NSAID misuse in endurance athletes

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There's a good chance that a bottle of over-the-counter painkillers are in your house right now. If you are an active individual or athlete, there's an even better chance that you have taken a pain reliever to reduce exercise-related inflammation, pain, swelling or soreness. Although NSAIDs are somewhat safe, most athletes have little awareness of (or choose to ignore) the risks and potential adverse complications. 

What are NSAIDs and how do they work?
Non-steroidal anti-inflammatory drugs are designed to manage pain, swelling and inflammation. They may also treat non-inflammatory conditions such as migraine, menstrual pain, fever and postoperative pain. Over the counter NSAIDs that you will typically see in the store include: 

  • Asprin (which has blood thinning properties)
  • Ibuprofen, Advil, Motrin
  • Naproxen

NSAIDs work by blocking a specific enzyme called COX (cyclooxygenase) used by the body to make prostaglandins. COX-1 and COX-2 are enzymes that are necessary for the prodution of prostaglandins. Prostaglandins are hormone-like chemicals in the body that trigger inflammation, pain and fever, which in turn sends signals to the brain. They also increase temperature and dilate blood vessels, which causes redness and swelling in the place where prostaglandins are released. NSAIDs result in fewer prostaglandins and thus, less inflammation and less dilation of blood vessels. 

What is the difference between NSAIDs and Acetaminophen? 
Tylenol (acetaminophen) and Ibuprofen (NSAID) both treat fever and pain. But Ibuprofen also targets inflammation. Acetaminophen is an analgesic which means it reduces pain signals within the nervous system. 

Why do athletes take NSAIDs? 
NSAIDs are widely used by athletes to: 

  • reduce anticipated inflammation and soreness that could occur during or after an event 
  • moderate or reduce muscle pain
  • treating soft-tissue disorders
  • increase recovery after a hard workout 
  • improve healing time after an injury
  • accelerate the return to training
  • reduce soreness 
  • supress inflammation
  • blunt the pain of strenuous training/competition 
  • attempt to make hard training more tolerable
  • to help get through a workout
  • to help get through daily living activities
  • ritual or habit 
What are the side effects of NSAIDs? 
Although effective in relieving pain, fever and inflammation, there are unwanted side effects. The risks are even greater when taken before, during or after exercise (especially endurance activity) or taken for long periods of time. 
  • Gastrointestinal -indigestion, nausea, stomach pain
  • Stomach ulcers
  • Bleeding in the stomach or other parts of the gut
  • Acute kidney injury
  • Altered kidney function 
  • Increased muscle damage
  • Increased risk of hyponatremia
  • Impaired ability for muscles to strengthen after hard workouts
  • Slow muscle recovery (prostaglandins have an important role of stimulating stem cells within the muscle to multiple, creating new muscle cells to repair damaged tissue. The healed muscle tissue is then stronger than before).
  • Increase risk of bone related issues 
  • Increase risk of heart attack and stroke 
Final thoughts
Several research studies have shown little performance benefit of taking ibuprofen to mask pain before or during endurance activity. Therefore, let it be known that NSAIDs do not help with performance, soreness or muscle damage during endurance activity but they do contribute to a wide range of serious side effects. If you must take NSAIDs, take occassionally on must-needed basis and at the lowest dose possible. Never take before, during or after exercise and absolutely do not take before, during or after races. If you are experiencing chronic pain or you can't get through workouts without NSAIDs, it's critical to address the root of the problem (or adjust training) than to risk health for performance. Consider magnesium creams, epson salt baths, massages and mobility as part of your daily routine. Also, skip the supplements and focus on your plate. Foods like fatty fish, pineapple, peppers, oranges, carrots, berries, leafy greens, tart cherry juice and the spice turmeric are also natural ways to help with inflammation. And remember, inflammation is not a bad thing. It's a natural and necessary process of the body trying to adapt to a stressor. And if your body is experiencing pain, it's trying to tell you something that shouldn't be ignored. 

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