Monday, June 01, 2009

Get Off The Ibuprofen Peoples!


Hey Kelly,

At the seminar you said no more ibuprofen, so I stopped. But what should I take when the DOMS (Delayed Onset Muscle Soreness) is bad? I foam roll, tennis/lacrosse ball roll, etc... But it only goes so far. Crushing the fish oil as well. ASA (an NSAID by the way) or acetaminophen or just suck it up? (all parentheses are mine)

Thanks

WC

----------------------------------

All right, let's set the record straight about this stuff.

The Disclaimer: Medicine is serious busines. Always follow the advice of your doctor.

Sorted?

Ok. Ibuprofen has no place in the life of the athlete obsessed with chasing performance.

Taking an anti-inflammatory drug of any kind makes tendons and ligaments weaker, and stops muscles from getting stronger.

Is this clear enough? Yes, we used to call it Vitamin I. Yes, we used to say that RICE should have a second "I" in it (Rest, Ice, Ibuprofen, Compression, Elevation).
We used to also do "21's" on back and bi's day too. It's not ok.

Here's the low down. Ibuprofen is an NSAID (Non-Steroidal-Anti-Inflammatory-Drug) which is believed to work through the inhibition of cyclooxygenase (COX), thus inhibiting prostaglandin synthesis. Prostaglandins, are like hormones in that they act as chemical messengers, but do not move to other sites, but work right within the cells where they are synthesized. Prostaglandins are vital mediators of the inflammatory cascade. The swelling and subsequent prostaglandin production signals all of the important cells circulating in your body to come and fix/reinforce the challenged tissues. That's right, all that soreness you feel after Fran is the resultant swelling from all the micro-damage you've done to your muscles. It's this very inflammatory response that is responsible for making you a BETTER ATHLETE. The Worst thing you can do is to go through a horrible workout like Fran and then not reap the resultant gains from the training stimulus.

No good coach should allow their athletes to take ibuprofen at anytime. Even if they are hung over..

Why?

NSAIDs have been shown to delay and hamper the healing in all the soft tissues, including muscles, ligaments, tendons, and cartilage. Anti-inflammatories can delay healing and delay it significantly, even in muscles with their tremendous blood supply. In one study on muscle strains, Piroxicam (an NSAID) essentially wiped out the entire inflammatory proliferative phase of healing (days 0-4). At day two there were essentially no macrophages (cells that clean up the area) in the area and by day four after the muscle strain, there was very little muscle regeneration compared to the normal healing process. (Greene, J. Cost-conscious prescribing of nonsteroidal anti-inflammatory drugs for adults with arthritis. Archives of Internal Medicine. 1992; 152:1995-2002.)

Long term NSAID use is hard on your tissues and directly responsible from some pretty gnarly chronic body issues.

So how do we treat acute inflammatory/inflammation pain?

You know the answer.

Ice. (Maybe a little Tylenol if you really, really need it, it's not an NSAID after all)

But remember, Acetaminophen causes three times as many cases of liver failure as all other drugs combined and is the most common cause of acute liver failure in the United States. Even recommended doses especially combined with even small amounts of alcohol (Yes you Crossfitters) have caused irreversible liver failure. Don't be so cavalier about treating your muscle soreness with drugs. Taking pain meds of any kind is serious.

Can you see the difference between treating pain and treating inflammation? Control swelling and Pain with Ice as seen below, it won't short circuit the way your body actually heals itself and becomes stronger. (Hell, the Ice bath might make you a little stronger too.)



Bask in your soreness!Brag about it at work as your friends help you get up off the toliet. And above all, practice all the recovery tricks you know! These include: Proper nutrition, fluid intake, ice bath, fish oil, active recovery, stretching, massage, etc.

Hell, you can even sneak in another quick workout the next day before the 48 hour soreness beat down really kicks in! Quick, let's do Fight Gone Bad before you get too sore from yesterday's double fran! For example.

Seriously. Knock it off. Get off the Vitamin I.


--K-There-is-no-I-in-Star

98 comments:

Anonymous said...

"No good coach should allow their athletes to take ibuprofen at anytime."

You might have a few angry girl athletes when it's Aunt Flo and not Helen that's the problem...

got any advice for that one? Can't live without the ibu on just 2 days of the month.

Anonymous said...

Train lighter on the day or two beforehand....that way, if you do take the ibu, there won't be microdamage and repair going on in your muscles. So it shouldn't affect them.

Anonymous said...

and in regards to Aunt Flo- typically there is a nutritional depletion happening that causes the need for ibu with women. Caffeine? Hydration? Gluten? Take a look at that first before popping the pills.

Kelly Starrett said...

Here is the disclaimer, disclaimer.
Ibuprofen is a miracle drug....for horrible non-soft tissue injury pain, like cramping.
We just want people to stop taking ibu for their ankle tweaks and sore muscles, and to understand the compromises they are making if they do take it.

Does tylenol work?

kstar

Anonymous said...

So this directive applies to joint pain as well as muscle pain? I can't fathom taking Ibu to help with muscle soreness, but when I blow out my knee or my shoulder, I've always heard that Ibu was a responsible way to keep the swelling in the joint down. This is wrong? Should I just chuck all my Ibu out the proverbial window?

Anonymous said...

Tylenol, aka acetaminophen, in large, prolonged doses can cause hepatitis, liver cell necrosis, and renal papillary necrosis. Don't mix Tylenol, NSAIDs, aspirin, or alcohol together, or I might see you in the ER. There is always a time and a place for these drugs, but not for soreness. If you do have prolonged/chronic pain you need to treat the root cause instead of masking the inflammatory patterns. So seek professional medical advice.

dave said...

sweet post. eye-opening, for sure.

Andy Petranek said...

Hey KStar - so I have tennis elbow - have been icing and doing various wrist flexion, extension and finger extension exercises. It's better, but not healed. I have a topical NSAID - Ketoprofen. I'm under the assumption that when applied topically, it is not systemic - so you reduce the likelihood of all the negatives of an NSAID. Is that correct?

Anything else you'd recommend for the Tennis Elbow?

ap

Michael said...

What is your opinion on products like Wobenzyme that use proteolytic enzymes like bromelain and papain to control inflammation? When I get a particularly rough massage and I take it I get almost no residual soreness the following day. My problems with inflammation usually stem from a chronic low back problem and I find being able to control the inflammation with the proteolytic enzymes quite helpful in that respect.

It's not a matter of the DOMS as much as that tricky back and crunchy shoulder.

T Miller said...

What about Arnica Gel? It works on muscle soreness and is herbal. It also helps on some injury pain.

wladimir said...

i have bicep tendinitis therefore it feels like its on my shoulder. I am a swimmer but i also do the WODs...i dont usually take any anti-inflammatory but sometimes after icing and stretching and all it's still pretty bad. i know tendinitis is just cuz of the overuse of my shoulder but what do u think could help me reduce a little inflammation without taking drugs?

Melliefarrell said...

Thank you for putting this out there! I have never advocated the use of pain pills and I'm glad someone put the info up for all to see.

freddy c._one world said...

Cool post!

Who the hell takes anti-inflammatory pills because they are sore? You are still gonna be sore. That's just how sore works.

Last year I had a mild case of bursitis in my left knee. I literally did not train any leg work for several weeks. The pain did not go away. I was very frustrated since I never previously had any kind of knee injury ever. I got some advice from John Welbourn which he in turn got from his doctor. Three Alleve (naproxen) and three Tylenol twice a day. I figured a NFL linemen has to know a thing or two about dealing with inflammation. Within a week my knee felt great and I was back to normal.

I try to avoid any Tylenol, ibuprofen, aspirin or naproxen whenever possible, but the Tylenol/Alleve combo worked great for a mild case of bursitis.

Blair said...

Thanks very much Kelly for this post. I didn't really know of the possible side effects but I never take the stuff anyways. Still, I probably have friends or family that will pop it like candy out there.

Anonymous said...

My orthopods also tell me not to take NSAIDS (I get excellent pain relief from Naproxen/Alleve) when I'm healing broken bones; I know studies with rabbits show it messes up bone healing, and there may be newer research with people.

Has anybody heard of or done "Recovery Workouts?" Cyclists do this on off days, spinning smoothly against almost no resistance to promote blood flow to the affected areas. I've done something similar with injuries in other areas, as long as it doesn't create additional pain.

Bèr said...

Very interesting Kelly.

What steps do you recommend to undertake when injured and being trouble by swelling and severe inflammation(in my case mainly my left knee)?

RICE, I assume?

I have found that massaging the injured area with an ice cube(or cryocup)is better than just putting the ice on the area.

Bob Guere said...

Thanks Kelly, I've reposted on my website with credit and link back to SFCF, hope you don't mind.

~Bob G. CrossFit California City

Anonymous said...

For the Aunt Flo problem try Alieve it works better. For all the injuries posted you all need to look into soft tissue therapies that deal with the fascia. It corrects the problem with no drugs and is noninvasive. I have been treated this way and it works and works fast.

Anonymous said...

I'd love to hear a response to Andy Petrenak's question about tennis elbow. I'd been doing large number's of pullups for about 6 months when out of the blue I get tendonitis in my elbow. I've eliminated pull-ups, dead-lifts, push-ups, presses, and others to get some relief. I've been icing, but after two weeks little improvement. I've have't taken ibu since I know this problem could be around for many weeks if not months. Any thoughts?

Anonymous said...

thanks for great info. what might help some is a review of how to use ice -- other than the ice bath illustration. (frozen peas or a bag of chunks will not do the job)

NBA team doctor told me to do this: freeze water in a paper cup, then tear off paper to expose ~1" of ice. hold cup upside down and use it to massage injured area for 5 minutes. sensation will go from cold to pain then numbness. stop at 5 minutes. this has been best method for me to treat tennis elbow and part of rehab after shoulder surgeries by said NBA doc.

Anonymous said...

http://coldone.com
Delivers ice and compression at the same time - lots more effective than a bag of frozen peas! I have the back wrap, 2 knee wraps and an elbow wrap for myself and family members and our different ailments.

Robb Wolf said...

Good Stuff K-star! I remember you were in the 800mg/Tid camp for a while...glad to see the shift ;)

Andy-

The ketoprofin IS working systemically, just at a less intense level than say 800mg oral. Do you have a good ART guy/gal to tear that thing apart? Flights to San Francisco are cheap out of LAX...I hear some stooge in the Bay Are is a pretty decent manual therapist...

RRX said...

Greetings,

The citation used after describing a study on muscle strains was a review of NSAIDs, "(Greene, J. Cost-conscious prescribing of nonsteroidal anti-inflammatory drugs for adults with arthritis. Archives of Internal Medicine. 1992; 152:1995-2002.)". Can you please cite the actually study you discussed about muscle strains. I would like to read it.

Thank you.

Anonymous said...

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Anonymous said...

"My orthopods also tell me not to take NSAIDS (I get excellent pain relief from Naproxen/Alleve) when I'm healing broken bones; I know studies with rabbits show it messes up bone healing, and there may be newer research with people."

Naproxen/Alleve, Naprosyn, Anaprox, Motrin, Naprelan, etc... These are ALL NSAIDS...

Pain relief said...

Chronic pain is very severe and this affects people's life, long known to people who suffered from a strange disease, were strong back pains, which were intense and not let them work, as was what they said were the doctor and he prescribed oxycodone for pain, but knew it was a very powerful medicine, and moreover, anxiolytics, and worry that they were doing things that previously did not like eating too much, smoking, etc, and read in www.findrxonline.com that this drug is well and that we must be very careful with their use, and everything must be under medical prescription.

Anonymous said...

study abstract

http://www.ncbi.nlm.nih.gov/pubmed/11832356?dopt=AbstractPlus

Anonymous said...

Is Aspirin OK? My doctor has me taking low dose (81 mg.) aspirin daily.

chef said...

Best.Thread.Ever.

I have an MMA/BJJ fighter that has been a long term client that has been on chronically administered Celebrex for over a year... started about the time his progress went to hell. REALLY looking forward to digesting these abstracts linked above.

Kstar, you rule, others drool.

Anonymous said...

NSAIDs are of the two major reasons why people get peptic ulcers (not from stress, coffee, alcohol, etc.). Don't take NSAIDs. Especially if you're over 60. Ulcers can lead to GI bleeding, surgical issues and other stuff that's not fun!

Jeanne

Amber said...

Recently I found a study that stated a few things to the contrary, I'm not stating who is right or wrong, but I'm curious of your opinion on it.

http://www.musculardevelopment.com/index2.php?option=com_content&do_pdf=1&id=1207

Smarry said...

Train lighter on the day or two beforehand....that way, if you do take the ibu, there won't be microdamage and repair going on in your muscles. So it shouldn't affect them.

___________________
Smarry
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Anonymous said...

So where does that leave fish oil? Or are it's anti inflammatory properties different from IBU?

merlie said...

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Ian Kovtunovich said...

Fish oil apparently works the same way NSAIDS do. Do not assume that just because something is natural, it is benign or an optimal thing to put in your body. Think about it - it has anti inflammatory action, and it has to work by some physiological means - it isn't magic! Oh well, there's always the ice bath. http://www.sciencedaily.com/releases/2006/04/060404085719.htm

Anonymous said...

Ice is great. I'm curious if there were any any studies on it's effect on muscle repair - if it affects the inflammatory response there is a physiologic reason. Slowing movement of fluids into the injured area, as ice would do, could have some of the ame impact as well though certainly not as long as an NSAID would. I'd have to back to you about that.

But, keep in mind you're looking at once research study above, the main subject of which has nothing to do with the topic discussed! In fact the abstract I read of the study didn't even mention this finding. Since then a lot more research has been performed.

I'm not an expert in the subject, though have some background. For example of a more balanced perspective see "Sceletal muscle damage and repair" by Peter M. Tidus in google books - page 226.
It's quite readable. There's reference to similar findings as the above author states. But also a balanced and fuller perspective.
http://books.google.com/books?id=ueMh1x7kFjsC&pg=PA226&lpg=PA226&dq=studies+muscle+repair+nsaid&source=bl&ots=wwIeuoi_Mw&sig=0m790vxWxqMlAHxVTn8hPpDnuLs&hl=en&ei=koDSSry-Oo3kNa2BvZQD&sa=X&oi=book_result&ct=result&resnum=1&ved=0CA0Q6AEwAA#v=onepage&q=&f=false

It's a bad practice to take one study, and learn a general rule from it.That's extreme and unfounded psudoscience. Don't do it. There is a pro/con to everything, including NSAID. Certainly take as little as possible, and if you're taking Tylenol, avoid alcohol that day.

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Max said...

My dermatologist once told me something truly wonderful "Pain is not an issue" ~ Dr. Ong.

of course this should be used with caution. but as long as it's healthy pain just enjoy it (because it means your getting better).

antun said...

Hey Kelly,

If I understand you correctly, I shouldn't take Ibuprofen as a matter of course when my muscles are sore (which I wouldn't do).

But is it OK to take a course of Ibuprofen when I'm injured?

I suspect my shoulder's impinged. I'm taking a week off training (no WODs at all) and icing regularly. I had planned to take a course of Ibuprofen during this time. Are you saying that would interfere with the recovery?

Thanks,

Antun

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Anonymous said...

Great info! I'm hoping someone will answer the question about bromelain and papain. I like to use these too and they are great for inflammation...any studies in these or do we assume since they reduce inflammation they are just asx damaging as NSAIDS?

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