About five years ago, I was talking to a sprinter at Newton North and asking about her recovery from an injury that had happened many weeks earlier. To my surprise and consternation, she said she had been taking ibuprofen -- six tablets a day, every day -- since the injury. I don't remember exactly what I said. I'm not a doctor and I'm always careful not to give medical advice, but in this case I did tell her that taking so much ibuprofen seemed wrong to me, and she should talk to a doctor.
I have always had a distrust of pain-killers in general, and NSAIDs (non-steriodal anti-inflammatory drugs) like ibuprofen in particular. I figure that knowing what hurts and regulating your training accordingly is just common sense. However, I have never had any solid scientific reason for my prejudice.
So I was fascinated to read a story in the New York Times summarizing several studies of ibuprofen use during races, and as a regular "supplement" during training. The results strongly suggest, as the article says, that NSAIDs are justified in reducing inflammation after an acute injury, but should NOT be used prophylactically.
Here's a link to the article. I'd love to hear from some of the medical professionals who read this blog what they think.
Does Ibuprofen Help or Hurt During Exercise?
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7 comments:
Intriguing that you post an article about the use of pain killers now of all times. Two weeks ago I was involved in a bicycling accident suffering several broken bones. I have been taking more pain-killers than ever before, first prescription drugs, then ibuprofen and now finally plain old acetaminophen.
I have never been a big proponent of pain-killers just for dealing with the soreness involved with training or racing hard. In fact I think there is something cathartic about the discomfort involved in pushing your body to the limit both during and after activity.
However as of late, I've unfortunately experienced the effects of chronic pain and have been extremely grateful for the pain dulling effects of western medicine. The article makes a valid point that ibuprofen is justified during the acute phase of an injury not as a general-use supplement to training. As with most things in life, moderation is key.
Outcomes studies!
In the real world, what actually happens to athletes who regularly take ibuprofen vs those who don't?
This medical professional notes that a lot of things that seem to make sense end up not working the way that we thought that they would.
I wouldn't call my self a medical professional, but I have done a fair amount of study on physiology and one thing I have actually looked at is the use of Ibuprofin. While the bacteria leaking into the stomach is not something I have seen before, most people do know that Ibuprofin is bad for the stomach (hence taking it with food) and long term use has the risk of leading to ulcers.
The article hit the nail on the head with talking about prostasglandins. This is what concerns me the most about Ibuprofin. Prostaglandins are essentially pain signalers, so Ibuprofin blocks these and blocks the sense of pain. But when prostaglandins signal pain, they also signal the necessary response to pain to promote fixing whatever the problem is, and that fix is usually in the form of inflammation. Inflammation is actually one of the best things in your body. You get inflammation so that you can get extra blood flow and heat to an injured area and get extra doses of all the goodies that your blood carries to heal your body. Inflammation is bad however in an athlete that will use a join regardless of whether it is injured or not (such as Achilles tendonitis) because an inflamed tissue does not move in the body as easily as it normally does.
I stopped taking Ibuprofin when I was having problems with repeated stress fractures because of its slight inhibition of new bone formation (because of the blocking of prostaglandins), this however is a SLIGHT inhibition and only really has an effect in a long term analysis, taking Ibuprofin a few times, or even for a few weeks, will not have an effect on your bones. Ibuprofin should also not be taken after weight lifting. The great "buff" look you get right after lifting is your muscles filling up with blood and getting inflamed. You just spent the last hour repeatedly tearing you muscles and now your body is going to work right away to repair them, Ibuprofin will cut this inflammation (and the pain) but also cuts off the supply of healing elements to your muscle and has been shown to significantly reduce the benefits form weight lifting.
On the subject of racing, rather than a rant I have one anecdote about senior year running XC at North. My achilles had started to hurt about two weeks before our last home meet and it was close to the end of the year, and I didn't know that much about running yet. So I had started taking heavy doses of Advil before runs to dull the pain. Well the pain kept getting worse and I could barely run the couple days before the last home meet, but I didn't want to skip it, so I took about 5 Advil before the race. Through about 2.5 miles the pain was numbed and I was able to run normally, then with around a half mile to go, the pain supersede the Advil and I started limping, eventually limping across the line. I didn't run another step for 2 weeks. I had basically pushed my ankle way beyond its limits because I couldn't feel the pain telling me to back off until it was too late and suffered the consequences. That taught me a valuable lesson about understanding that painkillers hide the pain, they don't fix any problems.
Now, after all this ranting about why Ibuprofin is bad, what I am really getting at is understanding how it works so you can asses when you should or should not use it. Used at the correct time I think Ibuprofin is a miracle worker. Even on hardcore regimens such as 4 pills 3 times a day for 4 weeks to treat a chronic problem like a tendonitis somewhere I think is great. Inflammation is great if you can rest the joint or muscle, bust most runners are not going to do that, so keeping inflammation at bay so that the joint or muscle can move more freely during activity and thus not get more aggravated is necessary. So in the end analysis I say take Advil in response to aches and pains, no problemo, don't take it in response to ANTICIPATED aches and pains.
I try to avoid Ibuprofen because like Scott I believe there is a healthy amount of inflammation.
One anecdote though provides an exception:
In my junior year at North I ran the 1000 in our first indoor meet. I'd improved my times in Cross Country a whole lot. 17:34/17:55 at Brown & Cold Springs from 18:50ish sophomore year XC. I'd run 2:49 the year before, had done tennis in the spring. In the race, I got a clean run from the barrel(I was North's #3 with Foote and Polgar running too). I held on for dear life behind Polgar, Foote, and Chris O'Day and ran 2:41. It was an 8 second PR. That night I woke up at 2 in the morning with my legs completely on fire. I was writhing iun pain and popped 3 ibuprofens and was asleep with the pain gone in a matter of 30 minutes. There was no way I would've fallen asleep without it, and it's for that type of thing I might make the exception. Again though, never anticipatory.
What's most interesting is the finding that inflammation is actually WORSE after taking an nsaid. I was talking about just this a few weeks ago with a phyisician who remarked that there are findings that one of the primary causes (or rather pre-conditions) of cancer is inflammation....but he was advocating the use of ibuprofen as a way to lessen inflammation post-workout. Seems as if the jury's way out on this one.
For the most part, drugs/chemicals of any kind are a bad idea, but that's just me...jk
Thanks for this article! As a 50+ woman with injuries that resulted in osteoarthritis, I have taken ibuprofen regularly for the last 20 years. There are times when it is absolutely necessary in order to function, but this is now another reason to avoid taking it.
Other reasons:
1. bleeding time increase (decrease in clotting).
2. increased risk of high blood pressure.
3. cited in other comments - impact on healing a bone fracture. My orthopedist noted that taking it at first for the acute pain would probably not be an issue.
I'm finding relief for moderate joint pain/inflammation in moderate exercise such as a pilates or yoga class. For an acute injury or overuse tenidinitis, follow your doctor's orders.
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