Anti-inflammatory medications (also called non-steroidal anti-inflammatories, NSAID’s) are used extensively by many athletes both before and during activity, with the belief that they help prevent pain and discomfort during their sport and prevent soreness afterwards. However, studies have shown that NSAID’s did not decrease the athletes’ perception of pain during the activity or decrease muscle soreness later.
There are 3 main considerations pertaining to side effects that runners should be aware of.
(individual response and side effects are variable and may be unpredictable)
- Inhibiting kidney function, with possible kidney damage.
- Increased risk of developing hypertension with regular use of NSAID’s.
- Inhibiting recovery of connective tissue after exercise.
Kidney Function
NSAID’s interfere with kidney function, and especially with dehydration, can limit clearance of myoglobin (a byproduct of muscle tissue breakdown during extreme exertion, such as marathons and ultramarathons), and this large molecule then plugs up the small filtering and drainage tubes in the kidneys, resulting in damage. There have been many cases of runners who require hospitalization and sometimes even dialysis after such cases of acute renal failure, and some with residual chronic renal insufficiency.
Preventing dehydration is essential, and some caffeine can even help boost kidney function a bit, as long as fluid intake is maintained.
Risk of Hypertension
One study (of 16,000 men with no prior history of hypertension) showed those who used NSAID’s 6 or 7 times a week had a 38% increased risk of developing hypertension; aspirin use caused a 26% increased risk. Even those who used acetaminophen 6 -7 times a week had an increased hypertension rate of 34%.
Inhibiting Connective Tissue Healing / Recovery After Exercise
Studies on ibuprofen use in ultramarathoners showed significantly more inflammation and other laboratory markers of high immune system response after races compared with runners who had not taken NSAID’s. Besides the laboratory signs of mild kidney impairment, there was evidence of damage to the lining of the G.I. tract (stomach and colon), indicating bacteria leakage from the colon into the bloodstream. NSAID’s slow the healing of running-injured muscles, tendons, ligaments, and bones, by inhibiting the production of prostaglandins, which are involved in pain and the creation of collagen. Collagen is the building block of most tissues, and fewer prostaglandins means less collagen, therefore inhibited healing of connective tissue after the micro-tears and other trauma to muscles and tissues that can occur after strenuous exercise. This reaction therefore limits the desirable adaptation to exercise of strengthening tissues, and could increase injuries also.
I recommend limiting the use of anti-inflammatory medications to use with acute muscle and tendon strains, along with the use of ice and other first aid and rehab treatments.