing on able-bodied evidence, combining methods before exercise and during exercise or rest periods/half-time may increase effectiveness; because research in SCI athletes is scarce, an optimal strategy cannot yet be defined, and strategies fitted to intermittent wheelchair sports and their logistics are still needed.
Other cooling methods reviewed in the body (preprint full text, checked 2026-09-28: sections 2.1-2.3, 3.2): hand/foot cooling (hands in 10 °C water; some positive findings, but grip loss and numbness limit it in wheelchair court sports), water sprays (the one SCI study found no thermal or performance effect), cooling garments (ice vests; cooling hats and neckbands), and water sprays and fans at venues during breaks; ice slurry and cold-water ingestion appear only as general cooling methods, not as SCI studies.
Practical Application
This review's message: SCI removes sweating and skin-blood-flow control below the lesion, so thermal strain rises with lesion level and cooling helps even at ~21 °C; the one intervention with SCI-specific evidence is an ice vest during intermittent sprint exercise (less thermal strain, better performance). Treat any hot session or competition for an SCI athlete as elevated-risk — build cooling in, don't react to symptoms.
Pre-cool (vest, cold drinks or ice slurry) and cool again in every break, on areas that still sweat and sense (face, neck, arms above the lesion); combining methods before and during is the reviewed recommendation. (Ice-slurry and site choices beyond the vest are review body, not abstract.)
Don't rely on thirst or perceived heat below the lesion as a warning — sensation is impaired. Agree a stop rule and a monitoring plan with the medical team. (Not from this paper; the base's own practice.)
Limitations
Narrative review; small heterogeneous intervention studies with mixed lesion levels; SCI-specific (amputee/CP/vision-impaired athletes differ); magnitudes qualitative — the abstract carries no effect sizes.
How this entry was checked and changed
Why this level
regraded 2026-09-27 from B: authoritative narrative review from the leading SCI-thermoregulation group (Goosey-Tolfrey, Price), not a systematic review
Content correction 2026-09-27
Level B -> B+ per the 2026-09-26 rubric (authoritative narrative review from the leading group).
Added what the abstract states: impairment proportional to lesion level, benefit even at ~21 °C, site-specific > immersion, ice vest during intermittent sprints as the evidenced method, combination strategy, paucity of research.
The list of cooling sites/methods labelled as review body; the stop-rule advice labelled as the base's own practice; Sport line normalised.
2026-09-28: lines labelled "full text; not checked" read against the open-access full text (Loughborough repository (via irep.ntu.ac.uk), accepted manuscript): 0 confirmed, 1 corrected (forearm cooling/"spray with airflow"/ice slurry -> hand/foot cooling, sprays with no effect in SCI, slurry not studied in SCI; "skin with intact innervation" removed), 0 removed.