Beware the hazards of NSAIDS

Chances are you’ve been in the locker room before an practice, workout or game, or the warm-up/transition area before a road race or triathlon, and have seen other competitors reach for a bottle of Advil or another anti-inflammatory medication along with their water bottle. Or maybe that competitor was you. “Just a couple of these will help me deal with that nagging knee injury and get me through the game/race” is what your thinking. You also may have been told that anti-inflammatory medication can help you get through the pain of a long workout day, even if you are pain-free before the event. Whatever the reason, it may be wise to take a different approach to being “pain-free”.

First of all, the side effects of medications such as Advil, Aleve and Nuprin, which are called NSAIDS (non-steroidal anti-inflammatory drugs), should be considered. A small amount of gastrointestinal bleeding occurs each time that NSAIDS are taken. In some people this can lead to ulcers and perforation of the gastrointestinal lining. Thus abdominal pain when taking NSAIDS should be taken seriously.

Recently, another side effect has been getting more attention and that is the effects of NSAIDS on the kidneys and the onset of hyponatremia, which is a lowering of the sodium levels in the blood, a very dangerous condition. These drugs work by inhibiting the action of an enzyme that is responsible for the inflammatory process, thereby reducing pain. But the same enzyme is also responsible for helping the kidneys to retain electrolytes, which is already a challenge during endurance sports. Thus, the ingestion of these drugs could contribute to hyponatremia.

Next, pain should be considered a warning sign, whose cause is to be investigated. Covering up your symptom of pain with medication can lead to more serious injury. New research has revealed that many overuse injuries aren’t even inflammatory in nature! Many tendon injuries have been found to involve degeneration of the collagen material making up the tendon, with no inflammatory cells present on biopsy. This is called tendinosis, not tendinitis, and will not be helped by trying to limit inflammation. In fact, Advil and the rest of the over-the-counter drugs may even delay healing of connective tissue and muscle, even though you may feel less pain.

What is the better approach? As for the event of day, remember that while participating in athletic events is supposed to be a healthy endeavor, the physical demands on the body can be tremendous. Endurance racing, for example, can involve the experience of some stiffness during the race, which you should not mind running with. The way your body feels at different points of a race is part of the challenge of the race, and it is much safer to “listen to” the level of tightness or pain you have than to hide it with NSAIDS. Pain that is more intense should not be numbed with medication so that you can “run through” it, as more serious injury and lost training time may result. Remember, mild to moderate stiffness usually will be gone when you finish, and most post-exercise soreness will disappear within a few days after the race.

If you are injured, it may be better to rest until the next race if you haven’t fully recovered. This approach involves determining, to the greatest extent possible, the true cause of the injury. Muscle tightness and weakness, poor foot mechanics (overpronation/underpronation), improper footwear, training too far, fast or often are just a few examples of correctable causes of overuse injuries. As noted above, the injured tissue is often not inflamed. Instead, tendons often have scarring in them (their fibers become less elastic and less flexible), and muscles are often tightened. Treatment must involve rehabilitating the injured tissue, which will eliminate the cause of the pain, instead of masking it with medication and risking serious side effects.

This article is for informational purposes only, and should not be used as personal advice or diagnosis without first consulting a health-care professional. If you have, or suspect you have a health-care problem, then you should immediately contact a qualified health-care professional for treatment.