Pain medication runs the gamut: from nonsteroidal anti-inflammatories to antipyretics to opioids and on.
And the way they impact our bodies, especially in relation to exercise, vary just as vastly.
So, for the purposes of this blog, we are looking specifically at nonsteroidal anti-inflammatory drugs (NSAIDs) or ibuprofen/pain medication and exercise.
Pain medication is an important part of pain management for most of us. And it’s not uncommon for people, athletes and vigorous exercisers especially, to rely on pain medication to help them battle the aches and pains associated with fitness. In fact, NSAIDS are often prescribed to offset the symptoms of exercise induced muscle damage (EIMD), which include delayed onset muscle soreness and loss of physical function (Schoenfeld, 2012). Have you ever tried sitting down after a heavy leg day and found it was nearly impossible? That’s what we’re talking about. However, is use of over the counter pain medication, specifically those with anti-inflammatory effects, before, during or even after working out safe? Additionally, can the use of NSAIDs reduce the efficacy of your workouts altogether?
Let’s take a look.
So, here’s what the literature says:
On Acute Kidney Injury
In 2017, the New York Times released an article outlining the dangers of NSAIDs and physical activity, specifically with respect to those who exercise vigorously (like athletes and pro-lifters). They pointed to two studies in particular to demonstrate that use of ibuprofen in conjunction with prolonged exertion resulted in increased risk of acute kidney injury. The first study was a trial using marathon runners who were given either ibuprofen or a placebo every 4 hours during several multiday ultramarathons around the world. The result was:
many of the ultra runners, about 44 percent, had creatinine levels high enough to indicate acute kidney injury after running 50 miles. But the incidence was particularly high among the runners who had taken ibuprofen. They were about 18 percent more likely to have developed an acute kidney injury than the racers swallowing a placebo. Furthermore, their injuries, based on creatinine levels, tended to be more severe (Reynolds, 2017)
These results were obtained via blood sample and none of the racers were sampled again afterward. It is impossible to confirm if their levels returned to normal, though the researchers strongly suspect they did.
The second trial reference used mice, where NSAIDs were given to the subjects who had sustained injuries in line with those seen after strenuous exercise. Compared to mice who healed without the presence of anti-inflammatory drugs, the mice had “fewer stem cells became active, fewer new cells were produced, and the muscle tissue, even after healing, was not as strong and springy as in tissues that had not been exposed to the drug” (Reynolds, 2017).
While these two examples do show the potential for acute kidney injury as a result of ibuprofen dosing during intense physical exercise, most of the population is not made up of ultra marathon runners. Additionally, few persons are taking NSAIDs every four hours over a multiday period. So, while those participating in strenuous sport, such as those in the above study, should be cautioned against use of ibuprofen before and during exercise, at least, the same cannot be said for the rest of us.
Occasional use of ibuprofen, before, during or after moderate activity has not been known to show deleterious or dangerous effects on the kidneys in the research I have seen so far.
On Muscle Growth and Development
It is often hypothesized that NSAIDs negatively impact muscle growth and strength. The reasoning behind the hypothesis is sound:
Of potential concern for those who use NSAIDs to treat EIMD is the possibility that they may impair the adaptive response to exercise. Specifically, there is emerging evidence that the action of cyclo-oxygenase (COX) enzymes, and COX-2 in particular, are important and even necessary to achieve maximal skeletal muscle hypertrophy in response to functional overload. Given that NSAIDs exert their actions by blocking COX and thus suppressing prostaglandin production, a theoretical rationale exists whereby these drugs may have detrimental effects on muscle regeneration and super-compensation (Schoenfeld, 2012)
In fact, high doses of ibuprofen have been shown to inhibit protein synthesis in muscle after resistance training sessions (Krentz et al., 2008). However! Despite the strength of this hypothesis and the vast body of research done on the subject, there is little evidence showing a correlation between NSAID ingestion and detrimental effects on muscle gain. The long term effects of NSAID use and muscle growth/development remain unclear as not enough research has been done.
Almost all of the studies I looked at confirmed that “there is little reason to believe that the occasional use of NSAIDs will negatively affect muscle growth…” (Schoenfeld, 2012).
On Bones
In one random clinical trial conducted with postmenopausal women, participants were randomly assigned to: supervised resistance training or stretching (placebo-exercise) with post-exercise ibuprofen (400 mg) or placebo supplementation for 3 days/week for 9 months. At the end of the study, results showed, “ibuprofen consumed immediately after resistance training had a deleterious effect on bone mineral mass at the distal radius while resistance training or ibuprofen supplementation alone prevented bone loss” (Duff et al., 2016).
It should be noted that this study was done on a very specific subsect of the population. The results of this trial cannot necessarily be applied to the whole of physically active people. Additionally, ibuprofen use for this trial was consistent over a short period of time for the test group. For those who only use NSAIDs occasionally as part of their pain management protocols, we would expect different results. More testing on additional cohorts would be required to confirm the impact of NSAIDs as an accompaniment to exercise on bone health.
Ultimately
The research has yet to fully elucidate the impact of nonsteroidal anti-inflammatory drugs on the body in relation to exercise. While more research needs to be done on the long term effects of their use in exercise, as well as in athletes who exhibit more growth potential, there is consensus that occasional use of ibuprofen for pain (before, after or during) will not have a deleterious impact on the body.
With that said, there are still other pain medications that have not been looked at in this blog that could have an impact on your health. Before taking any medication consult with your doctor to determine what is right for you.
As always, if you have any questions or concerns, don’t hesitate to reach out! No questions are unwelcome and what we don’t know we will find out for you.
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References:
Duff, W. R. D., Kontulainen, S. A., Candow, D. G., Gordon, J. J., Mason, R. S., Taylor-Gjevre, R., Nair, B., Szafron, M., Baxter-Jones, A. D. G., Zello, G. A., & Chilibeck, P. D. (2016). Effects of low-dose ibuprofen supplementation and resistance training on bone and muscle in postmenopausal women: A randomized controlled trial. Bone Reports, 5, 96–103. https://doi.org/10.1016/j.bonr.2016.04.004
Krentz, J. R., Quest, B., Farthing, J. P., Quest, D. W., & Chilibeck, P. D. (2008). The effects of ibuprofen on muscle hypertrophy, strength, and soreness during resistance training. Applied Physiology, Nutrition, and Metabolism, 33(3), 470–475. https://doi.org/10.1139/h08-019
Lipman, G. S., Shea, K., Christensen, M., Phillips, C., Burns, P., Higbee, R., Koskenoja, V., Eifling, K., & Krabak, B. J. (2017). Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: A randomised controlled trial. Emergency Medicine Journal, 34(10), 637–642. https://doi.org/10.1136/emermed-2016-206353
Petersen, S., Miller, B. F., Hansen, M., Kjaer, M., & Holm, L. (2011). Exercise and NSAIDs. Medicine & Science in Sports & Exercise, 43(3), 425–431. https://doi.org/10.1249/mss.0b013e3181f27375
Reynolds, G. (2017, July 5). Bring on the exercise, hold the painkillersr. The New York Times. Retrieved April 13, 2023, from https://www.nytimes.com/2017/07/05/well/move/bring-on-the-exercise-hold-the-painkillers.html
Schoenfeld, B. J. (2012). The use of nonsteroidal anti-inflammatory drugs for exercise-induced muscle damage. Sports Medicine, 42(12), 1017–1028. https://doi.org/10.1007/bf03262309