Athletes and amateur fitness buffs alike are quick to reach for a bottle of ibuprofen when they’re sore or have an injury. Some even take ibuprofen in anticipation of a tough workout in hopes it will prevent soreness. Ibuprofen is a non-steroidal anti-inflammatory drug or NSAID. NSAID block enzymes called Cox 1 and Cox 2 that play an active role in inflammation. They also block the production of prostaglandins, chemicals released by cells in response to injury. Prostaglandins are responsible for many of the symptoms you experience when you’re injured like pain, redness, and swelling.
The time most people use NSAID is when they’re sore or injured. Taking one of these medications when you’re injured temporarily masks the pain and reduces inflammation. Because you feel less pain, you may continue to work already inflamed muscles and tendons and prolong the problem or, even worse, injure yourself further.
Working out when you have muscle soreness due to DOMS (delayed-onset muscle soreness) is different than working muscles or tendons inflamed due to an injury. Working out with DOMS may feel uncomfortable but it won’t damage the muscles or tendons. Exercise with an injured muscle or tendon without modifying your workout can cause the injury and inflammation to become chronic. When this happens it can take weeks or months to resolve. That’s why you shouldn’t use NSAID to ease the pain enough so you can still work out.
Other Potential Risks of Taking NSAID
Non-steroidal anti-inflammatory medications block chemicals called prostaglandins. In addition to reducing inflammation, these chemicals regulate the flow of blood through arteries. NSAID reduce blood flow through the renal artery, the main blood supply to the kidneys. Fortunately, prostaglandins aren’t the main regulator of blood flow to the kidneys, but they play a role.
When you block prostaglandins with NSAID, it reduces blood flow to your kidneys. If you’re also dehydrated, the drop in blood flow can become significant enough to cause kidney failure. Fortunately, this type of kidney failure is usually reversible but it’s still not something you want to deal with. If you’re taking a diuretic, this further reduces blood flow to the kidneys and increases the risk for kidney problems.
If you’re like most people, you don’t always drink enough fluids when you’re exercising. Under normal circumstances, although not a good practice, you may not experience serious problems as a result. But if you’re taking an NSAID your risk is higher because you’re further reducing blood flow to the kidneys.
Have you ever felt nauseated when you took ibuprofen or another NSAID? It’s not uncommon to have digestive issues when taking NSAID. In the worst case, they can trigger enough stomach irritation to cause your stomach lining to bleed.
NSAID may even damage the lining of the small intestine. Some research suggests long-term use of NSAID can damage tiny gap junctions in the small intestines that keep food particles inside the intestinal tract. When this happens, proteins and other components from food can leak out and enter the bloodstream. This can elicit an immune response and, potentially, increase the risk for autoimmune disease. Naturopathic doctors call this condition “leaky gut.”
Some studies suggest athletes are at higher risk for small intestinal damage when they exercise and use NSAID. During exercise, blood flow is redirected to muscle tissue and away from the intestinal tract. This reduction of blood flow, especially when combined with an NSAID drug, can damage the tiny gap junctions in your small intestines enough so that they leak.
In one study, researchers took blood samples to look for a blood marker for intestinal leakage after cyclists on ibuprofen had cycled hard for an hour. As suspected, the levels of this marker were higher when the men cycled and took ibuprofen compared to when they did either alone. NSAID and exercise aren’t a good combination – and it’s not just your stomach that’s at risk, but your small intestines too.
NSAID Linked with Heart Attacks
Many doctors are reluctant to recommend NSAID after research linked them with a greater risk for heart attacks and heart-related deaths. The risk is higher with some non-steroidal anti-inflammatory medications than others, but they all carry some degree of risk. The risk is greater with higher doses and when you use them for a long period of time. If you have heart disease or are at high risk for heart problems, best to avoid these medications entirely.
Do NSAID Reduce Muscle Soreness after a Workout?
One reason people take ibuprofen before a workout is a hope it will reduce post-workout soreness or DOMS. A number of studies show NSAID is no better than a placebo for relieving muscle soreness related to DOMS. Some evidence even suggests NSAID delays muscle recovery after a workout. As some experts point out, inflammation is a natural part of the healing process when you’ve overworked your muscles and blocking it may delay healing.
The Bottom Line
NSAID, including common ones like ibuprofen you buy at the drugstore, won’t prevent muscle soreness after a workout and these medications can have serious side effects, especially if you use them long term. Don’t be too quick to reach for a bottle of Advil when you’re sore or have an injury. Be careful how often you take them and drink plenty of water if you have to be on one for medical reasons.
Donnelly AE, Maughan RJ, Whiting PH. Effects of ibuprofen on exercise-induced muscle soreness and indices of muscle damage.
Medicine and Science Sports and Exercise. 2006 Apr; 38(4): 618-22.
The New York Times. “For Athletes, Risks From Ibuprofen Use”
Brain Behaviour and Immunity. 2006 Nov;20(6):578-84.
Br J Sports Med. Mar 1988; 22(1): 35-38.
Up To Date. “Nonselective NSAIDs: Adverse cardiovascular effects”
Effect of Ibuprofen Use on Delayed Onset Muscle Soreness of the Elbow Flexors
By: Jayd M. Grossman, Brent L. Arnold, David H. Perrin, and David M. Kahler
MedPage Today. “Sore Muscles May Not Benefit from Regular NSAIDs”
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