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Survey and health risk assessment of products for treatment of sports injuries and pains 1 Survey1.1 IntroductionA large part of the population is today doing some sort of regular exercise often resulting in sore muscles and joints. Through recent years the Danish people are becoming more physically active and the increase is significant for both men and women from year 2000 till today[3]. An increasing activity level means increased risk of injuries. In case of minor injuries most people (professionals as well as exercisers) prefer to self-treat their injuries, this often means by products which are applied to the skin. Over generations various minor ailments have been treated by hot and cold therapy products. Recent years have seen an increasing number of therapy products for easing and removing muscle pain. The Internet contains a variety of web sites on exercise and injuries and more of these recommend use of pain relief creams and gels. 1.1.1 PurposeThe purpose of the survey was to identify the most commonly used products and try to assess how extensively products for sports pain and injuries are used. A survey of the products in the market within the category products for sports pains and injuries and their content of chemical substances has formed the basis of the subsequent assessment of the products. 1.1.2 DefinitionThe project includes only products which are promoted as suitable for relief of joint and muscle pain and only products which are not prescription drugs and not comprised by the Medicines Act. 1.1.3 MethodThe following activities are comprised by the survey:
Inquiries have been made about the products through the internet and by shop visits. 1.1.4 Product selectionThe criteria for selecting the products for the analyses, was that it should be products which were selling well. Thus the distributors in the shops have been asked which products were best-selling and which products he would recommend to customers without any specific product wish. Further, we have inquired about exact sales figures of the individual products. The same inquiries were made to the Internet distributors; however, here we did not always receive response from the supplier of the relevant product. Further, it has not been possible to get data on the exact number of units sold. The information given about sales figures was usually rather vague, such as "this product sells fairly well"... 1.2 ImplementationThe survey comprises the following three main elements:
In the following each product is specified by a number (purchased products) or by a letter (only product information, either through the Internet or through professional therapists and sports clubs). 1.2.1 Retail tradeFor the interview, questionnaires were handed out with the following questions:
8 shops were visited, comprising:
1.2.1.1 Sports shopsTwo of the visited sports shops had no sale of products for treatment of sports injuries. One shop stated that they refer any customers of such products to drug stores. The 3rd sports shop (a chain store) had two products[4] for treatment of sports injuries, product 15 and product F. According to the shop personnel they sell 4 units a month of which product 15 is the most popular. Product 15 comes in 3 concentrations, whereof 1 and 2 sell evenly, whereas 3, being the strongest, has low sales figures. The customers of these products are mainly young sports males at the age of 19 to 30 years. The majority of the customers to such creams already knows the product and therefore requires no product instructions. When instructions are given the customer is questioned about the cause of the injury. In case of genuine injuries Product no. 15 is recommended, whereas e.g. muscle stiffness can be treated by a heat therapy product prior to sports practising. (Product F). 1.2.1.2 Drug stores2 drug stores were contacted. Drug store 1 sells 17 products (Products 2, 3, 4, 5, 6, 7, 12, 13, 14, C, L, M, N, O, R, S and T), and drug store 2 is selling 11 products (Product no. 1, 2, 3, 4, 6, 7, C, L, P, Q and T). Altogether they sell 20 different products for treatment of sore muscles and joints. On a monthly basis drug store 1 estimates their sale to be approx. 100 units of sports injury skin creams, drug store 2 estimated their sales to be approx. 20 units. The major part of the sold products in the drug store chain is of their own brand. Both drug stores report that the customers to these products are mainly sports people and elderly people. Drug store 1 estimates their sale to be evenly distributed between men and women, whereas drug store 2 has a majority of male customers. Both stores estimate the age group to be 19-40 years. Within the elderly buyers both stores estimate the majority of the sale of joint pain relief products to go to women. If the customer does not ask for a specific product, but just something for pain relief, it is always recommended to buy one of the chain's own brands. The shops always give advice in connection with sale of this product type, but both shops state that their advice is limited to the informative labelling on the individual product. 1.2.1.3 Health foodVisits were paid to two health food shops, selling Product 13, Product K and Product M. Besides, health food shop 2 sells Product No. R. Both health food shops sell very little of these products and are therefore not able to inform about the general sales pattern, but both are aware of the media's influence on sales, as they have registered increased sales following a product advertisement. Health food shop 1 estimates the total, monthly sale for the category to be approx. 6 units, half being Product no. M. Further, this health food shop has also registered seasonal interest as sales have a small increase during summer half. The customers are primarily men aged 19-40 years. The estimated sale of health food shop 2 is approx. 4 units. Here they see two distinct customer groups, namely sports people and elderly people at the age of 19-30 years and 60 years plus. The younger groups are primarily men and the older group mainly women. Practically no instructions and advice are given, if so, it is limited to the information on the product labelling. The health food shops state that as the legislation stipulate that only medicine is allowed to "make promises" the health food shop personnel is subject to restrictions as to how they are allowed to advise on "alternative" products. 1.2.1.4 PharmacyA statement from one pharmacy totals 51 units sold during the first half of 2005 distributed on 4 products categorised as products for sports pains and injuries. The pharmacy's assortment includes 4 products (Product no. 4, Product no. 6, Product no. C and Product no. V). Of the total sales, Product no. C represents approx. half of the sale (23 units), and Product no. 4 (17 units) one third of the sale. In the same period the pharmacy has sold 235 units distributed on two products which are covered by the Medicines Act. The pharmacy's customers of this type of products are aged 30 and upwards with an even distribution between men and women. Further they informed that generally they do not give advice in connection with sale of these products. If customers do not ask for a specific product but only for a pain relief cream they are usually recommended to buy products which are covered by the Medicines Act (over-the-counter-drugs). 1.2.1.5 Summary - Retail TradeVisits have been paid to 8 shops comprising 3 sports shops, 2 drug stores, 2 health food shops and 1 pharmacy. Summary of pain relief products sold in the selected shops appear from Table 1.1. Table 1.1 Survey of products and number of sold units
As it appears products no. 4, 6, 13 and M are sold in three of the six shops dealing in products for treatment of sports pains and injuries. The customer groups of the 6 shops are almost identical. The age structure is approx. 19-40 years or approx. 60 year plus. The general rule is that the customers are sports practising people or elderly people. Two of the six shops claim to have primarily male customers, whereas three of the six shops maintain to have an even distribution between men and women. Common to all the shops is that they give very little advice in connection with sale of these products types, if so, the advice given is limited to the information from the product labelling and manuals. 1.2.2 Internet searchDifferent words and word combinations regarding sports pains and injuries have been searched on www.google.dk. Table 1.2 Survey of searched words and word combinations
Through the Internet searching we found a number of Danish web sites offering partly products partly instructions in connection with treatment of sports pains and injuries. In total 18 web sites have been reviewed. All advertisements and articles concerning sports products from Internet shops numbered 1-12 and web fora 1-6 have been examined. Based on the searchings contact has been made to a number of companies behind the web sites, where we have enquired about declaration of contents, e.g. data sheets, and further information about sales figures. Some of the companies have responded by sending data sheets and information about their most popular products, others have answered that they lack knowledge of the product contents, and some did not respond at all. 1.2.3 Professional therapists and sports clubsContact has been made to a number of football and handball clubs, physiotherapists, sports therapists, and similar in order to obtain information about which products are being used in professional connections. 17 professional therapists and sports clubs have been contacted distributed on
One of the physiotherapists uses creams for treatment of sports injuries, another uses product no. G. The other 6 physiotherapists are not using this product type. The chiropodist and the reflexologist/acupuncturist both use Product no. 12. One of the three contacted sports clubs uses Product no. 2 and Product no. T, another uses Product no. E. Sports club 3 is using Product E and F. One of the three interviewed educational establishments for sports massage and therapy uses product No. W and heat/cold products of brand B. The products are used only by trained therapists and they do not recommend the products for private use. Another educational establishment uses only products of one special brand – Product C. For heating massage Product no. X is used. Besides we have contacted one self-employed sports therapist, who did not want to use sports creams because of lack of documented effect. The sports therapist was attached to a football team, and he confirmed that the players were using heat/cold products mainly of brand B. 1.2.3.1 Summary of professionals’ and sports clubs’ use of sports creamsTable 1.3 gives an overview of sports products used by professional users as well as their estimated consumption. Table 1.3 Survey of products used by professional users and sports clubs
1.3 Purchased productsIn total 39 products were registered. Part of the products has been found on the Internet and only few of the web sites offer information about the contents of the products. 15 products were purchased (Product no. 1-15) and another 11 products (Product no. A, C, D, E, F, G, H, I, J and K) were registered only with the information available on the web sites. Finally, we became acquainted with further 13 products (Product no. L, M, N, O, P, Q, R, S, T, U, V, W and X) through professional users, sports clubs, shops, etc. All registered products are sold in shops or through the Internet. 1.4 ConsumptionStatistics Denmark has not been able to provide data for a quantitative analysis of the consumption of products for treatment of sports injuries, as there is no CN-code[5] solely for these products acc. to the Central Customs and Tax Administration. Information about product sale from both Internet-based shops and visited shops is inaccurate and undetailed therefore it is not possible to elaborate a proper estimate of the consumption in Denmark. Table 1.4 Survey of total sales of the contacted companies within the category stated in approx. number per month
1.5 ProductsThrough the survey we have become acquainted with 39 products for treatment of sports injuries and pains. Part of the products has been found on the Internet, where only some of the web sites include contain information about the product contents. 1.5.1 Product survey15 products (Product no. 1-15) have been purchased and Table 1.5 shows the disclosed constituents of the products. The information is a direct copy of the product labelling. Additionally, further 24 products (Product no. A-X) have been registered. The information about the product contents has either been given by the retailer or obtained from the Internet. Table 1.5 Survey of registered creams for treatments of sports pains and injuries
1.5.2 Selection criteriaIn cooperation with the Danish EPA 12 products were selected for further analyses in the project. The selection was made on basis of information about the product contents, i.e. substances which have been declared by the manufacturer as well as estimated consumption. The selection was based on the following criteria:
1.5.3 Selected productsThe following 12 products have been selected for analysis: Product nos. 1, 2, 3, 4, 5, 8, 12, 13, 15, C, E and H. Product numbers and letters from the survey are maintained in the following. Footnotes[3] Politiken, 4th Februar 2005 [4] According to the sports shop is it the same products that are sold in all the the chain store shops [5] CN-code is an 8-digit product code no. (CN ~ combined nomenclature)
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