How SCI Affects Temperature Control — Why Winter Requires Extra Awareness

As winter settles in across the country, many of us start reaching for heaters, cozy blankets, and warm drinks. While these seasonal comforts are familiar, they also mark an important time to pay closer attention to body temperature — especially for people living with a spinal cord injury (SCI).

After SCI, the body’s ability to regulate temperature doesn’t work the same way it used to. In colder months, this can mean navigating a fine line between being too cold and suddenly overheating, sometimes without the usual warning signs.

Why Temperature Regulation Changes After SCI

In a typical body, temperature is regulated automatically. The brain senses changes and sends signals to cool down or warm up. With SCI, that communication system can be disrupted.

• Disrupted signals: The hypothalamus — the body’s “thermostat” — may no longer be able to send messages past the injured portion of the spinal cord. As a result, sweat glands and blood vessels below the injury may not respond appropriately.

• Impaired sweating: Sweating is one of the body’s primary cooling mechanisms. Many people with SCI lose the ability to sweat below their level of injury, making it harder to release excess heat.

• No shivering below the injury: Shivering helps generate warmth when we’re cold. After SCI, this reflex may be absent below the injury level.

• Vascular changes: Blood flow regulation in the skin and muscles is often reduced, affecting how the body conserves or dissipates heat.

  
  

The Risks: Too Cold, Too Hot — and the Sudden Shift Between

Because temperature regulation is impaired, people with SCI face risks on both ends of the spectrum.

Cold exposure: There’s an increased risk of hypothermia because the body may not generate or retain heat effectively — even if you don’t feel extremely cold.

Overheating: Heated indoor spaces, layered clothing, or blankets can quickly lead to overheating. Without normal sweating, the body may struggle to cool down, and the shift from cold to overheated can happen faster than expected.

Staying Safer in Cold Weather

Winter comfort requires intention and monitoring — not just adding more layers.

Layer thoughtfully: Layering is important, but it’s equally important to check how clothing fits. Make sure layers aren’t bunching, pinching, or creating pressure points — especially around bony areas. Poorly positioned clothing can increase the risk of pressure injuries and, for some, autonomic dysreflexia. Smooth fabrics, proper positioning, and regular skin checks matter.

Monitor temperature closely: There’s often a fine line between being chilled and becoming overheated. Pay attention to subtle cues, adjust layers gradually, and avoid overheating indoor environments.

Warm up safely: Use blankets and warm drinks to raise body temperature slowly. Warm baths or showers can help, but always monitor water temperature carefully and avoid extremes.

Control your environment: Avoid drafty rooms, preheat vehicles when possible, and keep indoor temperatures steady rather than fluctuating dramatically.

A Seasonal Reminder

Winter invites us to slow down and get cozy — but for people with SCI, it’s also a season that calls for awareness and balance. Staying warm doesn’t mean piling on layers without thought, and staying comfortable doesn’t mean ignoring early signs of overheating.

By checking in with your body, monitoring temperature changes, and being mindful of clothing and environment, you can reduce risks and stay safer throughout the colder months.