The 3 Main Topical Remedy Types / Table Of Contents:
- Herbal Creams (Non-Medicated) – Non-drug-containing creams and lotions, like the well-known Penetrex Cream – Herbal, Non-Drug Creams
- Over The Counter “Liniment” Type Drugs – Basic, heating and cooling creams found in any drug store or supermarket without a prescription, like BenGay or IcyHot – Over The Counter
- And Steroid And Non-Steroidal Anti-inflammatory Creams – Prescription medications, including topical steroids (usually by Iontophoresis) or non-steroidal anti-inflammatory creams – Anti-Inflammatory Medicated Creams
Can A Lotion, Cream Or Liniment Actually Help Your Injured Tendons HEAL?
Your Golfer’s or Tennis Elbow is screaming, you desperately need some relief, so you buy some cream, spray or gel and rub it in… Presto! Instant pain relief! Great idea, right?
Maybe, maybe not! At best, you may get some temporary relief from your symptoms from that topical remedy – Possibly with little or no side effects or other downsides…
But, although you could reasonably expect a cream or salve to help protect your skin as it heals from a cut or abrasion, you can’t realistically expect something you put on your skin…
To help HEAL your Tennis Elbow injury faster! – But WHY not?…
Because Tennis and Golfer’s Elbow are injuries that involve changes (varying possible degrees of damage) DEEP in your tendons, below your skin – and that damage needs to be healed and repaired by your body – biologically, from the inside!
And there ARE significant potential downsides, depending on which kind of topical treatment (lotion, cream or spray; medicated – prescription or “over the counter” or herbal/non-medicated) you decide to use. (Especially if you use it long term.)
For simplicity, I’m going group them into three “sub classes” (AND because there are big differences between them – Some are much worse than others!)
Let’s talk about the pros and cons of each of these three groups, because they are different “creatures” with different properties.
But, first, let’s dispel a myth that makes up one of the biggest reasons these lotions, potions and creams are misguided in their application:
Inflammation!
The whole concept of applying a lotion (or taking a pill or getting a shot) to “reduce inflammation” when one has Golfer’s or Tennis Elbow is wrong at the root.
Firstly, because Tennis Elbow is not generally an inflammatory condition to begin with – It’s a chronic, degenerative process of gradual tendon degradation – TendinOSIS NOT TendinITIS.
And, secondly, because even if there is some inflammation that could potentially be “reduced” – that inflammation would be a normal, natural part of the healing process, anyway, and not something you would WANT to “reduce!”
(And it’s probably important to add that the burning pain and other symptoms of Tennis and Golfer’s Elbow are not generally caused by inflammation – Those symptoms seem to be caused mainly by other biochemical factors.)
And I hate to make it seem even more complicated, but all the major anti-inflammatory tactics from ice, to creams, pills and Cortisone Shots all WORK in the sense that they usually RELIEVE pain and other symptoms…
And they usually work (at least in the short term) whether those symptoms have anything to do with inflammation OR NOT!!
See my article Tossing The “Tendonitis” Myth for more on this inflammation fallacy…
Now, I’m going to cover each of the three “classes” of topical treatments, from the “least medicated” and least potentially harmful to the “most medicated” (and potentially damaging.)
Non-Drug Herbal Creams And Lotions: Penetrex, Biofreeze, Etc.
The best thing that can be said about these creams, like Biofreeze and Pentrex, is that they don’t contain any drugs…
Or at least any powerful medications that one would need a prescription for.
They may claim to “reduce inflammation” which we already know is a pointless NON objective…
But there’s no way that have the power to suppress ones natural inflammatory healing response the way the prescription drug-based creams and gels do.
Whatever positive effect to be gained by their ingredients, whether Vitamin or herbal, nothing of that nature has the ability to be absorbed through the skin and completely knock out inflammation the way a Cortisone cream (or shot) can.
At best these creams, lotions and sprays may provide some much-needed temporary symptomatic relief, which is perfectly fine.
And at worst, the only likely side effect would be a rash.
Next, we have the actual medications.
Over The Counter “Liniment” Lotion Drugs
The most well-known examples of these liniment creams, found in almost every grocery or drug store, are probably BenGay and IcyHot, but there are countless others.
Most of these drug-containing creams contain active ingredients like Methyl Salicylate, Lidocaine, menthol, and camphor.
Methyl Salicylate, Lidocaine (and Prilocaine) are topical anesthetics that penetrate the skin and block pain receptors in nerve endings.
So, most of these types of creams and lotions seen to belong more in the category of ‘Analgesics’
Members of the group of drugs used to achieve analgesia, which is relief from pain, AKA, “painkillers.”
(as opposed to Anti-inflammatories, which “target” inflammation – although, as mentioned earlier, seem to relieve symptoms whether those symptoms are related to inflammation or not.)
These creams have potential side effects, locally, including skin rashes, but, unlike the previous non-medicated creams, this group of creams can cause systemic reactions, since they contain drugs that wind up circulating through a users entire system.
And just like taking pills or using ice for pain, if you rely too much on the tactic of “relief by symptom suppression” – without taking the necessary steps to support the healing of the actual injury…
You may lull yourself into a false sense that your Tennis or Golfer’s Elbow is better than it actually is and continue to overwork and overload it.
But the upside is that, like the next class of creams, they do not seem to have the power to block or suppress inflammation.
Now, let’s get into the more “serious stuff!”
Topical Steroid / Cortisone And Non-Steroidal Anti-Inflammatory Medicines
This class of topical anti-inflammatory creams and gels are only available by prescription.
There are two major kinds, the steroid / Cortisone type and the non-steroidal anti-inflammatory medications (NSAIDs)
And the non-steroidal kind is much more commonly used, so lets cover that first.
Nonsteroidal Anti-Inflammatory Medications
It is well established that there are very serious gastrointestinal and other potential side effects from taking the oral (pill) forms of these anti-inflammatory meds.
Including stomach pain, diarrhea and internal bleeding – They can even be lethal.
Especially when taking these pills over a longer period of time.
(And this applies to the common, over-the-counter versions, like Ibuprofen – Not just the prescription varieties.)
The big upside, if you choose to use a topical anti-inflammatory cream or gel medication is that, although some of the medication will end up circulating in your system, it will be at nowhere near the levels you would expose yourself to by taking it in pill form.
So, it’s much safer, in that respect.
Voltaren Gel is one of the newer and, apparently, more effective topical anti-inflammatories.
It’s the topical version of Diclofenac, (which only came in a pill form, originally.)
So, do these drugs work?
According to this review study, seen at PubMed, which included 13 trials involving 664 participants:
“We are uncertain whether topical NSAIDs improve pain because of the low quality of the evidence.”
(The study was originally available at the NIH: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0012239/ but has since been removed.)
Of course, we need to ask ourselves:
What does it mean to “work” or to “relieve” pain?
Is a treatment working and relieving pain because it’s helping our body heal or is it merely suppressing our symptoms temporarily?
Let’s talk about the steroid versions of these topical anti-inflammatories first, and then we’ll conclude with the (hopefully) obvious answer…
Steroidal Anti-Inflammatory Medication Creams And Iontophoresis
Now, we come to the real “Bad Boys” of topical medications:
The Steroid creams.
Unlike the injectable versions of these Corticosteroid drugs, (Cortisone Shots) which are unfortunately still widely used, despite their well-known dangers and lack of long term effectiveness…
See my article and video on Cortisone Shots in the Treatment of Tennis Elbow here
The cream varieties are not very commonly prescribed and used for treating Tennis Elbow.
You may be familiar with something called Hydrocortisone Cream, but that is generally used for skin conditions (rashes, psoriasis, eczema etc.) – Not tendon injuries.
When steroids are used topically in a cream form they are usually applied in conjunction with a treatment called ‘Iontophoresis’
Which is often performed by Physical Therapists in a Physical Therapy treatment setting.
“Iontophoresis is a process of transdermal drug delivery by use of a voltage gradient on the skin. Molecules are transported across the stratum corneum by electrophoresis and electroosmosis and the electric field can also increase the permeability of the skin.”
Or, in simpler terms, Iontophoresis is a way of applying an electrical current with pads on the skin in such a way as to help the molecules of a drug get past the skin and into the deeper layers of tissue.
And it seems that the most commonly-used steroid in this treatment is a drug very similar to Cortisone, called Dexamethasone.
The upside is that having a steroid gradually seeping into ones tissues transdermally is safer and less potentially damaging than a sudden, powerful blast of Cortisone injected via a needle directly into ones tissues in a highly concentrated form.
However, these are still synthetic catabolic steroids that suppress natural metabolic functions necessary for the healing process.
And it has been well established by medical research and long-term-outcome studies that these drugs weaken and degrade the collagen protein that tendons are mostly composed of…
Making repair and recovery less likely and recurrences MORE likely.
Either way…
Whether we’re talking about steroid or non-steroidal anti-inflammatory creams, the question remains the same:
Is this treatment working and relieving pain because it’s helping our body heal?
OR is it merely suppressing our symptoms temporarily?
Even if these drug creams do “work” by effectively attacking and “reducing” inflammation…
The problem with Tennis and Golfer’s Elbow is NOT one of inflammation…
Yes, in spite of the deceptive, burning pain that seems to scream:
“I’m on fire with inflammation!”
It’s actually a failure of the healing process, usually with an absence of the normal, expected inflammatory healing response.
It’s the breaking down of the tendon (the degeneration) and the irritating metabolic chemicals that seem to be the source of the pain with Tennis and Golfer’s Elbow.
There SHOULD be some inflammation present as a symptom of the healing process doing its job…
Since there is no healing without it!
But there is often little to no inflammation present in these condition – at least past the very early stages.
And, even if there was significant inflammation present, to suppress it would be to suppress ones own healing process.
What a terrible trade off – Right?
To sacrifice long-term healing and recovery for fleeting, short-term pain relief.
So, if you don’t like the sound of that trade off (and I don’t blame you)…
And you don’t want to potentially sacrifice healing for pain relief…
Then you may want to avoid the topical anti-inflammatory creams.
And choose the less-powerful creams that may provide some pain relief – (if you really need it)…
But, at least not at the risk of attacking and suppressing what little inflammation may be present (and necessary) as your body desperately tries to heal your injured tendons!
That’s it for now on this topic – But be sure to explore all the other free articles and videos I have here for you, as well as my free video course:
Treatment In The Marin County / S.F. Bay Area
If you happen to live in the S.F. Bay Area, especially in Marin County, please see my article and video about how I treat Tennis and Golfer’s Elbow:
For the original article and over a dozen visit my Tennis Elbow Classroom:
Original Article about Lotions and Creams for Golfer’s and Tennis Elbow Here