What does Biofreeze do?
Ahhh, Biofreeze. The magic gel. Ask any athlete how it works, and you will get a very undeveloped answer. “You put it on your skin and your pain goes away”. Well, how does a gel that sits on the skin cure injuries that are deep underneath it? The answer is, simply, it doesn’t. I’m a fan of Biofreeze, but I always acknowledge its limitations when recommending it to athletes. Simply put, all Biofreeze does is make your skin tingle and mask pain temporarily. So, if Biofreeze doesn’t cure injuries, why do so many people love it? The answer is likely: if the gel masks pain enough to keep athletes in the game, athletes will appreciate the outcome, even if it is largely placebo.
Biofreeze is far from the only topical analgesic ointment; there are dozens of other brand names that do essentially the same thing. IcyHot, Bengay, Vaporub, Aspercreme, Flexall, Voltaren, Absorbine, Tiger Balm, Atomic Balm, Cramergesic, Cold Spray, the list goes on. All of these creams contain a slightly different combination of active ingredients. These active ingredients, however, almost always belong to a handful of classes and provide the same therapeutic effect.
Counterirritants — typically menthol (a plant extract that is responsible for the rapid cooling sensation when applied or inhaled) or camphor (a tree bark extract that creates a tingling sensation and a more cinnamon-like smell)
Salicylates — often methyl salicylate or trolamine salicylate (organic compounds that have a wide variety of uses in medicine, usually related to pain-relief because they block enzymes that produce pain, used in products like aspirin)
Capsaicin — extracted from hot chili peppers and cause a warming or burning sensation that is intended to reduce joint pain
Lidocaine — a local numbing agent that rapidly blocks nerves’ ability to feel pain (used widely in medicine, including cough suppressants, dental procedures, and surgeries)
Unfortunately for the advertising of these products, they do not penetrate the skin barrier. In other words, they activate on the skin but not underneath it to the muscles or joints. Rather than impacting the tissues below the skin, they activate nerves and block pain via the gate control theory. Gate control theory goes something like this:
The body uses nerves to sense things in the environment. Different nerves correspond to different sensations. For example, we use chemoreceptors to sense different chemicals and nociceptors to sense pain. Some nerves follow similar pathways to the brain, and just like a highway can get congested and block the on ramp, nerves can get congested and block the pathway to the brain. When larger nerves (associated with the sensation of light touch or pressure) are active, the signal reaches the brain very quickly. When smaller nerves (associated with pain) are active, the signal reaches the brain slower. So, when the larger nerves are active, they interfere with the brain’s interpretation of the smaller nerves, effectively blocking the stimuli. This is why it is so common for people to grab or rub something when it hurts; it reduces pain. Next time you stub your toe or bang your knee on a door, watch for your response. Instinctively, you will probably grab the painful part to subconsciously activate the gate control theory.
So, all of this in mind, what does Biofreeze do? In simple terms, it tingles the skin to reduce pain. In more thorough explanation, the chemical active ingredients activate larger/faster nerves to reduce the transmission of pain via the smaller/slower nerves. When do I suggest the use of Biofreeze or other topical analgesics? I always caution athletes that these creams and gels will not fix any underlying issue. They will simply reduce pain which may make participation or athletic performance improve temporarily. Some issues like patellar tendinopathy take time to warm up and athletes often feel stiff/sore while warming up. A topical analgesic can mask the pain to allow for a more proper warm up. However, I also follow up with them to address the underlying issue with things like rehabilitation.
I hope this helps to clarify the benefits and limitations of Biofreeze. Feel free to drop a comment below with any questions or anything you would like me to write about in future posts.
