Tuesday, July 20, 2010

Bashing NSAIDs

How many times have you said this to yourself or someone else: Oh, just go pop a couple ibuprofen, aleve or "NSAID of choice" and you'll be pain-free and able to power through that triathlon, marathon, big game, training session or whatever. But are NSAIDs just masking the problem and possibly a) making things worse, b) hindering recovery? Yup.

I've taken my share of NSAIDs throughout my athletic life (also in my college life when hangovers were frequent, but that's another story). Back in my volleyball days I suffered from shoulder tendinitis in my hitting arm--I played outside and R-side hitter--so being the stubborn competitor I was (am), I would take a pill before a game so I could still pound the ball. What did I know? You hear "pain relief," so that's good, right?

As recent as last year, I still occasionally took ibuprofen for triathlon-related things if I was feeling really bad soreness or pain somewhere--it was rare that I'd resort to a pill, but I did a handful of times.

Not anymore. I'm done with NSAIDs. Threw 'em out at the end of last year when I learned more about then, and I have not taken any with this current ITB thing.

The adverse side effects of NSAIDs are not breaking news, but it's funny, you don't hear about the downsides as much of the purported benefits of NSAIDs. Athletes especially should be cautious about these things for many reasons. Here are some:

1. NSAIDs alter and delay healing. They do this by (forgive the big words) blocking the enzyme cyclooxygenase (COX) and, therefore, prostaglandins don't form. Prostaglandins are good because they begin the process of repairing damaged tissue via inflammation, i.e. the natural way of healing (like I discussed on the Prolo blog.) There are three main phases in inflammation, and without all three phases taking place, which takes time, you won't get better and stronger. NSAIDs screw with this multi-phase healing process big time. You may feel better temporarily, but the problem is simply masked or worsened... (#2)

2. NSAIDs cause scar tissue (fibrous). Basically, by interfering with the natural healing process scar tissue is created and remains. Keep in mind, scar tissue is naturally created during inflammation but--when no drugs are involved--that scar tissue will eventually be eliminated and replaced with new, healthy, strong, kick-ass tissue. However, throw NSAIDs in the mix and that can lead to permanent scar tissue. Scar tissue is crap; it's tough, dry, stiff and eventually leads to more problems, such as chronic pain.

As a side note: also guilty for the creation of scar tissue are cortisone shots and, believe it or not, excess icing.

3. NSAIDs can cause GI issues, ulcers, etc. If taking ibuprofen for a race or competition, the last thing you want is it to create GI issues--endurance racing+nutrition is tricky and tough enough on the system as it is! But sure enough NSAIDs can cause major issues if taken in excess or on a regular basis: GI bleeding, nausea, vomiting, ulceration, possibly permanent damage. There are also risks associated with renal and cardiovascular function. Taking the drug once in a blue moon likely won't result in these issues, but, still, be careful.

4. No evidence that they work in treating sports-related injuries. All those recommendations you hear about rehabbing with rest, ice... and NSAIDs. No! Don't do it! (Well, rest--yes!) For the reasons I just mentioned, NSAIDs will not fix your problem. That pill may be a temporary band-aid, but it's a jacked up band-aid on crack that will mess you up and leave you uncured. Yea, you can take a pill or two for pain relief to get through a race vs. taking them with direct intent to cure an injury, but you're better off just toughing it out naturally either way.

Ok. Time to end my NSAID-bashing blog.

One last thing... I hyped up inflammation, but I'm not saying inflammation is always a good thing. When it comes to an acute injury that needs to heal, inflammation is awesome and necessary. But chronic inflammation is very bad and needs to be handled appropriately (not with NSAIDs). In chronic cases, a healthy diet of anti-inflammatory foods, physical activity, sleep, etc are often needed.

Bottom line: when you get an injury or feel pain, don't take a pill. Go au natural and let nature take its course.


  1. I have been tooting the same horn for years. Glad to hear someone else take up the rant. Hopefully SOMEONE will listen!

  2. I think I will join this bandwagon. Thanks for the advice!

  3. Such a good post.
    I learned this from my chiropractor a couple years ago and I'm totally with you on going au natural
    Does a beer and ice pack count as au natural?

  4. This blog in becoming educational and I promised myself that I would stop learning new stuff after I graduated. Darn you Tawnee!!

    It’s funny; I used to carry ibuprofen with me during a marathon and would take them along with my salt tablets. At the end of the race, I would pop whatever was left because I “assumed” it was helping. I stopped doing this awhile ago and have no intentions of doing it again.

    Part of the fun is being a little sore at the end of the race, right?

    Great post.

    All the best,


  5. great post, when I stopped taking them a few years ago, things healed faster :) the inflammation is part of the healing process, messing with that can mess with the process..and ones tummy

  6. I recently had an IT band injury and my doctor prescribed what I thought was an excessive dose of Ibuprofen for the inflammation. I was skeptical, as I had already read that Ibu. is hard on the kidneys, but I tried it for a few days. Nothing! A little relief from pain, but zero relief from inflammation. I stopped after a week.

    A week later one of my friends who has also had IT band issues said that running with a compression bandage on her knee helped her a lot. I tried it (walking only -- still not ready to jog) and got immediate relief! Very little discomfort while I was moving or afterward. That really felt like the beginning of my healing. Include the old Ace bandage in your natural treatments.

  7. Also bad for kidney and if taking statins along with strenuous exercise like marathon it may lead to kidney failure.