Thursday, June 23, 2011

PSA on Ibuprofin and Racing

I've noticed recently that a lot of people mention in their race reports that they take ibuprofen either before or during their races.  I wanted to mention that there are some serious health risks associated with taking NSAIDs.

First and foremost, taking NSAIDs before or during a race means that you are taking it with the intent of masking pain.  In other words, you are less likely to experience the pain your body may naturally indicate when something is wrong.  Obviously, there is good pain (wow, this race is making me tired) and bad pain (my ankle hurts, but I sure am glad I took that ibuprofen).  In the good pain situation, you should feel some pain - you're racing!  But in the bad pain situation, you risk further injury by inhibiting those pain management receptors that NSAIDs block.

On the other hand, if you experience an acute injury (you just returned from a run and feel immediate pain), it is OK to take some kind of NSAID to help manage the pain AFTER the workout.  However, this is not a long term solution and it will not necessarily help solve the problem.  A better solution would be to reduce inflammation by ice and let your body heal the issue.  Depending on what it is, it could just be a case where ice and rest can resolve it.  Other issues may require more focused therapy/self massage.  In either case, NSAIDs are not going to cure the problem and they should not be replied upon to do so, despite their frequent use among endurance athletes.

This post was partly inspired by a recent article describing the inheirent risks of NSAID usage amongst endurance athletes.  Among the many side effects of NSAID usage is GI bleeding and additional stress on the body, which can create further dehydration.  When you carry that over the course of a long distance endurance event, you find that cramps and other muscular issues result - something everyone tries to avoid if at all possible  An interesting result from that study referenced in the article was this:

Between 2002 and 2006, Dr. D.C. Nieman, director of the human-performance lab at Appalachian State University, conducted a study comparing the finishing times, rate of perceived exertion and physical states (using pre- and post-race blood samples) between two groups of competitors at the Western States 100. Members of one group took between 600 and 1200 mg of ibuprofen before and during the race, and members of the other group took no pain relievers.

Dr. Nieman's study found little variance between the two groups when it came to muscle soreness or  race performance, but did find greater instances of inflammation and endotoxemia (when toxins leak into the bloodstream from the colon) among the ibuprofen users.

"Ibuprofen had no beneficial effect on muscle soreness or pain," says Nieman. "When I presented these findings at a seminar for Western States runners, just about everybody said they would continue using ibuprofen."

So ultimately, you're doing yourself more harm than good by taking NSAIDs.  As far as natural anti-inflammatories go, fish oil is always considered one of the best sources.  I think the common perception that taking a pill is somehow magically better than taking something natural has led to the misuse over time.  And if you notice the conclusions from another study regarding the increased risk of heart attacks and stroke when taking NSAIDs, I think you might be able to draw some type of relationship between the recent increase in deaths during endurance races.  Sure there are other factors at play, but it is highly likely that many of these same people took a few NSAIDs (because everyone else was doing it) and suffered.  Each person is different and just because you're friend has taken something with "success", doesn't mean you should. 

Hopefully the next time you are thinking about popping another pill, just remember that it very likely isn't going to benefit you the way you are hoping it will.  So save yourself the risk and use an alternative approach.


Sean in NY said...

I'd be interested to hear more about your opinion regarding the use of NSAIDs for anti-inflammatory purposes. Some people (myself included) have taken an anti-inflammatory prior to a long run if they've noticed in the past that their joints tend to swell and hinder the full range of movement during especially long-distanced runs. Of course, the swelling could be from a number of different reasons, such as over-use or under-training. But, if you have a race just around the corner and you're not left with enough time to address the problem correctly, this might be your middle-ground. Sure, you could fore-go the race itself, but that's probably not going to happen.

I'm not saying it's right, but perhaps just an example of where using NSAIDs could get you past the finish line w/o the reasons + risks being as potentially damaging as the ones you mentioned in your post above. I'm curious to hear what you think.

Great post!

Lesser is More said...

Well that's exactly my point - people use it for the purposes of getting through a race, but the studies have shown that it doesn't reduce inflammation and only serves to create the potential for issues that could hinder you during the race (ie dehydration, GI distress, heart attack, etc).

I realize that most people are going to ignore subtle signs of pain and either enter a race slightly dinged up or take NSAIDs and hope for the best. But my point is that I don't think many people realize the risks or that taking it with the intent of reducing inflammation may be nothing more than a placebo effect.

It just goes to show how big of a pack mentality people have - "if someone does it, then I'll do it too". Look at the results of frequent usage - they aren't pretty.

If you are looking for natural solutions to increased mobility and reduced inflammation, you can find it through diet, a proper warm up, and consistent self message to tender areas. And if you can't make it to the starting line without being confident that you'll finish, then maybe it is a good idea to sit it out. If you are in it for the long haul, your health tomorrow is always going to be the most important thing. You sacrifice that by trying to take shortcuts for instant gratification.

Sean in NY said...

I guess I'm a little confused. Are you saying that anti-inflammatory medications don't actually reduce inflammation? I'm assuming that's not what you mean, but I can't see where you stipulate.

I'm also not talking about pain or the placebo effect. I'm simply talking about specific instances (not chronic, recurring) where mild inflammation flares up prompting you to make a calculated decision on managing it (go ahead and assume everything else was done properly - diet, rest, warm-up, etc) and that you're not at an obviously high risk of injury.

The results of the study above are a bit suspect to me since it takes an anti-inflammatory and says that it essentially does not reduce inflammation. I find that hard to believe, but perhaps I'm misinterpreting.

I also wonder if perhaps too much emphasis is focused on the negatives. Technically speaking, you're at risk for much of the same things were you to ingest a Gu or energy drink. Then again, like you're alluding to, some people use NSAIDs (and Gu, etc) as a crutch for their training. I wonder if there isn't some advice out there for how (if possible, in your opinion), NSAIDs can be used in a positive manner and actually aid your training/recovery - possible scenarios, if you will. Maybe there are very few, and perhaps they are only justified in very specific situations, but that side of the argument could off-set a placebo effect in the opposite direction.

Lesser is More said...

If your body is creating inflammation somewhere, it is telling you something is wrong. To continue to cause inflammation (with repeated doses of NSAIDs to block the pain) it will only cause further damage and more inflammation. It is a vicious cycle that typically just delays an injury or worse.

My personal belief is that you can use NSAIDs for acute injuries AFTER exercise, but only for the first few days if needed. If you have to take NSAIDs any longer than a few days in the hopes that it will reduce inflammation or reduce pain, it is time to see a doctor.

To me, the biggest issue is that if you take it after, you can still claim the benefits of the drug, but without the risks you would experience were to use it before/during. It is true that GU (especially with caffeine) has the potential for GI issues/dehydration, but there is no study (at least that I'm aware of) that links it to GI bleeding or heart attacks, both of which are far more serious than any other side effect of eating too much GU.

While I don't claim this study as fact, I have become more and more skeptical based on my personal experience and from reading a large number of studies questioning its effectiveness. I think it can be helpful in SOME cases, but most people treat it as a magic pill (Vitamin I, anyone?), which it is clearly not.


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