Nowadays the amount of topical analgesic creams on the market are endless and without proper guidance, one may get lost easily. I hope to guide beginner chiropractors in the right direction and provide them with clarity on topical creams. Upon reflection, I decided to write about products that I have personal experience with and give my two cents. I am not endorsed or sponsored by any company and therefore I hope to be as unbiased as possible.

1.     Packaging

a.     Tub

i.     Pro: Great portability in bags, don’t have to worry about them leaking, can use up every ounce of cream, ability to refill the tub.  

ii.     Cons: Double dipping or scooping from the tub with dirty hands/tools (cleanliness problem).

b.     Roll-on stick

i.     Pro: Ease of self-application, portability in general (under 100ml for planes), roll-ons can only come in liquid form (some people prefer not having cream/lotion on them), usually dries quick and leaves little to no residue.

ii.     Cons: Cost, for personal use only because of communicable infectious disease risk, risk of roller not working or jamming especially if you haven’t used it in a while.

c.     Pump bottle

i.     Pro: Cost effective (bang for your buck), clinic use, clean.

ii.     Cons: Not as portable, hard to get all the cream out at the very end, pump mechanism may fail (happens all the time with deep cold).

2.     Portability

a.     For personal use, I find roll-ons the most portable especially in backpacks or on planes while you are travelling.

b.     For your clinic bag, I find tubs the most effective because you can stack them and you really don’t need to be carrying as much cream as you would think.

3.     Purpose of the cream

a.     IASTM

i.     This factor is very dependent on whether you like glide with your IASTM or whether you even use lotion with your tools. Maybe you don’t even want a lotion that causes the patient to feel cold or warm. I usually lean towards using one that has no active cooling or warming properties.

b.     Manual therapy

i.     If I am providing manual therapy with lotion, I would prefer one that does not evaporate/absorb quickly. I prefer something that I can do multiple passes on without causing skin drag.  

4.     Area of application

a.     This is important especially when you are looking to use a lotion that has cooling or warming properties. A cooling lotion is usually well tolerated in all regions of the body. A warming lotion with capsaicin needs to be applied with caution because it can really burn on sensitive skin. Some areas I would avoid applying warming lotion would include the neck, inner thigh, face…etc.

5.     Condition you are dealing with

a.     What condition are you dealing with? If you read up on each active ingredient and what their main purpose is, you will be able to better select the right topical cream.

b.     For example, I would use capsaicin topicals for neurogenic pain or anything that is more nerve related in comparison to general muscle ache. I know you could argue that both muscles and nerves are interconnected. This is just what I do.

6.     Natural vs. Synthetic

a.     Do you care if the ingredients aren’t all natural? Will your patients care? Should you tell them about every ingredient in the topical cream? I think this is something you will have to decide for yourself. Know the risks of each active ingredient because I don’t think anyone really does until you look into them.

7.     Hypoallergenic

a.     Does the person using the topical cream have sensitive skin? Will they react to the cream? I think if they know that they have sensitive skin, err on the side of caution or ask them to bring in their own hypoallergenic cream.

8.     Allergies/intolerances to ingredients?

a.     Pregnant

i.     You should know what ingredients you are applying and the mother should approve of them. For example, camphor is something to avoid with your pregnant patients.

b.     Kids

i.     Just be careful of open wounds because toxicity thresholds would be lower in kids.  

9.     Smell/Odour

a.     You should definitely consider how the topical cream smells especially if you are indoors in a treatment room. Some topicals have a very very strong smell and can upset the following patient entering the room. Some patients really like that smell and some really hate it.

b.     I would recommend using a neutral or minty smelling topical cream. People usually find peppermint a tolerable if not soothing scent.

10.  Intensity of ingredients/subjective feeling

a.     Some topicals will have higher active ingredient percentages. You need to understand how intense the topical cream will feel on your patients.

11.  Stain

a.     This is especially important if your patients are in nice clothing and you don’t want to dirty them. Obviously if you avoid using any topical cream, you are playing safe but if you do decide to use some, make sure you know it won’t stain their clothing.

12.  Before or after taping? Over tape?

a.     Yes, you can apply topical creams over Rocktape, Kinesio Tape, Spider Tape…etc. This concept was introduced to me by Rocktape and it really does work and I find that the cooling or warming sensation can last for longer sometimes.

b.     If I know at the beginning of the treatment that I will be taping the patient, I will avoid using any topical cream just because I find that the tape will stick better that way.

13.  Glide

a.     This is a personal preference. Some people enjoy a watery glide and some enjoy a thicker glide. I’ve heard of people complaining about how some creams make it hard to grip or stay on the target tissue. You will have to test this out for yourself.

14.  Longevity

a.     This is how long the cream will last before it dries up. You also have to pay attention to whether or not the cream will clump up after it dries. You really don’t know this until you try the cream but hopefully the guide below will give you some insight.

15.  Easy to clean?

a.     This is super important because some topicals are really hard to clean if you need to have a clean surface afterwards. This applies more towards IASTM oils/emollient.

16.  Cost

a.     This is definitely a factor when selecting a cream. I would be lying to you if I told you it doesn’t matter. I prefer selecting a brand that offers professional pricing. For example, I know that RockTape and Medistik offers professional discounts. Most brands are sold at clinic supply stores at a reduced rate.