The Center for Podiatric Care and Sports Medicine

Should Athletes Take Ibuprofen? NYC Sports Medicine Doctors Examine the Dangers of NSAIDs

Posted by on Friday, August 11th, 2017

Athletes sometimes joke that ibuprofen is their “Vitamin I.” They work out, push themselves, and take a non-steroidal anti-inflammatory drug (NSAID) later to suppress the inflammatory response and recover faster. However, two new studies reveal the potential dangers of such an approach. “While the medicines are popular, they may also overtax the kidneys during prolonged periods of exercise and actually inhibit the muscles’ ability to repair afterward,” explains NYC sports medicine doctor Dr. Josef J. Geldwert. Although Dr. Geldwert was not directly involved with the studies, he routinely counsels athletes on proper recovery protocol and understands the dangers of relying too heavily on NSAIDs such as ibuprofen.

NYC sports medicine doctors recommend taking Tylenol, rather than ibuprofen, to cope with severe muscle pain.
NYC sports medicine doctors recommend taking Tylenol, rather than ibuprofen, to cope with severe muscle pain. Image Source: Wikimedia user Dcoetzee.

Ibuprofen Use is Widespread, But Not Well-Informed

By some estimates, up to 75% of long-distance runners take NSAIDs such as ibuprofen or naproxen either before, during, or after training and races. The hope is that the drug will reduce inflammation enough to alleviate Delayed Onset Muscle Soreness (DOMS) and improve the functioning of stiff muscles.

NSAIDs work by slowing the production of prostaglandins—biochemicals that typically flood injury sites, causing blood vessels to dilate in order to facilitate blood flow to the area. However, in the process, prostaglandins also trigger inflammation and pain.

While an ibuprofen may take the edge off acute pain, some studies have found that painkillers work about as well as a placebo for truly alleviating muscle soreness and dysfunction. Additionally, most recent studies suggest that NSAIDs may lead to kidney problems in endurance athletes.

“In medical school, we were all taught to be careful of ibuprofen because it decreases blood flow to the kidneys,” said Dr. Grant S. Lipman from Stanford University, who has studied the drug’s effects on ultramarathoners. So, naturally, he wondered why these conclusions were not widely available to the public through studies in respected medical journals.

Ibuprofen Increases the Risk of an Acute Kidney Injury by 18%

In the study published in the Emergency Medical Journal, Dr. Lipman had 89 ultramarathoners take either an ibuprofen or a placebo once every four hours over the course of a 50-mile race. To assess acute kidney injury, he and his colleagues looked for high levels of creatinine, a by-product of blood filtration.

Researchers found that 44% of the runners had creatinine levels signaling acute kidney injury. The group taking ibuprofen was 18% more likely to develop an acute kidney injury than the placebo-using group, and their injuries were more severe.

The experiment did not look at the long-term health of ibuprofen users or attempt to explain why ibuprofen may have increased the risk of kidney problems. However, Dr. Lipman speculated that, by inhibiting the prostaglandin production, the drug choked off blood flow to the kidneys, making it more difficult to filter the blood.

Study Shows Prostaglandins are a Necessary Evil

A study published in the Proceedings of the National Academy of Sciences found that NSAIDs not only reduced the production of prostaglandins but also changed the way muscles responded to exertion. Stanford scientists examined this phenomenon by looking at mice with slight muscle injuries.

They noted that, when stimulated with prostaglandins, the cells began to multiply and create healthy new muscle cells to restore the damaged tissue. Ideally, this is what should happen when we’ve exercised strenuously—we rebuild with healthier, stronger muscle.

With the introduction of NSAIDs, researchers noticed that fewer cells were activated, fewer new cells were created, and the muscle tissue was weaker and less springy. “There’s a reason for the inflammation,” summarized Dr. Helen Blau, overseer of the experiment. “It’s part of the regenerative process and not a bad thing.” The old saying “no pain, no gain” does appear to be true in this case.

Should You Stop Taking Ibuprofen For Exercise-Related Muscle Pain?

In alignment with recent research, Dr. Josef Geldwert, NYC sports medicine doctor with The Center for Podiatric Care and Sports Medicine, recommends that patients take acetaminophen (such as Tylenol) if absolutely necessary, as this drug does not interfere with inflammation. “Something like icing tends to work just as well,” he adds. If you have any questions about your training and recovery, contact us today or stop by one of our locations in Manhattan or White Plains.

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.