A black box warning is the strictest warning placed on a drug label by the FDA!
What does the research have to say? The first study is from the British Journal of Sports Medicine, the most prestigious sports medicine medical journal in the world.
The U.S. Food and Drug Administration (FDA) is strengthening an existing label warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) increase the chance of a heart attack or stroke.The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID.
The risk appears greater at higher doses.
It was previously thought that all NSAIDs may have a similar risk. Newer information makes it less clear that the risk for heart attack or stroke is similar for all NSAIDs; however, this newer information is not sufficient for us to determine that the risk of any particular NSAID is definitely higher or lower than that of any other particular NSAID.
NSAIDs can increase the risk of heart attack or stroke in patients with or without heart disease or risk factors for heart disease. A large number of studies support this finding, with varying estimates of how much the risk is increased, depending on the drugs and the doses studied.
In general, patients with heart disease or risk factors for it have a greater likelihood of heart attack or stroke following NSAID use than patients without these risk factors because they have a higher risk at baseline.
Patients treated with NSAIDS following a first heart attack were more likely to die in the first year after the heart attack compared to patients who were not treated with NSAIDs after their first heart attack.
There is an increased risk of heart failure with NSAID use.
Men? Ibuprofen linked to male infertility, study says
"There is evidence that some medications are particularly harmful to the male reproductive system, including testosterone, opioids, antidepressants, antipsychotics, immune modulators and even the over-the-counter antacid cimetidine (Tagamet)," she said. "However, prescribing providers rarely mention these adverse effects with patients when prescribing these medications."
Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes, August 2009
"the prolonged prophylactic use of NSAIDs [anti-inflammatory medication like Advil (ibuprofen) and Aleve (naproxen)] by athletes is unsafe."
"there is no clilnical evidence to suggest that regular use of NSAIDs reduces injury risk or improves function in the typical athlete."
"a paradoxical consequence of the prophylactic use of NSAIDs by athletes is that these agents can compromise the musculoskeletal system. NSAIDs taken before activity may mask pain and thus cause athletes to inadvertently allow pathology to progress."
"Athlese who regularly take NSAIDs before exercise may have reduced tissue adaptations to prevailing loads potentially predisposing them to future injury."
NSAID use delays fracture healing and also delays "healing of acute ligament, muscle and tendon injuries." They prevent bones, muscles, tendon and ligaments from thickening and becoming stronger.
Athletes taking NSAIDs during competition are at increased risk for bleeding into their kidneys, and for intestinal bacteria to enter their bloodstreams.
More warnings from the FDA! Use of Nonsteroidal Antiinflammatory Drugs An Update for Clinicians A Scientific Statement From the American Heart Association, July 2015 "Current evidence indicates that selective COX-2 inhibitors have important adverse cardiovascular effects that include increased risk for myocardial infarction, stroke, heart failure, and hypertension. The risk for these adverse effects is likely greatest in patients with a prior history of or at high risk for cardiovascular disease. In these patients, use of COX-2 inhibitors for pain relief should be limited to patients for whom there are no appropriate alternatives, and then, only in the lowest dose and for the shortest duration necessary. More long-term data are needed to fully evaluate the extent to which these important adverse cardiovascular effects may be offset by other beneficial effects of these medications. More data are also needed on the cardiovascular safety of conventional NSAIDs. Until such data are available, the use of any COX inhibitor, including over-the-counter NSAIDs, for long periods of time hould only be considered in consultation with a physician."
Aggravation of exercise-induced intestinal injury in athletes by ibuprofen, December 2012
"This is the first study to reveal that ibuprofen aggravates exercise-induced small intestinal injury and induces gut barrier dysfunction in healthy individuals. We conclude that nonsteroidal anti-inflammatory drugs consumption by athletes is not harmless and should be discouraged."
Rehabilitation of muscle after injury - the role of anti-inflammatory drugs, August 2012
"... it appears that a potential beneficial effect of NSAIDs in the early phase after injury is not maintained in the long term, or is even negated by a long-term repair deficit. At the cellular level, evidence exists for a negative influence of NSAIDs on the muscle stem cell population (satellite cells)."
Treatment of Skeletal Muscle Injury: A Review, April 2012
"Prolonged use of NSAIDs (over 7 days) is not recommended as it would delay muscle regeneration by inactivating the proliferation and differentiation of satellite cells and inhibiting the production of growth factors [18, 19].
It would also reduce the biomechanical strength of the injured muscle and delay elimination of the haematoma and the necrotic tissue."
NSAID use increases the risk of developing hyponatremia during an Ironman triathlon, April 2006
" NSAIDs are commonly used by athletes competing in endurance events and are a risk factor for hyponatremia and altered renal function."
Non-steroidal anti-inflammatory drugs in athletes, 2006
"... NSAIDs are not recommended in the treatment of completed fractures, stress fractures at higher risk of nonunion, or in the setting of chronic muscle injury. The only exception may be very short-term use (eg, a few days) for analgesic purposes only. Judicious use of NSAIDs may be more appropriate in the management of acute ligament sprains, muscle strains, tendinitis, and eccentric muscle injury. However, length of treatment should always be kept as short as possible, with consideration of the specific type of injury, level of dysfunction, and pain."
How about Tylenol?
"It is tempting to point accusing fingers at physicians who say that acetaminophen is safe when they literally have no grasp whatsoever of the relevant scientific literature. However, this would be a mistake." Read on....
WHAT IS THE TAKE HOME MESSAGE OF THESE STUDIES?
1. DON'T KEEP IGNORING THE PAIN! Your body is telling you something ... listen! Stop and assess the damage.
"But to take the drugs before every run and throughout the year is a concern. You need to think of pain not as a hindrance, but as a signal that something is not quite right," he says, adding that, "NSAIDs should not be used at the expense of a thorough assessment of an injury by a trained professional, such as a physical therapist or physician." (Source) And I would add a sports trained chiropractor!
2. PERSISTANT PAIN REQUIRES PROFESSIONAL HELP! Get an examination from a competent practitioner who will not simply say, "Stop your activity and take Motrin." That is the standard medical approach and as you have read, completely contraindicated. Get some answers:
Are you hypomobile (stiff and tight) or hypermobile (lax and too loose)?
Do you have strength deficiencies and/or imbalances in different parts of your body?
Is your ability to balance, your coordination, up to par. Click here to learn about the Functional Movement Screen
Is your exercise technique on target?
Have you had your gait analyzed, swim stroke reviewed, bike fitted properly?
Are you nutrient deficient? Click here to learn more...
Do you use proper ergonomics at work and at home?
Do you have a plan to manage stress?
3. FIND A NATURAL ANTI-INFLAMMTORY SUPPLEMENT
There are many nutrients and herbs which have powerful, but safe anti-inflammatory properties. They include tumeric, boswellia, bioflavinoids, vitamin D, vitamin D, astaxanthin, fish oil, co-enzyme Q10, ginger, and probiotics.
I have experimented with many products and found that Overdrive has worked the best for me. As a master's athlete, I know the difference this makes in my recovery and ability to train. It is up to you to experiment and discover what works best for you.
"I had the opportunity to try and review the contents of OverDrive. I found that there are only positive and beneficial ingredients in the contents of this product. I further found that a number of vitamin and mineral supplements in the product can be beneficial to athletes, and to all those who use them. Further, there were no substances in these products that could be banned in competition under Surf Life Saving Australia's Drug Policy." Dr PETER FENNER MD (Lond), DRCOG, FACTM, FRCGP, Hon. National Medical Officer, Chairman, Surf Life Saving Australia Medical Advisory Committee. (Source)
4. TAKE AN EPSOM SALTS BATH
Many top athletes use Epsom salts as a natural remedy to help their bodies recover faster. Epsom salts are made up of the naturally occurring mineral magnesium which aids in muscle recovery and is commonly deficient in most peoples diet. Magnesium is critical for muscle recovery, energy production, metabolic efficiency (decreasing the amount of oxygen required for strenuous exercise), and the availablility of glucose in the blood, muscle, and brain.
Epsom salt baths can be taken routinely, just before going to bed, after practice or a game. It also helps with combating jet lag. Use 1 cup of Epsom Salts per every 60 lbs. of body weight (it is not necessary to exceed 4 cups) in a warm/hot bath tub of water (104 degrees F or less). soak for 10 to 20 minutes. Make sure to mix the water so the salts fully dissolve. Don’t rinse off before getting out of the bath tub. Just dry off and retire for the evening.