NSAIDS - Are You Sure?

NSAIDS: Non-steroidal anti-inflammatory drugs

Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs (with different chemical components) known to have potent anti-inflammatory, analgesic (pain relief), antipyretic (fever relief), and antithrombotic (thin the blood preventing clots) effects. There are multiple ways to take them, the most common being oral (pill, capsule). There are topical NSAIDS and even IV.

“Athletes use NSAIDs more than any other medication. For example, during the 2000 Olympic Games in Sydney, one in four athletes reported using NSAIDs 3 days before drug testing.”

“Athletes take NSAIDs for preventing pain, continuing athletic activities in spite of injuries, or accelerate return to function after injury”

“However, NSAIDs have side-effects including asthma exacerbation; gastrointestinal and renal side-effects including acute kidney injury; hypertension; and other cardiovascular diseases [3, 10–14]. Therefore, NSAID use presents a potential health risk for athletes.” (Source).

A black box warning was placed on NSAIDS back in 2005 due to the (Source). A black box warning is the strictest warning placed on a drug label by the FDA! Since that time, warnings about NSAIDS continue:

FDA Drug Safety Communication: FDA has reviewed possible risks of pain medicine use during pregnancy

  • Miscarriage

  • Spinal Cord Defects

FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. July 2015

  • 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.

  • There is an increased risk of heart failure with NSAID use.

What does the research have to say about athletes and the use of NSAIDS?

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 clinical 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."

  • "Athletes 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.

Ibuprofen alters human testicular physiology to produce a state of compensated hypogonadism

"Our data demonstrate that ibuprofen alters the endocrine system via selective transcriptional repression in the human testes, thereby inducing compensated hypogonadism." YIKES!!

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....

Is there any ergogenic (performance enhancing) effect from taking NSAIDS?

Effect of Non-Steroidal Anti-Inflammatory Drugs on Sport Performance Indices in Healthy People: A Meta-Analysis of Randomized Controlled Trials

Short answer – probably not, but the research is still not clear.

What is the take home message?

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. PERSISTENT 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:

  1. Are you hypomobile (stiff and tight) or hypermobile (lax and too loose)?

  2. Do you have strength deficiencies and/or imbalances in different parts of your body?

  3. Is your ability to balance, your coordination, up to par. Click here to learn about the Functional Movement Screen

  4. Is your exercise technique on target?

  5. Have you had your gait analyzed, swim stroke reviewed, bike fitted properly?

  6. Are you nutrient deficient? Click here to learn more...

  7. Do you use proper ergonomics at work and at home?

  8. Do you have a plan to manage stress?

3. FIND A NATURAL ANTI-INFLAMMATORY SUPPLEMENT

There are many nutrients and herbs which have powerful, but safe anti-inflammatory properties. They include turmeric, bromelain, boswellia, bioflavinoids, vitamin D, fish oil, astaxanthin, co-enzyme Q10, ginger, and probiotics.

I take turmeric and bromelain post workout and they work great for me!!

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 people’s diet. Magnesium is critical for muscle recovery, energy production, metabolic efficiency (decreasing the amount of oxygen required for strenuous exercise), and the availability 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 bathtub 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 bathtub. Just dry off and retire for the evening.

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