Anti-Inflammatories and Sport

Introduction

Jimmy, this one’s for you!

Aging (sadly!) leads to joint problems. In older masters athletes (NB. runners, team sport players and triathletes), and in particular heavier masters athletes who have trained hard for a long time, joint pain becomes common as the accumulation of small musculoskeltal injuries grows over time.

In younger athletes the use of anti-inflammatories – sometimes called NSAIDS (nonsteroidal anti-inflammatory drugs) – is very common varying from 12% in cyclists to 90% in professional footballers.  These drugs are widely used to reduce existing pain or to prevent anticipated musculoskeletal pain during training or competition. They also reduce the pain and inflammation related to arthritis, menstrual cramps, headaches and muscle pain by creating a shield against certain enzymes that cause inflammation. Thus, in athletes young and older it is assumed they improve training and racing performance by enabling more frequent and more intense training sessions.

Common anti-inflammatories include medications such as Aspirin, Celebrex, Indocin and Voltaren.

Adverse Effects

NSAIDs are widely known to cause gastrointestinal complications including gastric ulcers, bleeding, perforation, and abnormal narrowing of the gut. In 2011 some Dutch researchers found that 1 hour of hard training can also lead to small intestinal injury and short-term loss of gut barrier function (the cells and mucous lining the gut to protect it against bacteria, viruses and toxins). In 2012, the same research team found that taking NSAIDs before training lead to gut damage and gut upsets.

So when athletes young or older both train hard AND use anti-inflammatories, the poor old gut is copping a hammering making it very open to damage both short-term and longer-term. In the short term, gut upsets such as side stitches, flatulance, belching or vomiting and diarhoea can be expected. In the longer term the risk of ulcers and bleeding become greater.

Previous research has also shown there are some groups who should NOT use NSAIDs:

  1. People allergic to NSAIDs (if allergic to aspirin, you are most likely allergic to other NSAIDs)
  2. People that are highly sensitive such as asthamtics or those who suffer urticaria (hives) or rhinitis
  3. Pregnant or breastfeeding women
  4. Masters athletes with kidney disease
  5. Masters athletes with a history of ulcers
  6. Masters athletes taking other medications that may interact with NSAIDs – ALWAYS check with your family doctor and pharmacist.

 The Bottom Line?

NSAIDs should only be used in the early stages of musculoskeletal injury repair. Even then, recent research suggests that NSAIDs may not benefit initial injury repair and indeed may have a detrimental impact on longer-term injury repair and potential gut damage in at-risk and /or chronic users. In older athletes at risk of gut injury negative side-effects (see list above) or  plan to train hard regularly, NSAIDs are NOT recommended as they can lead to gut damage both short and longer term.

Sources:

Houglum, J. (1998). Pharmacologic considerations in the treatment of injured athletes with nonsteroidal anti-inflammatory drugs. Journal of Athletic Training, 33(3): 259-263.

Mackey, A. and others (2012). Rehabilitation of muscle after injury – the role of anti-inflammatory drugs. Scadinavian Journal of Medicine and Science in Sports, 22: e8-e14.

Van Wijck, K. and others. (2012). Aggravation of exercise-induced intestinal injury by Ibuprofen in athletes. Medicine and Science in Sports and Exercise, 44(12): 2257-2262.