Runners and prophylactic NSAID use

MANY RUNNERS READING THE ARTICLE WRITTEN BY Linzay Logan for Competitor.com, “3 Rules Every Runner Should Live By” would says these several simple rules are no-brainers and of course we agree with their importance. But take a closer look at the title. It says “live by”, not “train by”, or “follow”, which indicates that a greater degree of incorporation of these rules into our busy days, 24/7, all year round is required of runners. 

The last of the three listed rules (be consistent, rest, listen to your body), all attributed in this piece to San Diego-based running coach Jennifer Gill, has to do with pain encountered in the course of running. “Pain is your body’s way of telling you something is wrong” is Gill's perspective, which differs somewhat  from the one sometimes seen on T-shirts, “no pain, no gain”.

Athletes, generally being over-achievers in the area of physical activity, tend to be more welcoming of the theory that pain is a good thing if it ultimately leads to an enhanced performance in sport. Many athletes would also rather prevent pain if it meant performing better.

In a 2010 article "Prophylactic Use of NDSAIDs in Athletes: a Risk/Benefit Assessment" in The Physician and Sportsmedicine, author Stuart J Warden begins by saying that  “athletes often seek artificial means to gain advantage and prolong participation when competing”, which he says include taking non-steroidal anti-inflammatory drugs (NSAIDS) prior to training and competitions. The analgesic (pain relieving) and anti-inflammatory effects of NSAIDS are NOT considered to be performance ENHANCING; they “are at best performance ENABLING”, he explains. For this reason and because NSAIDs are available as over-the counter preparations and their use is not banned by anti-doping agencies, common prophylactic use by athletes has raised concerns about associated dangers. Thus his article “discusses current observations regarding athlete use of NSAIDs, and the possible benefits and potential risks of their use”.

The article references sources that indicate “about one-fourth to one-third of Olympic athletes report using NSAIDs” prior to performance, and that this “value is 50%” in some sports. According to these sources, levels of use are “estimated to be 6 to 10 times greater” than in similarly-aged non-athlete populations.

Observations, it’s reported, indicate that 1 such medication at a time is self-administered by about 10-20% of athletes; some admit taking “up to 5 different compounds concomitantly”.

According to this article, the presumed benefits of prophylactic NSAID treatment and rationale for use in athletics, such as lessened muscle inflammation and soreness and improved recovery of muscle function after exercise, have not been clearly demonstrated. The author says the reason behind this apparent inconsistency is that exercise-related damage is thought to be degenerative in nature and not caused by inflammation, so blocking it isn’t all that helpful. He says there is evidence that NSAID pre-treatment may block some of the desired musculo-skeletal effects of training and delay normal healing. This is related to the analgesic effect of NSAIDs, which inhibit the production of pain-causing prostaglandins that also, importantly, act to stimulate the synthesis of collagen required for “restoration of normal tissue mechanical properties”, or proper healing. In addition, there are well-known risks of gastrointestinal bleeding from long term NSAID use, and side effects on the heart/blood vessels and kidneys.

A 2015 article, ”Non-steroidal Anti-Inflammatory Drug Use and Endurance During Running in Male Long-Distance Runners” by Eduardo Da Silva and colleagues, was published in the Journal of Athletic Training and addressed similar concerns regarding risks versus benefits. It concluded, “Ibuprofen did not reduce the effect of muscle damage and pain on performance”; prophylactic NSAIDs did not enhance running ergogenics (athletic performance) “after exercise-induced muscle damage in male long-distance runners.” A small number (20) of military endurance runners participated in this study, so the results might not apply to others.

An April 2016 item in Verywell.com, “Ibuprofen and Exercise: Help or Harm for Endurance Athletes?” by Elizabeth Quinn, summarized some earlier research on the subject. Her “bottom line” advice re-iterated that endurance performance is not helped by prophylactic NSAID use and it is best reserved as therapy administered after intense exercise.

After wading through all the research it seems that, as expected, these medications are best used for their intended purpose. The risks of other usage possibly outweigh the perceived benefits, which may not even be real! Smart training, appropriate nutrition and hydration practices, and adequate recovery periods are likely the soundest foundations on which to build better performance in sport. Perhaps "no pain, no gain" is part of the truth, and like Gill said with her 3rd rule, we should allow our bodies to listen to the biological signals that accompany pain.

RUN HAPPY!

http://running.competitor.com/2013/11/training/3-rules-every-runner-should-live-by_38107

http://www.ncbi.nlm.nih.gov/pubmed/20424410

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4477926/pdf/i1062-6050-50-3-295.pdf

https://www.verywell.com/risks-of-ibuprofen-before-athletic-exercise-3120492