The Center for Podiatric Care and Sports Medicine

Wondering When to Use NSAIDS for Foot or Ankle Injuries? We Tell You When to Use NSAIDS and When to Stay Away

Posted by on Wednesday, December 23rd, 2015

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The body does what it can to repair soft tissue and bone damage, but this comes at a cost. Inflammation is one of the first reactions to injury. We tend to think of inflammation as a negative thing because it looks unsightly and causes significant pain in most cases. However, there are a few benefits of acute inflammation, notably1http://www.sharinginhealth.ca/biology/inflammation.html:

  • Activation of the immune system
  • Destruction of pathogens and dilution of toxins
  • Delivery of oxygen, nutrients, proteins, and repair cells
  • Assistance with drug delivery

For these reasons, you don’t necessarily want to rely heavily on anti-inflammatory medication to take care of an injury — particularly a chronic one. In this article, we’ll take a look at what science has to say about the widespread use of NSAID medication like ibuprofen, aspirin, and naproxen to recover from injuries to tendons, muscles, ligaments, joints, and bones.

NSAIDs
This is what inflammation looks like! Image Source: Wikimedia.org

How NSAIDs Work

Non-Steroidal Anti-Inflammatory Drugs work by inhibiting COX enzyme function, which prevents the conversion of arachidonic acid from the cell membrane into prostaglandins, prostacyclins, and leukotrienes. When distributed through the body tissues, these compounds are responsible for muscus production, platelet aggregation, blood flow, pain receptor modulation, and the development of fever and inflammation.

Unfortunately, some essential functions — like gastric mucus production, bicarbonate production, and gastric acid secretion — are also suppressed by NSAID use, which explains the gastrointestinal irritation many people suffer. Also, prostaglandins are helpful in bone repair, as they prompt cell differentiation that forms new bone.

NSAIDs: Foe

Bone Healing: A comprehensive review of research published on the Rheumatology Network site points out several studies demonstrating delayed bone healing with NSAID use2http://www.rheumatologynetwork.com/articles/do-nsaids-impair-healing-musculoskeletal-injuries#sthash.tmNeCvgM.dpuf:

  • One human study found a four-fold risk of fracture nonunion when ibuprofen or diclofenac was taken for 21 weeks.3http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764618/
  • Another study found that 26% of patients who suffered high-impact fractures suffered nonunion when indomethacin was taken, compared to 7% of the patients who underwent radiation therapy instead.

The general consensus is that NSAIDs given for longer periods of three to 12 weeks impair fracture healing in ways that are not seen with acetaminophen. On the other hand, short-term use (less than a week) is not associated with significant disturbance in the healing process. In the short term, NSAIDs can take inflammation down to enable early casting and control pain enough to keep patients mobile for an active recovery.

NSAIDs: Friend

There were, however, other studies that showed no real impact of NSAID use on healing or beneficial effects:

Tendon Healing: The effectiveness of NSAIDs depends upon whether the tendon is actually inflamed or degenerated. When inflammation is present, short-term use for the first few days following injury is warranted. When degeneration has occurred, NSAID use does not provide many beneficial effects.

Ligament Healing: Though few studies have examined NSAID treatment on humans with ligament injuries, one study of grade 1 or 2 ankle sprains treated with ibuprofen and celecoxib found less pain and earlier return to function.4http://www.ncbi.nlm.nih.gov/pubmed/12216965

Muscle Healing: Most patients can benefit from up to 10 days of naproxen treatment for muscle soreness that often accompanies rehabilitative eccentric exercise programs.

The Bottom Line:

Evidence suggests that NSAIDs should not be used for long-term pain management, as they disturbs the healing processes for bone healing and disrupt normal digestive, renal, and cardiovascular functions. When the issue is tendon degeneration (tendinopathy), short-term NSAID use can be beneficial as a short-term analgesia. With sprains, strains and ligament tears, or muscle injuries, NSAIDs can limit pain and swelling so patients can regain function and return to activity sooner — which can benefit healing.

That said, it’s important that athletes not use NSAIDs in the absence of injury or rely solely on these drugs for rehabilitation, warns researchers writing for the British Journal of Sports Medicine.5http://bjsm.bmj.com/content/43/8/548.full The best indication is to give the minimal dose during the first week when swelling and pain are present. If you have a history of adverse side effects from NSAIDs, you may try paracetamol (acetaminophen), which is as effective at reducing pain, without some of the GI and cardiovascular risks.

NYC Tendon Repair

Doctors at The Center For Podiatric Care and Sports Medicine have methods of stimulating natural healing processes — either by using injection therapy, ultrasound, laser energy, or electromagnetic shockwaves. These direct methods are not only more efficient and targeted, but they also come without many of the adverse side effects of medication. In addition to progressive treatments for inflammation, pain, and function, we recommend several types of exercises that work wonders for tendon problems in the feet and ankles.

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1. http://www.sharinginhealth.ca/biology/inflammation.html
2. http://www.rheumatologynetwork.com/articles/do-nsaids-impair-healing-musculoskeletal-injuries#sthash.tmNeCvgM.dpuf
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3764618/
4. http://www.ncbi.nlm.nih.gov/pubmed/12216965
5. http://bjsm.bmj.com/content/43/8/548.full

If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.