“Should I take an anti-inflammatory pain reliever before training to reduce pain, stiffness, and other symptoms from training?”

Endurance Athletes like Cyclists, Runners, and Triathletes commonly take an ibuprofen, motrin, advil, or some other NSAID (diclofenac, celecoxib, rofecoxib) before training with the hopes that it would reduce inflammation and pain from pushing your body.

The practice of pre-training over the counter anti-inflammatory use is actually common in many sports/types of training.

NSAIDs are often taken because they are readily available, while seemingly reducing pain and inflammation. These factors make these drugs very common among endurance athletes like runners, cyclists, and triathletes.

Often these athletes will take a significant amount of these drugs before, during, or after training to reduce post-workout delayed onset muscle soreness.

This can help the soreness in some cases, but it can come at a significant price, more on that in a moment.

What Are NSAIDs?

These are common over the counter and prescription pain relieving medications.

The group of medications in questions are referred to as NSAIDs.

The Over The Counter pain relieving anti-inflammatory drugs include:

• Aspirin (Bayer, Bufferin, Excedrin)
• Ibuprofen (Advil, Motrin IB)
• Ketoprofen
• Naproxen (Aleve)

Prescription NSAIDs include:
⦁ celecoxib (Celebrex)
⦁ piroxicam (Feldene)
⦁ indomethacin (Indocin)
⦁ meloxicam (Mobic Vivlodex)
⦁ ketoprofen (Orudis, Ketoprofen ER, Oruvail, Actron)
⦁ sulindac (Clinoril)
⦁ diflunisal (Dolobid)
⦁ nabumetone (Relafen)
⦁ oxaprozin (Daypro)
⦁ tolmetin (Tolmetin Sodium, Tolectin)
⦁ salsalate (Disalcid)
⦁ etodolac (Lodine)
⦁ fenoprofen (Nalfon)
⦁ flurbiprofen (Ansaid)
⦁ ketorolac (Toradol)
⦁ meclofenamate
⦁ mefenamic acid (Ponstel)
⦁ and the no longer available Vioxx and Bextra that were pulled from the market due to the high risk of heart attack and stroke.

We’ll mostly consider over the counter NSAIDs in this article, but some athletes are taking the prescription NSAIDs while training and the information below can also apply to this situation.

NSAIDs slow tissue healing.

When you train, you hope to achieve a positive response that enables you to progressively improve over time.

The problems with NSAIDs include that you reduce that positive response.

The first phase of soft tissue healing is the inflammation phase.

Taking an anti-inflammatory will reduce inflammation. This intereferes with the process of soft tissue healing. It’s counter-productive for your recovery.

Several studies (below) have shown that NSAIDs interfere with recovery from your workouts and prevent the benefits of adaptation to a hard work out.

Going back to 1986, researchers expressed concern that NSAIDs would interefere with soft tissue injury recovery.

Workouts place singificant stresses on the muscle and soft tissue. This stress results in essense, an injury.

It’s the recovery and adaptation to this stress that provides the benefit of the workout.

Anti-inflammatories block the initial inflammatory process halting soft tissue healing before it ever even gets started.

Am J Sports Med. 1986 Jul-Aug;14(4):303-8.
Healing of experimental muscle strains and the effects of nonsteroidal antiinflammatory medication.

http://journals.sagepub.com/doi/abs/10.1177/036354658601400411

Several studies (a few representative studies discussed below) have shown that NSAIDs interfere with recovery from your workouts and prevent the benefits of adaptation to a hard work out.

NSAIDs Reduce Recovery and Training Adaptation In Athletes

Athletes train with the hopes of creating an adaptive stress on the body to help them improve future performance.

NSAID use during training prevents this positive training response.

How?

NSAIDs work by blocking an enzyme in the body that breaks down the omega 6 fat, arachidonic acid into prostaglandins associated with inflammation.

The problem is that your body needs the inflammatory response to heal and recover from training. If we artificially drop this response, it results in your body not being able to clean up the damage.

An interesting article published in the British Journal of Sports Medicine, Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes, addresses this very topic. http://bjsm.bmj.com/content/43/8/548.full

The article reports that athletes taking ibuprofen during endurance training had poor recovery and adaptation to the training.

“These results indicate that ibuprofen administration during endurance training cancels running-distance-dependent adaptations in skeletal muscle.

This suggests that even if ibuprofen administration facilitates longer-distance running, no further effects of training on skeletal muscle can be expected.”

In other words, when taking Ibuprofen during training, the musculature does not repair itself properly reducing any benefit of the training.

This leads to weaker soft tissues and increased risk of injury.

Another study “The influence of anti-inflammatory medication on exercise-induced myogenic precursor cell responses in humans” J Appl Physiol 2007;103:425–31 found that there was a significantly reduced amount of satellite cells (critically important for skeletal muscle adaptation to exercise) in people that used NSAIDs during their training cycle.

“Satellite cells are crucial for skeletal muscle adaptation to exercise. They contribute to hypertrophy by providing new myonuclei and repair damaged segments of mature muscle fibers for successful regeneration following injury or exercise-induced muscle damage.

There is ample evidence to show that exercise can stimulate satellite cells to re-enter the cell cycle and proliferate, reviewed by Kadi et al.

Cyclooxygenase (COX) is necessary for satellite cell activity and muscle regeneration. Furthermore, it has been shown that inhibition of COX activity by ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) suppresses the increased muscle protein synthesis rates normally observed following exercise.

Such an observation is clinically relevant given the widespread consumption of NSAIDs among athletes”

This further evidence suggests that it is harmful for athletes to take NSAIDs during training if they wish to have a more positive training impact and recovery.

Article link: http://jap.physiology.org/content/103/2/425?ijkey=7a7459919960744740f75011df392a42a0383526&keytype2=tf_ipsecsha

Another study with mice found that if the medication allowed for a longer training session, no benefits would occur as a result of the training.

J Physiol Pharmacol. 2010 Oct;61(5):559-63.
Ibuprofen administration during endurance training cancels running-distance-dependent adaptations of skeletal muscle in mice.

full article here: http://www.jpp.krakow.pl/journal/archive/10_10/pdf/559_10_10_article.pdf

Are there other side effects from taking aspirin and NSAIDs?

Yes. The potential problems with NSAIDs goes far beyond the loss of training adaptation though.

NSAIDs carry a serious risk of cardiovascular event (including heart attack, stroke, death), Gastrointestinal damage (including ulcers, bleeds, death), kidney problems, and MANY other potential problems that we’ll cover in other posts.

 

This post is not meant to give specific medical advice for you, but to provide education about possible risks. You should always talk to your doctor about taking these medications. It’s important to understand your individual risks and any possible benefits. This includes if you are taking over the counter pain relievers.

 You should talk to your doctor if you are taking these medications on your own for training soreness. If you’re experiencing pain related to your training, then there are many things that you can do to improve it without turning to these anti-inflammatories.

We’ll cover those in another post.

If you’re experiencing an injury, acute or chronic musculoskeletal pain then I suggest you see a good Chiropractor. If you’re in the Texarkana Area, then click here and we’ll set up an appointment for you.

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