Tuesday, March 12, 2013

Coach Laura: Working Out and Pain Medication

Dear Coach Laura,

I've been trying to increase my workouts and get stronger, but I hate the sore feeling that comes afterwards. Is it okay or beneficial or not so good to take something like aspirin or Ibuprofen before working out, to forestall any inflammation that may come from the workout?


I'm So Sore 
Dear Sore,

First of all, great job on increasing your workouts! The soreness you experience is called DOMS. Sounds serious, doesn't it? Don't worry - it just stands for Delayed Onset Muscle Soreness. Although it varies among exercises and individuals, the soreness usually increases in intensity in the first 24 hours after exercise. It peaks from 24 to 72 hours, then subsides and disappears up to seven days after exercise.

As far as taking ibuprofen or aspirin before working out, studies have been done recommending that you don't. One reason is that NSAIDs (nonsteroidal anti-inflammatory drugs including aspirin, ibuprofen, naproxen sodium [Aleve], and ketoprofen [Orudis KT]) can prevent the body from manufacturing prostaglandins. Prostaglandins are substances produced naturally by the body that act as mediators for a variety of physiologic functions including protecting the stomach lining, and regulating blood pressure. They also mediate pain and inflammation.  Therefore, taking NSAIDs can sometimes cause stomach upset or gastrointestinal (GI) bleeding. The risk of stomach irritation or GI bleeding increases with long-term use of NSAIDs. (Source.)

So, does taking an NSAID really improve athletic performance? Does it prevent or reduce muscle soreness? So far, the research doesn’t support the use of NSAIDs for athletes. Here’s what they have found so far: 

  • Several studies have found little actual performance benefit of taking ibuprofen and warn that it may mask pain, which can lead to increased risk of injury.
  • Further studies have cautioned that the use of NSAIDs during ultra distance exercise, such as an Ironman Triathlon, is associated with an increased risk of exertional hyponatremia. Researchers believe that this effect is likely due to altered renal (kidney) function. The issues related to altered kidney function in athletes are not hard to imagine. Poor fluid transport and restriction can lead to dehydration, hyponatremia and at the extreme, kidney failure.
A study published in 2003 in "Medicine & Science in Sports & Exercise" found that taking ibuprofen before exercise did not reduce muscle soreness or inflammation. The authors also found evidence that the practice may inhibit muscular growth in response to exercise.

Other researchers monitoring ultramarathon racers found no reduction in muscle damage or soreness among athletes who took ibuprofen the day before and on race day. Their study, published in 2006 in "Brain Behavior and Immunology," also found indications of increased inflammation among the ibuprofen users.

A study published in January 2013 in the "British Journal of Sports Medicine" also concluded that taking prescription-strength ibuprofen before strenuous exercise results in increased markers of muscle damage and inflammation in the bloodstream and does not reduce post-exercise muscle soreness.

The most convincing real-life study may have been the one conducted during the running of the 100-mile Western States trail running race. Researcher David Neiman measured the influence of ibuprofen use during the grueling race by studying runners in three groups: a control group, a group taking 600 mg of ibuprofen one day before and on race day and a group taking 1200 mg of ibuprofen one day before and on race day.
  • Both groups taking ibuprofen had higher plasma levels of markers (serum C-reactive protein, plasma cytokine and macrophage inflammatory protein) for muscle damage.
  • Reported DOMS was the same across all groups.
  • Serum creatine kinase levels was the same across all groups.
  • Race times did not differ among the groups.
  • Ratings of perceived exertion did not differ among the groups.

The bottom line was ibuprofen use by endurance athletes did not affect performance, muscle damage or perceived soreness but it was associated with elevated indicators of inflammation and cell damage. It’s a reasonable assumption that using NSAIDs has no positive effect on sports performance. It may, in fact, cause a serious health risk in some endurance athletes.

Alright, that's a lot of science-speak. The best way to overcome DOMS is to, believe it or not, keep exercising. Gradually increase the intensity of any new exercise - don't go all out the first time you're trying something new.

Here's the most important thing I'm going to tell you in this long-winded answer. Neither Madame L or I are doctors, nor do we play one on TV. This is not meant to replace any medical advice you may receive from your doctor. So, ASK YOUR DOCTOR! The two of you together can decide on the best course of action for long-term health and fitness.

To your health,

Coach Laura


Aunt Louise said...

Thanks, Coach! This is is just the kind of thoughtful and well-researched advice I was looking for! I appreciate the science-speak and also the quick summary. And I *need* the science-speak b/c when people only give me the quick summary, I have no idea what they're basing their ideas on, so no idea whether I should trust them. ---Aunt Louise

AskTheGeologist said...

Wow. Awesome substantive content - thanx.

Perhaps you can address the concept of keeping general inflammation under control. The death-spiral issue that sometimes afflicts people with back-pain is that the inflammation increases the pressure on the irritated nerve-root, which causes more flooding by fluids loaded with white blood cells. Which makes everything worse. Also, gingivitis and other low-level oral inflammation correlate rather closely with atherosclerosis and eventually heart attacks: too many cortisols flooding the body.

In the meantime, did you stay in a Holiday In Express? If you did, then you are qualified to offer medical advice like this. Also, to suck rattlesnake venom out of a bite...