When I’m working, clients and I chat about all sorts of things. Obviously the many different aspects of endurance exercise are popular and fascinating topics. One of the things that crops up increasingly frequently around marathon time is the use of NSAIDs (non-steroidal anti-inflammatory drugs) during exercise ie ibuprofen, aspirin, diclofenac among others.
I’m not a doctor or pharmacist so I’m in no position to talk with authority about this, but I thought as some of you are endurance athletes, you might be interested. Please discuss this with someone medically-trained if you’re concerned or have questions.
What we all know is that NSAIDs are often prescribed for inflammation: “to get the swelling down”, “to get rid of the inflammation” as well as “to get rid of the pain”. When you know that prolonged exercise causes inflammation and pain in muscles, it would seem to make sense to use a drug that deals with those things to reduce your symptoms… or to prevent them occuring in the first place. I know of many athletes who have swallowed a couple of Nurofen before a big event to stave off the pain they know is coming.
BUT. Evidence shows it’s not a good idea.
Before examining why this may be, a quick explanation of the inflammation process might be useful.
The inflammation response is your body’s highly effective automatic response to trauma such as sprains, cuts, muscle tears, abrasions, fractures, infections etc. It kicks in instantly and over the next 36-48 hours (or possibly longer) helps your body to deal with the trauma and start the healing process, including stopping any bleeding. Specifically it causes swelling (fluid leaking out of damaged cells and extra chemicals brought to the area), heat (extra blood flow and increased metabolic activity), redness (extra blood flow) and pain (all that extra fluid and damaged tissue pressing on pain nerve endings). So all the symptoms of inflammation are features of the healing process and completely normal and useful.
So why might it not be useful to use NSAIDs while undertaking endurance activity?
There are several reasons, all of which are discussed in the link to a Runners World online forum thread on the topic which I’ll put at the end of this post. The link is to the Runners World thread and includes related comments from runners and triathletes. Additional (and more recent) research published in Science Tranlational Medecine on 1 Feb 2012 also provides good insight – I’ve included a link to this, too, as reported in the New York Times. If you google something like ‘endurance training NSAIDs’ you’ll get a wealth of other info on the topic.
However, the highlights are as follows:
- NSAIDs, being anti-inflammatory, are said to interfere with the inflammation process. So if your muscles are newly damaged, or are still being damaged because you are still running/cycling etc, popping a Nurofen hinders their healing process.
- According to the studies in the RW/New York Times article, the NSAIDs didn’t decrease the pain experienced by ultra long distance runners.
- NSAIDs can interfere with kidney function. When you consider how crucial hydration and electrolyte balance is during endurance exercise – especially on a hot day – anything that interferes with the kidneys (which regulate the body’s hydration and electrolytes) is definitely not what you want.
- NSAIDs may actually hinder healing, although they reduce inflammation.
So what does this mean to endurance athletes?
I think it means you should read up on ibuprofen, pain and understand what you are doing if you take pain killers during exercise so that you can make an informed, sensible decision, based on factors such as why you think you need to, the temperature, how long you’ll be exercising for etc.
I think it means you should think twice before taking Nurofen or ibuprofen for pain when exercising (I take paracetamol if I have to, but I’m not telling you to do the same).
I think it means that when you do long distance events, you need to accept that pain can be part of the picture and you need to know whether that pain is acceptible discomfort or whether it’s an injury that needs urgent attention. Masking either as a matter of course may not be helpful.
One question you might be asking: if NSAIDs are so bad, why are they on sale as over the counter painkillers? My understanding is (and please remember that I’m not a medic) that once that initial 48-72 hour phase of the inflammation process is over in an acute situation, the swelling, redness and heat should naturally be reducing and are no longer desirable or as useful as they were initially and therefore, anti-inflammatory drugs are appropriate. Similarly, if there is a chronic inflammatory situation (eg a tenditis or tendinopathy which has been going on for several weeks) anti-flammatory drugs can be useful to break the cycle of inflammation and re-inflammation.
So – if any of you are about to do a spring marathon in the next week or so… do read up on taking anti-inflammatories and consider whether they’re the best thing for you.
Other related links:
Endurance Corner: Think Twice about NSAIDS – this highlights a possible link to cardiac issues. This one gets a bit technical, but it’s actually quite easy to read. If you scan down the page, however, you can skip to the heading which relates to endurance athletes.