Raynaud’s syndrome: the curse of the cold hands, and how you can beat it
Raynaud’s syndrome: dreaded nemesis of many runners and otherwise outdoorsy folk. Raynaud’s sufferers spot one another at races and often exchange a wry, sympathetic smile. We’re the people whose hands have turned completely white, and who are struggling to do basic tasks such as tie our shoelaces or pin on our race numbers. We might also be moaning about how we can’t feel our feet, or actually be making no sense because our lips are numb and we’re mumbling!
Raynaud’s phenomenon is a circulatory problem experienced by many people, but it’s especially annoying if you spend a lot of time outdoors in the winter. A doctor friend described it to me as ‘an inappropriate response of the blood vessels in your extremities to cold temperatures’. Everyone gets cold hands and feet when the weather is cold, but most people retain blood flow, and therefore feeling and movement in their fingers and toes. People with Raynaud’s find that when they are cold, the small blood vessels in their extremities completely close down, sending more blood into their core area. It’s the correct response from the body when you’re very cold, but with Raynaud’s it happens too quickly and too early. The outcome is that hands and feet (and sometimes lips, ears and nose) lose all their blood flow; they can turn very pale (which for some people is also painful), and it generally also means that the ability to grip or manipulate things is lost. This can last from minutes to hours, and some people also have a lot of pain when the blood flow eventually returns.
I first experienced Raynaud’s one winter in my 20s (it occurs most often in women, beginning in early adulthood), and have had it all year round ever since, although of course it’s worse in the colder months. The briefest exposure to cold can bring it on: looking for something in the bottom of the freezer, taking the bins out without gloves on, or holding a cold steering wheel are all enough to send large chunks of my fingers and hands into the dead zone. They will then remain that way for some time, usually somewhere between minutes and hours. I remember once travelling home from a particularly brutal cross-country fixture with the heating in the car turned up to full. We were all boiling, but my hands simply didn’t react. I started worrying at about the two hour mark, but thankfully a hot shower at home did the trick (albeit painfully).
The impact on manual dexterity and grip can range from mild nuisance to actual danger. On the comedic end of the spectrum, having to use the heel of both hands to turn my front door key in the lock when I get home probably looks quite amusing, but finishing a training run very low on energy because I couldn’t open any food wrappers or gels is quite unpleasant. Even worse is not being able to put on an extra layer because I can’t operate the zips on my bag or coat. In extreme circumstances, the inability to do something like put up a group shelter or use the items in a first aid kit could be really dangerous.
Over the years I have tried many of the recommended techniques and kit to keep my hands in a functional state while training, racing or hill walking. The main things I have found effective are:
- Don’t get cold before you even start! Often the damage is done before the activity begins – by not wearing enough clothes in the car on the way, or taking layers off too early. I now wear ridiculous numbers of warm layers before racing, right down to travelling in warm boots and thermals. Think base layers, fleece layers, down layers, windproof layers, and don’t neglect big hats and gloves. If possible, start your activity with one layer too many, and take something off once you’re warmed up. An oft quoted piece of outdoors advice is ‘be bold, start cold’. If you are a Raynaud’s sufferer, this tactic is not for you!
- Pay attention to core temperature. Often it’s not the temperature of your hands which controls things, but the temperature of your torso. If your body feels your core is too cold, it will start to restrict blood flow to extremities. In other words, putting on a base layer or a gilet may be more effective than several layers of gloves.
- Having said that, gloves, gloves, gloves! I am a connoisseur of gloves: I have tried pretty much everything. I don’t recommend anything marketed specifically for Raynaud’s sufferers (you can buy e.g. gloves made with silver thread, but I’ve never quite understood how these are supposed to work, and I don’t find them effective) but do recommend playing around with different combinations to see what suits you. Glove layering is more effective than wearing a single pair of thick gloves; the layers of trapped air help with insulation. Mittens are also more effective than gloves because they trap more air. My favourite combination is an old pair of thin fleece gloves with inov8 over-mittens (these are marketed as waterproof and windproof; I don’t find them very waterproof but they do keep out the wind extremely well). I put these on at the start of a run, even if not feeling very cold, and don’t take them off until I’m sure blood is flowing well in my hands. For milder temperatures, you can also get gloves with attached mittens that fold away. If I’m really struggling, I add these Montane mittens over the top of everything – they are both warm and genuinely waterproof (the outer is Pertex), and they pack into a very small pouch. Get something like this in a bigger size, so that you can layer underneath. There are also heated glove options, such as these from Outdoor Research. As far as I can tell (I’ve researched it quite extensively!) these are the only manufacturers worth considering – the gloves are expensive but universally well-reviewed. And of course, a couple of disposable handwarmers slipped inside your gloves would do a similar job.
- Finally, I use a prescription medication called nifedipine. This is an old treatment for high blood pressure; it’s been superseded for that purpose by newer options but remains effective for Raynaud’s as it works by opening up blood vessels all over the body. I can’t over-state the difference it’s made to me. I take one capsule in the morning if the weather is chilly – this helps to stop Raynaud’s attacks indoors, for example in the freezer aisle at the supermarket. If I’m out on the hill for the day, I might take another one or two capsules at around 4-6 hour intervals. You can take it every day, or just when you need it. Although it hasn’t completely eliminated my issues, I’ve noticed a huge difference in the frequency and severity of attacks. It goes without saying that you need to speak to your own doctor before trying out any new prescription medication.
Sending (warming!) hugs to all my fellow Raynaud’s crew out there – I hope there’s at least one thing here that you haven’t tried that might make your winters a bit more tolerable!
Article written by Jenny Bushell, coaching and guiding runs and walks