Upgrade Your Topical Pain Relief with a Layered Approach

Topicals have long been used as a in clinic and at home pain control.  As clinicians have incorporated more advanced soft tissue treatments in their clinics, we have also started introducing topicals for a number of different reasons.  The two major reasons for utilizing topicals in conjunction with soft tissue treatments are as a “distractor” or counter-irritant to allow for treatment to start, and secondly as a post treatment application to assist in pain control and/or reduce post treatment soreness.  As far back as late 1990’s I was using topical products with my soft tissue treatments to assist in post treatment soreness and assist in healing.  

The use of topicals for pre-soft tissue treatment is beneficial for those with high sensitivity to the tissue being worked on.  Simple examples to this include areas like the bottom of the ticklish foot.  Other situations include area of high sensitivity to injury like tendinopathy, hypersensitive areas due to heavy fascial restriction, post-surgical tissue/scars, or high tissue sensitivity/reactivity.  Applying the topical about a minute prior to treatment allowed for desensitization of the region.  This then allowed the clinician to work without the patient consistently trying to “run” away for tissue contact.  I especially found this valuable with treatment of plantar fasciitis and the foot being very sensitive to being ticklish.  While the topical was applied to the bottom of the foot, I would work on the anterior and posterior compartments of the leg.  I would ask the patient when they started feeling the sensation of the topical.  Once they replied in affirmative, I would switch focus to the bottom of the foot with much greater ease of treatment to the plantar surface.

With post treatment application, topicals can be used to reduce post treatment sensitivity.  I have always asked a patient as part of my initial encounter, “if they get a deep tissue massage, do they get very sore?”   If the patient responds in affirmative, I would always reduce the intensity of the treatment and make sure I applied topicals to the involved tissue and sent them home with small sample packets to apply over the next 24-48 hrs.  Patient in return would tend to ask for the product as they saw the benefit of pain control in the acute state between visits.  I recently had the opportunity to use a new menthol topical analgesic, Stopain® Clinical in my clinic.  Within 24hrs of using this product with patients, many have returned asking how they can purchase it.

Topicals have also been used with the application of taping in clinical settings.  As Kinesiology taping has become more prevalent, the use of topicals in conjunction with taping has also increased in use.  The greatest obstacle to taping with topicals is the base of the topical.  If the topical is applied prior to taping and does not absorb well or is oilier in base; the tape will not stick to the skin.  If the tape is applied first and the ‘creams’ are applied on top of the tape, the tape will not stick long as an oily product will start to dissolve the adhesive and the tape will fall off.  Eventually, companies started producing topicals that could be used on the skin prior to taping, or applied over the tape.  This in affect created pain patches.  Not only did you have the ability to use taping as way of treating patients when they left your office, but you turned the tape into a dermal patch.  

The benefit to this is the much longer lasting effect of the topical application and works exceptionally well with a Menthol-based topical.   The topical “re-activates” during showers or during times of exertion as sweating may start or pores open.  This gives a sensation of cooling on the skin for days following application.   The advent of sprays that will not affect the adhesive of the tape made it that much easier to turn your tape into a dermal patch and a double effect pain control application.  After I have determined the best taping procedure through specific evaluation methods, I will spray the tape with topicals to increase the pain control of the tape on 2 different fronts both neurologically mediated.   The tape when applied in proper methods can assist in resetting the muscular function allowing for greater movement or muscle function with less pain as well as stimulating the nerve receptors in the skin that assist in blocking pain sensation.  The topical further enhances this pain control with ingredients like Menthol that further stimulates nerve receptors in the skin assisting in blocking pain sensation. Taping has always been one of my best ways of sustaining the improvements I make in the office and to control pain.   With the use of topicals like Stopain® Clinical, I maximize the benefits of my clinical application for days until their next treatment.

Dr. Gregory Doerr is the developer of Functional Soft Tissue and Functional Taping for MSK Injuries as well as the co-developer of FAKTR.  He practices in Cliffside Park and Hackensack, NJ.  His website is www.Functionalsofttissue.com