Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of drugs designed to reduce pain and inflammation as well as to lower body temperature. Whether you have had a headache or a mild fever, you have probably taken an NSAID before. Many exercisers opt to use NSAIDs in order to provide pain relief. The most common NSAID used by people who exercise is ibuprofen (Motrin or Advil) which provides short-term relief in pain and inflammation. NSAIDs have been shown to help relieve pain and inflammation due to exercise, but there is debate on whether or not the drug should be used to prevent pain due to exercise. To look into this debate, let’s first get an idea of how the drug works.
These drugs work by blocking cyclo-oxygenase (COX) enzymes. These enzymes are involved in producing chemicals called prostaglandins which have various functions in the body. Both the COX-1 and COX-2 enzymes produce prostaglandins that are associated with pain, inflammation, and fever. The common side-effects observed with NSAID use is with the additional effects of blocking the COX-1 enzyme. These enzymes allow for the production of prostaglandins associated with protecting the lining of the gastrointestinal (GI) tract as well as activating blood platelets associated with clotting. By blocking the COX-1 enzyme, complications within the GI tract can potentially occur such as stomach ulcers and temporary intestinal leakage. These side-effects are usually not observed when one occasionally uses NSAIDs, but what if one regularly uses NSAIDs while exercising?
A study published in the 2012 edition of Medicine & Science in Sports & Exercise looked into this potential factor. The study compared nine healthy men at four different time points to see if a combination of high intensity exercise and taking ibuprofen can increase temporary damage to the small intestine. This was after completing a previous study where they concluded that high intensity exercise leads to temporary small intestine injury. The four time points were 1) cycling at high intensity for one hour with 400 mg of ibuprofen in their system, 2) cycling at high intensity for one hour with no ibuprofen in their system, 3) staying at rest with 400 mg of ibuprofen in their system, and 4) staying at rest with no ibuprofen in their system. At the end of each time point, the researchers analyzed the blood of the subjects for levels of intestinal fatty acid binding protein (I-FABP) which is an indicator of injury to the small intestine. They noticed that there was a significantly higher level of I-FABP present in the blood of the subjects who cycled and took ibuprofen compared to the other three groups and that the I-FABP levels were high for as long as 2 hours post exercise. These results show that taking NSAIDs during exercise may be detrimental to the body, especially since many endurance athletes exercise for longer than one hour and may actually consume more than 400 mg of ibuprofen prior to or during their exercise.
Besides the known side-effects, research has shown that there may be a few hidden side-effects by taking NSAIDs with exercise. A paper published in the 2009 edition of the British Journal of Sports Medicine analyzed these potential side-effects. The paper states that taking NSAIDs prior to exercise may negatively impact the musculoskeletal system by masking the pain one feels and potentially causing an injury to inadvertently get worse. The paper also states that prostaglandins are associated with the production of collagen which is an important building block needed for muscle, tendon, ligament, and bone recovery. By blocking the COX enzymes, prostaglandin production decreases causing a decrease in the production of collagen. As the author states, a decrease in the production of collagen may result in adverse effects such as the inability of healthy tissue to adapt to increased loads or a decrease in the rate of collagen regeneration after injury. These effects may lead to an increased risk of injury as well as a delay in recovery after injury.
After reading through these two papers, I found a few limitations. In the first paper, a limitation I found was that they only tested male subjects undertaking endurance exercise. I wonder if there are any adverse effects of taking NSAIDs while performing resistance exercises and if there are any differences between males and females. In both papers, a limitation I found was that they only tested NSAID use prior to exercise. From past experience, I have occasionally used NSAIDs a couple hours after exercise to reduce excruciating pain that had already developed. After taking the drugs, I was pain-free and felt no side-effects. It would be interesting to see whether or not the risks discussed are also associated with taking NSAIDs after exercise if the pain has not already developed.
Overall, it may seem tempting to take NSAIDs to prevent pain due to exercise, but it may not be the ideal thing to do. Although NSAIDs can help you relieve pain, research shows that there are a number of additional risks you may be taking by using these drugs to prevent pain either prior to or during your exercise. If you want to manage pain during exercise, I would recommend just dealing with the pain or maybe looking into non-NSAID drugs such as acetaminophen (Tylenol) which provides pain relief through a different mechanism. If you want to take NSAIDs after exercise, it would be best to use the drugs only when pain has already developed instead of using it to prevent potential pain. It would also be best to use the drugs occasionally in order to prevent an additive effect of the side-effects on your body. But remember, it is always best to talk to a health care professional prior to making decisions regarding your health.
Recommended Further Reading:
Nonsteroidal anti-inflammatory agents
Cyclooxygenase: COX-1 and COX-2 Explained
Aggravation of Exercise-Induced Intestinal Injury by Ibuprofen in Athletes
Exercise-induced splanchnic hypoperfusion results in gut dysfunction in healthy men
Prophylactic misuse and recommended use of nonsteroidal anti-inflammatory drugs by athletes
Questions to Consider:
1.) Have you ever used NSAIDs before? If so, when and/or why did you take them?
2.) If you have taken NSAIDs before, did you use them as a preventive measure or as a way to reduce any discomfort?
Interesting article, especially for those who are in rehab after a painful injury and have to keep moving through the pain! You said that production of prostaglandins activates blood platelets associated with clotting, did you find any information about increased risk of blood clots as a result of using NSAIDs regularly for exercise?
The information I found states that NSAIDs can either increase or decrease the risk of blood clots. It depends on the type of NSAID you use. Some NSAIDs are selective inhibitors which means they only target the COX-2 enzymes. Other NSAIDs are non-selective inhibitors which means they target both the COX-1 and COX-2 enzymes. The selective inhibitors can increase the chance of blood clots because the COX-1 enzymes are still functioning, but the exact reason behind why clotting increases is not known. As for non-selective inhibitors, they can actually decrease the chance of clotting because the COX-1 enzymes are blocked. I hope this clarifies your question!
When I played softball in high school we would play 5-6 games a weekend and I swore by Advil between games and after to deal with the soreness. I never really thought about taking it beforehand in preparation for the inevitable soreness though.
This class discussion was particularly interesting for me as my mother and sister swear by the pain-relief of motrin. They have both had issues with migranes and therefore take motrin as needed, but they have also both come across stomach issues as well. I wonder if it is directly related to the COX-1 and COX-2 being inhibited together.
7 months after my ACL surgery in high school I was taking a ton of Advil – 1200 mg per day for a couple months – to be able to work through my patellar tendon pain. It would have been helpful to have someone tell me that these NSAIDs were decreasing production of collagen, which likely was necessary in fully healing the tendon. Also, I feel somewhat lucky to have suffered no gastrointestinal consequences.