Salves for sore limbs Relief often is only skin deep

August 06, 1991|By Ben Yagoda | Ben Yagoda,Universal Press Syndicate In Health Magazine

AT THE MOMENT, my office smells more like a Y than most Y's. There are no sweaty guys here, just a bulging shopping bag full of Ben-Gay, Aspercreme, Eucalyptament, Heet and other "topical analgesic balms."

This is the stuff you rub into your skin after you've played tennis for the first time in years, when you feel that familiar ache the medicos call delayed-onset muscle soreness. The stuff tends to the pungent.

I've been collecting the balms because after years of blind faith, I want to find out whether they really work. The rest of the public certainly believes they do. How else to explain their dizzying display in drugstores and $64 million in sales in 1990? Marketed not only to athletes but to people with backaches, arthritis and rheumatism, most of these products don't promise to heal anything. Their only claim is that they'll make you less sore.

I began my experiment by doing more push-ups than I thought I had in me. A day and a half later, I rubbed Ben-Gay into my screaming left pectoral and Sportscreme into the right one. After a few minutes, the pain on the Sportscreme side seemed dulled. On the Ben-Gay side there was a burning sensation, but again I couldn't tell if my muscles actually hurt any less than before. It occurred to me that applying rubs to both sides of my chest at the same time probably hadn't been the smartest way to proceed. I hadn't left one side untreated for comparison.

So a few hours later, I applied Heet to only one side. The combination of the Heet and the Ben-Gay residue produced two noticeable effects: One, my skin began to itch like crazy. Two, my wife screwed up her nose in disgust and retreated to the other side of the house. I was left -- smelly, alone -- with no clearer idea of whether the balms work.

So I did some homework.

The first thing I learned is that there are two basic categories of rubs: the smelly and the non-smelly. Ben-Gay and other odoriferous ointments like Tiger Balm, Sloan's Liniment, Flex-All 454, Icy Hot, Warming Ice and Dragon Balm are all examples of what's known in the business as a counterirritant. They contain ingredients like menthol or camphor, which irritate the skin, promoting the flow of blood to the area. They redden the skin and bring on a sensation of warmth or coolness.

Most researchers I spoke with believe that counterirritants do relieve pain, even though few controlled studies have been done. In one experiment by James R. White, director of the Exercise Physiology and Human Performance Lab at the University of California at San Diego, 40 people exercised until their forearms were sore. Then they massaged their muscles with either Ben-Gay or a placebo cream with no active ingredients. The Ben-Gay reduced soreness significantly more than the placebo. White has gotten similar results in people with arthritis.

You might assume that counterirritants work the same way a heating pad or a warm bath does: The heat increases blood flow to the area, which helps wash away waste products from the tiny rips in the muscle that occur when you overexert. That eases the swelling as well as the discomfort.

But you'd be wrong. While counterirritants definitely produce a small increase in blood flow and temperature in the skin, the heat probably doesn't reach the muscle tissue.

"Rubs generate heat that penetrates about 1 centimeter below the skin," says Phillip Marone, medical director of the Sports Medicine Program at Thomas Jefferson University Hospital in Philadelphia. "Ultrasound or microwave works much deeper and better."

How, then, do the rubs work?

Most likely, says Edward R. Perl, a physiologist at the University of North Carolina at Chapel Hill, it's simply a case of masking one pain message with another. The noxious ingredients in these rubs irritate your skin, creating minor pain signals that compete with those your muscles are sending out -- sort of like punching yourself in the arm after you've hit your thumb with a hammer.

The potent smell of the rubs may not be incidental, either. Doctors and trainers agree that the ointments' mentholly aroma may create a pain-relieving placebo effect: A single whiff is enough to transport every athlete back to a comforting remembrance of locker rooms past. In the words of David W. Hill, director of the Exercise Physiology Lab at the University of North Texas, "If you're going to be going around smelling like that, this stuff better be working."

However they work, counterirritants have been given the nod by the Federal Drug Administration as effective pain relievers.

The second category of rubs -- the ones that don't smell -- are a different story. Sportscreme, Aspercreme and Myoflex are examples of balms that contain trolamine salicylate, a substance similar to aspirin that is absorbed through the skin but only minimally into the bloodstream. That means they can be used in conjunction with aspirin without fear of overdose or stomach upset. In theory, they get the relief closer to the site of pain.

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