Athletes with tetraplegia (spinal cord injury at the cervical region of the spinal cord) are at a greater risk of heat illness than their able-bodied counterparts, due to the loss of sweating capacity and vasomotor control below the lesion level. Commercially available ice vests worn prior to exercise (pre-cooling) have received considerable interest in the able-bodied athletic population eliciting varying results in performance, and physiological and thermoregulatory responses. However, limited research has been conducted in thermoregulatory impaired athletes with tetraplegia. Anecdotally water spraying the face and torso is commonly used by these athletes during breaks in play, though the effectiveness of this method has not been established. The purpose of this study was to investigate the effects of pre-cooling using an ice vest and the combination of pre-cooling and cooling during play using water sprays on simulated wheelchair rugby performance in athletes with tetraplegia.