Pain is the most common reason athletes seek medical treatment.
Sore muscles and joints are not only physically annoying but they hinder training—and ultimately performance. Research tells us that pain and nociception alter motor output, which can lead to dysfunction in the injured area as well as elsewhere throughout the body.
Pain is complicated. It involves a number of factors—including a person’s mood, memories, genetics, and expectations. These are in addition to the noxious stimulus itself, which sends a threatening signal to the brain (nociception).1
Given that this is a complex issue, it will generally have a complex solution. Systemic approaches, including narcotics and NSAIDs, often bring with them a host of side effects and risks, making them unattractive to many athletes.
A second option is to correct any structural factors that drive pain, such as poor posture, stability, and motor control. Pain driven by these factors is common with athletes because they are often asked to perform unnatural movements (e.g., overhead throwing) and perform them repeatedly. While most clinicians prefer this option for treating pain, oftentimes athletes find it difficult to make significant progress during a competitive season or intense training.
The gate control theory
A more localized approach to reducing pain is cutaneous stimulation. By changing the input to the brain (nociception), you can change the output (pain).2
The pain gate theory, first introduced in 1965, states that nociception related to chronic pain travels along slow “C” fibers, which are small and unmyelinated.
Larger, faster “A-beta” fibers carry non-nociceptive signals to the brain and can be stimulated through the skin. The theory states that when A-beta fibers are stimulated, they can thwart nociception, thus reducing pain.3
The human body utilizes pain gating instinctively. The first thing that people do after they hit their head is rub it. This is our brain’s way of closing the gate.
Pain gating is the basis for many of the common modalities, including electrical stimulation, massage, instrument-assisted soft tissue mobilization (IASTM), topical analgesics, and kinesiology tape. These modalities offer varying levels of pain relief based on settings, depth, rate, direction, and other variables. These modalities offer immediate pain reduction, simplicity, low cost, and are well tolerated.
There are two categories of pain-treatment modalities: mechanical and chemical. Both gate pain by stimulating mechanoreceptors in the skin and fascia, but through different paths.
The mechanical approach involves physically stimulating the skin to provide some sort of compression, lift, sheer, contraction, or a combination thereof to stimulate the autonomic nervous system and reduce nocicep- tion. Some examples of mechanical modalities include massage, IASTM, and kinesiology taping.
Topical analgesics are an example of chemical remediators that moderate pain. There are a number of different analgesics on the market. The majority use one or more active ingredients to elicit a cold or hot sensation (or some combination of the two). Typically, this is accomplished by using menthol, methyl salicylate, or capsaicin as the active ingredient.4, 5
Multiple research studies have shown a pain-relieving effect when menthol soaks into the skin, some with impressive results.6 It is believed that this occurs through the activation of the TRPM8 channel, leading to a perception of cooling by the brain.7
On the other side of the conversation, capsaicin causes a heating effect and pain relief when used in small doses. In larger doses, it can cause a burning sensation, which is why it is included in pepper spray. The mechanism isn’t completely understood, but it is believed to work through the TRPV1 receptors.5 Methyl salicylate’s analgesic mechanism is also not well-understood, but we know that it is metabolized by the body into a known NSAID, making it a counter-irritant.6
A multifaceted strategy
There are a number of topical options available, so selecting the best one can be challenging. Rather than trying to offer the perfect product for all of your patients, have several options available for athletes, because some
will respond differently to the various active ingredients.
A rule of thumb is that if an athlete prefers heat for calming and relaxation in painful situations, then a warming analgesic is a good choice.
It is common for athletes to prefer heat as part of their warm up, and use cold sensations to start the recovery process after a training session.
A fairly new approach to reducing pain combines a mechanical approach with a topical analgesic. This includes using an analgesic as a medium for massage or IASTM. The analgesic can augment mechanical stimulation to increase pain relief. This does have limitations, however, in that it has to be applied manually and usually by a qualified clinician. The relatively short duration of this intervention is also somewhat limiting because the anal- gesic will eventually absorb into the skin, resulting in a diminishing effect.
Combining kinesiology tape with a topical analgesic can address some of these issues. Note that not all analgesics are designed for this use and may interfere with the adhesion of tape, so research the product options before making your purchase.
Whether you put the analgesic on first and then apply tape, or apply analgesic over the tape, both can significantly improve the effect, strength, and duration of the stimulus. Because the tape can hold the anal- gesic longer than skin, it will lengthen the duration of the application.
Another advantage of this approach is that the modality can be worn for several days at a time, and during workouts and training sessions. This simple “pain patch” is easily applied and reapplied by the athlete whenever needed.
When dealing with pain, there are a number of options to choose from, all with advantages and disadvantages. Due to its high effectiveness, ease of use, long-lasting effects, and ability to use during motion, consider combining kinesiology tape with topical analgesics with your athletes who are experiencing pain and soreness.
Mitch Hauschildt, MA, ATC, CSCS, serves as the prevention, rehab, and physical performance coordinator at Missouri State University and the founder and president of Maximum Training Solutions, a full-service sports medicine and sports performance consultancy. He is a noted speaker who has worked with thousands of athletes throughout his career, and has been published in professional journals and coaching websites.
1 Butler D, Moseley GL. (2003). Explain Pain. Adelaide: Noigroup Publications.
2 Melzack R, Wall PD. Pain Mechanisms: A New Theory. Science. 1965;150(3699):971-9.
3 Nijs J, Daenen L, Cras P, et al. Nociception Affects Motor Output: A Review on Sensory- Motor Interaction with Focus on Clinical Implications. Clin J Pain. 2012;29(2):175-81.
4 Johar P, Grover V, Topp R, Behm D. A Comparison of Topical Menthol to Ice on Pain, Evoked Tetanic and Voluntary Force During Delayed Onset Muscle Soreness. Int J Sports Phys Ther. 2012;7(3):314-322.
5 Fattori V, Hohmann M, Rossaneis A, Pinho- Ribeiro F, Verri W. Capsaicin: Current Understanding of its Mechanisms and Therapy of Pain and Other Pre-Clinical and Clinical Uses. Molecules. 2016;21(7):844-77.
6 Higashi Y, Kiuchi T, Furuta K. Efficacy and Safety Profile of a Topical Methyl Salicylate and Menthol Patch in Adult Patients with Mild to Moderate Muscle Strain: A Randomized, Double-Blind, Parallel-Group, Placebo-Controlled, Multicenter Study. Clin Ther. 2010;32(1):34-43.
7 Proudfoot C, Garry E, Cottrell D, et al. Analgesia Mediated by the TRPM8 Cold Receptor in Chronic Neuropathic Pain. Cur Biology. 2006;16:1591-1605.
8 Sundstrup E, Jakobsen M, Brandt M, et al. Acute effect of the topical menthol on chronic pain in slaughterhouse workers with carpal tunnel syndrome: triple blind, randomized placebo-controlled trial. Rehab Research Practice. 2014;2014:1-7.