Sports Cream Safety
By Deborah W. Singer, MS, PT, ATC

Many people have recently read about the terrible accidental death of Arielle Newman, a cross country runner at Notre Dame Academy in New York.

The teen apparently died from an overdose of methyl salicylate, which is an anti-inflammatory medication commonly found in sports creams such as Bengay and Icy Hot. Methyl salicylate is produced by some plants - commonly the Wintergreen plant (thus getting its common name - Oil of Wintergreen).

Commercial methyl salicylate is now synthesized, but in the past, it was commonly distilled from the twigs of Sweet Birch (Betula lenta) and Eastern Teaberry (Gaultheria procumbens).

It is important to realize that this teen used this product in excess, according to the New York medical examiner. The medical examiner's spokeswoman, Ellen Borakove stated that the teen spread the muscle cream on her legs, used adhesive pads containing the cream and an unspecified third product that also contained the chemical. In addition to excessive use of the product, far above the labels recommended dosage, she used the products over long periods of time.

The lowest published lethal dose is 101 mg/kg body weight in adult humans.[1] It has proven fatal to small children in doses as small as 4 mL.[2]

Dr. Ronald Grelsamer, of Mount Sinai Medical Center, said Newman had a very abnormal amount of methyl salicylate in her body.

"She either lathered herself with it, or used way too much, or she used a normal amount and an abnormal percentage was absorbed into her body," he said.

The Food & Drug Administration is very clear that it can cause breathing problems, it can cause convulsions, it can cause fever. However, it is very, very unusual, doctors say, to have any kind of toxicity when it's just used at the skin.

There are two important precautions to think of when using these creams. First, follow the label directions - Bengay Ultra directions specifically state to use no more than 3-4 times per day and to stop and see a doctor if conditions worsen or continue for longer than a week.

These products are not meant to be used for chronic conditions. The danger in overuse of the ingredients appears to come from continued excessive use and not the occasional use that the product recommends.

The product begins to build up in the system and therefore should be discontinued after 7 days of use. Continuing to apply the product before it has been completely expelled simply can compound the levels of the chemical in the body.

Secondly, make sure that you are not using multiple products that contain the same ingredients - using adhesive pads, creams and oils all of similar content is the same as taken multiple oral medications without first clearing them with your doctor.

Since this toxicity is so rare, medical professionals are quick to caution that we really don't know the extent to how this girl used these products. It is well known that heat improves absorption of the methyl salicylate, so being an athlete certainly could have contributed to that medication saturation as well as her hydration levels.

"Chronic use is more dangerous than one-time use," Edward Arsura, chairman of medicine at Richmond University Medical Center, told the Staten Island Advance on Friday. "Exercise and heat can accentuate absorption."

Mild chronic salicylate intoxication is termed SALICYLISM and includes symptoms that could include headaches, dizziness, ringing in the ears, difficulty hearing, dimness of vision, mental confusion, thirst, drowsiness, sweating, nausea, vomiting, among others. [3]

The false security when using any type of over-the-counter medication is scary in itself. People need to realize that just because a medication is sold over-the-counter, that doesn't mean it is less powerful or dangerous than a prescription. Many of these medicines used to be prescription strength.

The over-the-counter medication whether oral or not, needs to be treated with the same level of caution and safety measures as its' prescription counterparts. These medications need to be put up high and away from children just like prescriptions.

It is when the user decides to treat themselves carelessly with an over-the-counter medication, that we really need to become concerned.

Proper exercise (not over doing it in the first place) and exercise under the prescription of a doctor or physical therapist is the best line of defense against muscle and joint pain.

Muscular sports creams bring blood flow to the area thus making it "feel" warm. Often a warm bath can accomplish more than a sports cream anyway - it is safer, and it is much more enjoyable!

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