Massage therapy typically involves the use of some type of cream, lotion or gel, and sometimes the addition of hot stones or another therapeutic device. During hot summer days, clients might welcome some relief from the heat in the form of topical cold therapy. Certain topicals produce a cooling effect, and with it relief from pain and inflammation.
What Makes Cooling Topicals Cold?
For the most part, topicals with cooling properties contain the same or similar ingredients, i.e., menthol, camphor, magnesium sulfate, capsaicin and lidocaine, according to Gina Scianimanico of Yoga and Massage EDU. “Menthol is an organic compound that can be made synthetically or obtained from mint or peppermint oils,” she said. “It has local anesthetic and counter-irritant properties.”
Camphor, which is oil extracted from the wood of the camphor tree, also contains anti-inflammatory and analgesic properties, according to Scianimanico. Another cooling product, magnesium sulfate, is used topically for pain and bruising, while capsaicin, which is extracted from chili peppers, contains analgesic properties helpful for nerve pain. She added that lidocaine has anesthetic properties.
How Does Cold Therapy with Topicals Work?
Cooling topicals, which are available over-the-counter, work by permeating the outer layers of the skin. “Transdermal is a route of administration wherein active ingredients are delivered across the skin for systemic distribution,” Scianimanico said. “Humans have used the skin as a gateway to the body for many years. We are only beginning to understand the science behind this.”
A 2018 study published in the International Sports Journal of Physical Therapyoffered an explanation for the mechanism of action: “…menthol cooling gel increases cutaneous blood flow and cooling sensation alongside reduced intramuscular and skin temperatures.”
The study’s authors pointed out that the reduction in intramuscular and skin temperature was likely due to the evaporation “…of the alcohol content in the gel rather than from any pharmacological action of the menthol.” They added that, while more research is needed, “…this cooling effect along with the possible analgesic effects of menthol gel, indicates that it could provide an effective practical alternative to ice treatment for practitioners seeking to treat soft tissue injury.”
According to WebMD, when used topically, camphor products increase local blood flow and act as a “counterirritant,” reducing pain and swelling caused by irritation. Camphor, as well as menthol and methyl salicylate (oil of evergreen), are called counterirritants because they create a burning or cooling sensation that distracts your mind from the pain.
When camphor is applied to the skin, it is thought to stimulate nerve endings, thus relieving pain symptoms and itching. WebMD cautions against applying the product to broken skin; camphor “…can enter the body quickly and reach concentrations that are high enough to cause poisoning.”
Scianimanico echoed that advice. “You can safely use any of these options as long as you do not have an allergic reaction and do not have any open wounds. Do not use heat or ice pack[s] in combination with these items; you could injure your tissue. You can safely use these products several times per day,” she said.
Applying Cooling Topicals
Therapists have several options when it comes to a delivery method for topical cold therapy. Scianimanico explained that cooling topicals are available as patches, roll-ons, crèmes, ointments, balms, lotions and fragrance-free options.
Sean Smedley, massage director at Currie Hair Skin and Nails, located in Pennsylvania and Delaware, also favors a cooling topical with menthol and camphor to address minor aches and pains and sore muscles and joints.
“Menthol stimulates cold receptors that create a cooling sensation on and under your skin, helping to relieve pain,” Smedley said. “Our formula has optimized the ideal menthol concentration for maximum effectiveness.”
Following a massage session, Smedley applies a menthol-based cream. “I usually use it only for deep tissue clients,” he noted, explaining that those who present with arthritis, backache, muscle strains and sprains find relief from massage with cooling topicals.
Clients with muscular discomfort and other bodily aches and pains typically feel better and more relaxed following a massage with topical cold therapy products, which makes the therapist’s job easier, according to Smedley. “I don’t use the cooling cream until the end of the massage, as I want the client to feel how the massage is working without any outside influence.”
According to Smedley, cooling topicals can safely be applied up to four times a day, as needed. However, he reiterates Scianimanico’s warnings, cautioning that creams and lotions containing cooling ingredients should not be applied to damaged or irritated skin, wounds or around the eyes or mucus membranes.
Additionally, Smedley recommends keeping the area to which the cooling topical has been applied uncovered. “[The skin] should be exposed to air after [using a cooling topical] so you can’t use bandages or apply hot items on top of it,” he explained.
He also pointed out that any hot item, such as hot stones or hot towels, should not be part of the therapy when using cooling topicals. Furthermore, he nixes the idea of a hot shower immediately after massage with any cooling cream or lotion.
Cool Works in Winter, Too
Although summer might seem like the ideal time to bring out the cooling lotions and creams, Smedley emphasized that massage with cooling topicals does not necessarily have to be limited to warmer months.
“Since I use a heated table, it doesn’t matter if it’s winter,” he said.
Cooling topicals offer relief not only from the heat but may also address pain and inflammation, regardless of the season.
About the Author
Phyllis Hanlon has written nonfiction articles and book reviews as well as human interest stories, profiles and award-winning essays. Her specialty areas include health and medicine, religion, education and business. She regularly delights in the joys of massage.