BetterAthlete

  • Increase font size
  • Default font size
  • Decrease font size
Home
  • swim.jpg
  • triathlon2banner.jpg
  • RunnerBanner.jpg
  • nice path.jpg
  • MountainBikeBanner2.jpg
  • picBanner01.jpg
  • cycle1.jpg
  • banner_triathlon.jpg
  • swim1.jpg
  • swim2.jpg
  • trail run.jpg
  • running1.jpg
  • legs.jpg

Anti-inflammatory Medication and Exercise

Is it safe for athletes to use anti-inflammatories before and during long endurance races and longer training sessions?

All athletes, from professional athlete to beginners, will need pain medication from time to time. Joints get injured, muscles are strained and “overuse" injuries such as shin splints, plantar fasciitis, and tendonitis are common. Athletes, like their non-athletic counterparts, are not immune to headaches and old-fashioned back pain either. NSAIDs have commonly been used by athletes to treat many conditions including acute musculoskeletal injuries, such as a sprained ankle or muscle soreness after an intense workout. However, athletes are beginning to use these anti-inflammatories to prevent injury or pain, especially before and during long endurance races. It is estimated that 30-50% of participants in Ironman races and marathons take NSAIDs. The theory behind this practice is that the prophylactic inhibition of the production of inflammatory mediators will lead to decreased muscle soreness, fatigue, and ultimately shorter recovery times and improved performance.  But is this safe?

 

What’s the difference between pain medications?

Pain medications can be grouped into 2 categories: those that possess anti-inflammatory actions, and those that do not:
 
Pain Medications with Anti-inflammatory Actions:
  • aspirin and other salicylates
  • NSAIDs or “non-steroidal anti-inflammatory drugs” (Ibuprofen and others)  
Pain Medications without Anti-inflammatory Actions:
  • acetaminophen (Panado and others)
  • opiate agonists (morphine, codeine, and others)
Because inflammation is typically a component of most sports injuries, drugs with anti-inflammatory actions are effective analgesics. For the same reason, analgesics that do not possess anti-inflammatory actions are less effective for sports injuries. 
 
What do the studies say?
Several studies have found little performance benefit from taking ibuprofen and warn that it may mask pain, which can lead to increased risk of injury.  Side effects of chronic anti-inflammatory use are well-documented. A common side effect of using NSAIDs is bleeding from the gastrointestinal tract. In a study of gastrointestinal (GI) bleeding in marathon runners, more than half of the applicants had to be excluded because of regular aspirin use (Stewart JG, et al. 1984).
Further studies have cautioned that the use of NSAIDs during ultra distance exercise, such as an Ironman Triathlon, is associated with an increased risk of exertional hyponatremia (low sodium concentration in the blood) as Aspirin and NSAIDs can affect kidney function. In otherwise healthy athletes who stay well-hydrated and do not use these drugs excessively, kidney problems may never appear. However, there is some concern that taking aspirin or one of the NSAIDs just prior to endurance exercise (e.g. a marathon) might increase the risk of hyponatremia.
Starting in 1979, reports began appearing in the medical literature of marathon runners who developed hyponatremia. In May 2000, a report was published describing 7 marathon runners who developed hyponatremia with complications; one of these athletes died. All 7 of the athletes had taken NSAIDs, but the authors did not clarify when the drugs were consumed in relation to the race (Ayus JC, et al. 2000).


When should you use NSAIDs?
So, with all of these possible side effects and lack of scientific evidence that they help to enhance athletic performance, should one ever take NSAIDs? In general, moderate use after exercise to treat acute musculoskeletal injuries or muscle soreness for a short period of time is usually safe. People who have a history of gastrointestinal bleeding or kidney problems should check with their physicians before taking any NSAIDs. One week should be considered the maximum time frame to self-medicate with a NSAID. Chronic use of NSAIDs should be discouraged, not only to reduce the risk of adverse reactions but also because the condition may require medical attention if it does not resolve within this time period.

Bottom Line
Take care of your body including proper training, rest, nutrition, hydration and recovery. Occasional NSAID use AFTER exercise is probably helpful and safe if used for a short time period for an acute injury. It is probably safer to avoid taking it as an aid to improve athletic performance before or during races. Always seek physician recommendations and expertise if you are ever in doubt about what is best for you.