Salve Savvy

Like many locker rooms, that of the New York Knicks often reeks of the sports salves and the liniment that achy athletes rub into sore muscles and joints. But team internist Dr. Peter Bruno, like many sports medicine specialists, is no great fan of these topical pain relievers.

“They give you a sense of warmth and smell good,” says Bruno, who acknowledges that players love getting massaged with these products. But despite some manufacturers’ claims of “deep strength,” Bruno says sports balms’ effects are largely superficial.

“They don’t actually penetrate deeply,” he says. “You’d be better off taking a hot shower or putting a hot towel on the joint.”

Unlike oral pain relievers such as aspirin and ibuprofen, which can help reduce inflammation, topical analgesics have little, if any, curative power, experts say.

At best, they provide symptomatic relief. At worst, they can exacerbate injury by masking pain or delaying appropriate medical treatment.

But when used according to directions, they are relatively harmless and may help some people manage pain.

“People like to be able to do something,” says Dr. Doyt Conn, a rheumatologist and senior vice president for medical affairs for the Arthritis Foundation in Atlanta. “Topical analgesics are safe, easy to administer and can help some people relieve minor muscular and joint pain.”

Adds Frank Rathbun, a spokesman for the Non-Prescription Drug Manufacturers Assn. in Washington, D.C.: “Topical analgesics are approved for safety and efficacy by the FDA. And people wouldn’t continue to buy and use these products if they didn’t provide relief.”

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Topical pain relievers work in one of several ways, depending on their ingredients. Many contain counterirritants such as menthol, camphor or eucalyptus oil that cause a distracting sensation of burning or tingling.

These so-called counterirritants “suppress the pain response by substituting another sensation,” says Victor Padron, associate professor of pharmacy at Creighton University in Omaha. “It’s like getting rid of a headache by dropping a bowling ball on your foot.”

Some topical analgesics contain salicylate--the same pain-relieving substance found in aspirin--which can decrease the ability of the nerve endings in the skin to sense pain.

These products also can be absorbed into the bloodstream, but in “minuscule amounts compared to aspirin” taken orally, says Dr. Thomas Kantor, professor of clinical medicine at New York University School of Medicine and past chairman of the Food and Drug Administration advisory review panel on over-the-counter analgesics. They can, however, be harmful to people who are allergic to aspirin or to those taking anticoagulant medication.

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Another frequently used ingredient is capsaicin, a substance found in hot peppers, which reduces the amount of a neurotransmitter called “substance P” that sends pain signals to the brain.

“Many people find these to be the most effective of all the topical analgesics,” says Dr. M. Joseph Grennan, an anesthesiologist at the Center for Pain Medicine at Allegheny General Hospital in Pittsburgh. But analgesics that contain capsaicin must be applied three to four times a day, every day, and usually take two to four weeks to begin working.

The major caution with all topical analgesics is to be sure you’re using them as directed for appropriate conditions.

“It’s important to ask yourself, ‘Why am I using this stuff?’ ” says Dr. Ben Kibler, a sports medicine specialist in Lexington, Ky., who is vice president of the American College of Sports Medicine.

“They’re probably OK to help you over a little soreness from an acute overuse problem like skiing too much. But if you’re dealing with a chronic overload problem, like pain, whenever you play racquetball or run, your body is trying to tell you something and you’re not listening.

“You’re not doing yourself a favor by slapping on salve every time you play softball, since what you might really need to relieve your pain is to take some time off or try a brace or do some exercises.”

In general, Kibler says, “heat has less of a role in treating sports injuries than cold.”

New injuries need ice for at least the first 48 hours, notes Kibler, who says that “the only time I use heat is for stiffness,” typically after an injury is several days old.

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If you want to use sports salves, follow the directions on the label and be sure that you:

* Never use topical analgesics on an indefinite basis unless it’s under the guidance of a physician.

* Seek medical attention for swelling, redness, tenderness or inability to move a joint.

Or, consider trying gentle massage with a warm oil or lotion to bring relief.

“Massage helps remove the inflammatory fluids and increase circulation, which promotes healing,” says rheumatologist Kantor. “The massaging action involved in applying these creams may have a benefit all its own.”