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{{DISPLAYTITLE: NSAIDs (Ibuprofen, Naproxen, Aspirin) and Acetaminophen/Paracetamol) for runners, impairs healing and interferes with hydration}}

NSAIDs are generally unhelpful for runners, masking the symptoms while impairing healing, interfering with hydration and can be life threatening. Risks include kidney failure, heart attacks, strokes, intestinal damage, and liver failure. The most common NSAIDs (Non-Steroidal Anti-Inflammatory Drugs, the most common ) are Ibuprofen (Advil, Motrin), Acetaminophen/Paracetamol Naproxen (TylenolAleve, aspirin-free Anacin, ExcedrinNaprosyn), and numerous cold medicines) and Aspirin. They work by inhibiting a particular enzyme ([http://en.wikipedia.org/wiki/Cyclooxygenase Cyclooxygenase]) which reduces pain, fever and inflammation. NSAIDs are generally bad for runners, impairing healing, masking symptoms, interfering with hydration and in extreme situations can be life threatening. Ibuprofen use is so common among runners that it is sometimes called "Vitamin I"<ref name="VitaminI"/>. This article also covers Acetaminophen (also called Paracetamol), though it's not technically an NSAID.

* '''Muscles'''. <ref name="MuscleTrappe"/>. A 2001 study showed that Ibuprofen and Acetaminiaphen Acetaminophen reduce [[Muscle|muscle]] growth after eccentric exercise. Another study<ref name="muscle"/> on muscle damage and NSAIDs showed impaired recovery in the early stages of healing. There was some increased [[Protein]] synthesis with NSAIDs in latter stages of healing, but the muscles were still weaker 28 days after injury. Other studies<ref name="muscle2"/><ref name="muscle3"/> have shown that four days after injury, NSAIDs resulted in very little muscle regeneration compared with no drugs.* '''Tendons'''. A primate study<ref name="TendonPrimates"/> showed "a marked decrease in the breaking strength of tendons at four and six weeks in the ibuprofen-treated animals". Another animal study<ref name="TendonCOX2"/> showed treated tendons were 32% weaker than their untested counterparts. * '''Bone-Tendon Junctions'''. An animal study<ref name="tendon"/> of rotator cuff injuries shows that NSAID usage resulted in injuries that did not heal, and those that did heal were weaker than those without NSAID. To quote from the study "Given that NSAID administration was discontinued after 14 days yet affected load-to-failure eight weeks following repair, it appears that inhibition of the early events in the inflammatory cascade has a lasting negative effect on tendon-to-bone healing," Dr. Rodeo said. * '''Cartilage. ''' NSAIDs have been shown<ref name="CartilageRabbit"/> to impair the healing of bone and cartilage in rabbits.

If NSAIDs are bad for healing, should we treat with ice? So far I have found no definitive studies, but ice has a differenct different mechanism of action from NSAIDs. By cooling the tissues, ice temporarily reduces inflammationswelling, thereby flushing the wound. It does not directly impact any of the body's enzymes or other processes. If applied for a longer period of time, ice will produce a periodic increase in blood supply that creates a further flushing effect. I have found that ice can produce dramatic improvements in healing speed. See [[Cryotherapy - Ice for Healing]] for more details.There is no evidence that ice reduces any of the inflammation processes.

* '''NSAIDs'''. NSAIDs also reduce blood flow to the kidneys<ref name="coxibs"/>. NSAIDs reduce prostaglandin production, and prostaglandins are vital to maintaining blood flow to the kidneys. While NSAIDs are considered safe drugs, NSAIDs are associated with a relatively high incidence of adverse drug reactions involving the kidneys. Generally , NSAID side effects are restricted to individuals with predisposition to kidney problems, so extra care should be taken if you have a history of kidney problems. However, athletes push their bodies to extremes, so what applies to the general population may not be valid for runners. One runner was told<ref name="Anecdote"/> by doctors that 2400mg Ibuprofen in an ultramarathon was a contributing factor to his kidney failure.

=NSAIDs causing Heart Attacks or Strokes=The U.S. Food and SicknessDrug Administration (FDA) warnings that non-aspirin NSAIDs increase the risk of a heart attack or stroke<ref name="www.fda.gov"/>. The risk appears to be related to ongoing usage rather than single doses, with the risk increasing in the first weeks of usage and the risk may increase with prolonged usage. The increased risk is dose dependent (taking more has a greater risk), and the includes those without heart disease or risk factors for heart disease. Not surprisingly, those already with a higher risk of heart disease or stroke have a proportionately higher risk with NSAID usage. =NSAIDs and Infection=

* The most common NSAIDs (Ibuprofen, Acetaminophen (Paracetamol), and Aspirin) are unlikely to help with DOMS.

* If an NSAID is taken for DOMS, it should probably be taken immediately after the damaging exercise rather than waiting until the soreness develops. * It seems likely that taking an NSAID for DOMS will reduce the muscular growth that would normally occur as part of the recovery. ** In one study, rabbits treated with flurbiprofen after DOMS inducing exercise regained more strength after 3-7 days, but between days 7 and 28 days the treated rabbits became weaker while the controls became stronger<ref name="Mishra-1995"/>. This is only one study, and on animals, but it is rather troubling as none of the human studies look at the results over this time period.

{| class="wikitable"!NSAID!!Soreness!!Weakness

|Ibuprofen|2xImproved<ref name="Hasson-1993"/><ref name="pmid12580656"/>

|1xMaybe<ref name="Hasson-1993"/>

|Ibuprofen Gel|1xNo Effect<ref name="HyldahlKeadle2010"/>|

|Acetaminophen (Paracetamol)|2xNo Effect<ref name="Barlas-2000"/><ref name="SmithGeorge1995"/>|

|Aspirin|2xImproved<ref name="Riasata-2010"/><ref name="Francis-1987"/>

|2xNo Effect<ref name="Riasata-2010"/><ref name="Francis-1987"/>

|Naproxen |4xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/><ref name="journals.ut.ac.ir"/>

|3xImproved<ref name="Dudley-1997"/><ref name="Baldwin-2001"/><ref name="Lecomte-1998"/>

|Diclofenac |Possible slight reduction<ref name="DonnellyMcCormick1988"/>|

|Codeine|1xNo Effect<ref name="Barlas-2000"/> |

|Rofecoxib |1xNo Effect<ref name="LoramMitchell2005"/> |

|Ketoprofen |1xImproved<ref name="Sayers-2001"/>|1xImproved<ref name="Sayers-2001"/>

|Bromelain |1xNo Effect<ref name="Stone-2002"/>|

=NSAIDs and wound healingWound Healing=

* It seems likely that NSAIDs will increase the risk of injury rather than reducing it, as the symptoms of damage will be masked. * The most common NSAID for racing seems to be ibuprofen. I've not seen any evidence of the relative effectiveness of different NSAIDs on performance. * It is better to take liquid ibuprofen than tablets or capsules. The tablets and capsules take longer to dissolve and if you have a digestive problem they may not be fully absorbed. You can chew the tablets, but this is unpleasant and ibuprofen can irritate your mouth and throat slightly, so the liquid form is best. It's obviously harder to transport, but you can fill an old film canister with a dose.

* Taking NSAIDs in marathon or shorter races is probably ineffective as the level of damage seen is not as great as in ultramarathon events.

=Tangent - Is Acetaminophen really an NSAID?=There are differing opinions around the classification of Acetaminophen (also called paracetamol) is generally not classified as an NSAID with some resources<ref name="NotAnNsaid"/> stating it is not an NSAID. While Acetaminophen has limited anti-inflammatory properties, it shares the same mechanism of action with most NSAIDs of inhibiting the COX enzyme and the inhibition of prostaglandin synthesis<ref name="Graham-2005"/><ref name="BottingAyoub2005"/><ref name="ToussaintYang2010"/><ref name="Anderson2008"/>. It is therefore reasonable and useful to classify Therefore, this article includes Acetaminophen as an NSAIDin with NSAIDs.