Gary's new website

Saturday, June 16, 2012

Does taking anti-inflammatory drugs (NSAIDs) improve performance and recovery?

Gary's bruised and battered thigh -
No anti-inflammatories - just quick healing!
A report from the annual meeting of the European League Against Rheumatism (June 11, 2012. Abstract FRI0457) showed that in exercisers with Delayed Onset Muscle Soreness (DOMS), taking non-steroidal anti-inflammatory drugs (NSAIDs) such as ketoprofin (100 mg twice a day) increased the amount of pain and delayed healing. Celecoxib (Celebrex, 200mg twice a day) treatment diminished total pain slightly. The authors state that "the inflammatory reaction following muscle injury is essential for recovery".  This supports other studies showing that competitive athletes do not benefit from taking NSAIDs. For example, Ibuprofen did not reduce elevated cytokine levels that signify muscle damage in ultra-marathon runners (Brain Behav Immun 2005;9: 398-403).
"So, Gary, when was the last time you took an anti-inflammatory?"

Answer: "Not in the last ten years at least".

Because anti-inflammatories interfere with healing and recovery. By interfering with healing and recovery, the athlete risks ending up with structures, such as tendons and ligaments that are incompletely healed and, therefore, weak and at risk of further injury. Any further injury to an already weakened structure may result in catastrophe such as complete avulsion of the ligament or rupture of the tendon.

Please read this article for a more detailed explanation as to why anti-inflammatories should be off the treatment list:

If you hurt yourself, the better course of action is to bear with the pain and use treatments that do not interfere with healing like compression and elevation in the first instance and then gentle exercise, massage and warmth, depending on the medical advice.

"Should I take anti-inflammatories NSAIDs before doing bruising or exhausting exercise?"

The answer is an emphatic "NO!"

Quoting from Dr Mirkin's article above: ".. competitive athletes do not benefit from taking NSAIDs".  In fact, the evidence is that taking NSAIDs before and after hard exercise causes physical harm by directly interfering with the healing processes, of which inflammation is an integral part.

If inflammation is excessive, then you need to take a hard look at your nutrition, as well as adrenal health - Do so with the assistance of a suitably qualifies health practitioner please.

You need inflammation in order to heal!

"If this is the case, then why does it seem that every sports medicine practitioner recommends and dispenses anti-inflammatories for just about every sprain, strain and bruise - even the most minor?"

It all comes down to the power of the Market - the Almighty Dollar!  Millions are being raked in daily by powerful and influential pharmaceutical companies from the sale of NASID's and they are not about to let a minor detail, such as "harm" to get in the way of a healthy profit.

"So, why don't the Medical Professors say something?"

My opinion: Medical schools rely on millions of dollars of research grants and direct funding from pharmaceutical companies for survival nowadays.  No longer can such institutions of higher learning be considered independent of commercial interests.  Do you really think the Professor in charge of Rheumatology is going to make a public song and dance about the inappropriateness of and excessive prescribing NSAIDs for most injuries and aches and pains?  Not likely!  While he/she may express an opinion in private that is similar to mine, he/she is unlikely to speak of such things in public, lest it jeopardises millions of dollars worth of Faculty funding.  Ethically, he/she should speak out regardless of the possible consequences, but don't hold your breath on that one folks!

About this website
The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.


Anonymous said...

dearest Gary, interesting blog as always. While, as a general rule, I refrain from using NSAIDs myself may I humbly offer an alternative perspective on how beneficial inflammation during tissue injury is, at least the inflammatory proceses occurring in the first 24 hours. While it is true inflammatory cells and processes play a role in tissue repair the cells involved in repair are actually quite distinct from the initial inflammatory macrophages and neutrophils that enter an injured tissue site. These cells are nasty, full of reactive oxygen species and other harmful substances that actually further damage tissue. I would actually argue that nothing good happens during the first 24 hours of inflammation! Rather I would argue that the primary purpose of inflammation at this point is infection prevention. The products of tissue injury do trigger nasty inflammatory processes and from an evolutionary point of view this makes sense. As most invading pathogens cause tissue damage the products of tissue injury serve as an early warning signal of the potential presence of something pathogenic. If we respond early to tissue damage before infection sets in (with nasty inflammatory processes that create a hostile environment for the growth of pathogenic organisms) we are at a distinct survival advantage... some degree of collateral tissue damage is a small price to pay for infection prevention which may be deadly. While obviously there is not an infection risk with every tissue injury I would still argue our body responds the same to all with the primary purpose of the initial inflammation being infection prevention. Why does our ankle swell when we roll it? It is not the result of increased blood flow in but rather decreased blood flow out. In addition to the inflammatory processes occurring the decreased blood flow out forces the extra fluid into the extracellular compartments where it is drained by the lymphatic system, the entire purpose being for immune surveillance. So what am I saying? While I would not advocate the use of NSAIDs I would argue that not all inflammation is good and essential to the healing process and that the first 24 hours is usually excessive and further aggravating to the inital injury. I actually have no interest in sports injuries at all but should I happen to be having a hit of squash or tennis one day and I have the misfortune of spraining an ankle or tearing a hamstring I wouldn't hesitate to grab a bag of ice and try and reduce the inflammation, assuming I wasn't in too much of a hurry to get to the pub for a post game beer! So my two cents worth. BTW next time you take my fiance out for a run can you please beat him? All I've heard this evening is his gloating over how he dominated in the run this afternoon!

Gary Moller said...

Ha, ha! Was he really gloating? All I recall is he almost died of hypothermia!

Re: your comments about the use of NSAID's in the first 24 or so hours of an injury. I am so grateful that you raised the issue. Thank you.

Yes, much of what Nature does is a trade-off. A good example is the need for sun exposure for vitamin D. While there is a risk of developing skin cancer, it can be assumed that the immediate benefits outweigh the potential longterm risks.

So, some of the immediate inflammatory activity to prevent infection may appear to be counterproductive in the absence of infection, such as with the closed wound of a sprain. Yes, I agree and I respect your authority on the topic. However, I alluded to the solutions in my article that do not require a drug:

1: Ensuring that the person has strong adrenal glands prior to the injury because the adrenals regulate the inflammatory response to injury.

2: Ensuring that the diet is supportive of healing and with moderating inflammation. This includes ensuring that there is a rich supply of anti oxidants, such as mixed betacarotenoids, that will mop up the free radicals you refer to, as they are formed, thus sparing the undamaged cells from further harm.

As you know, I participate daily in bruising sports. What has blown me away, is how this approach to healing has worked so well. For example, I whacked my shoulder really hard on a tree trunk earlier today while out mountain biking. Gosh did it hurt! All I could do for a few minutes is moan, curse and nurse my shoulder due to the pain. However, all is fine right now other than some lost skin and a wee bit of swelling.