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Taking Ibuprofen before Endurance Exercise is Not Recommended

Ibuprofen and other NSAIDs are not recommended for endurance athletes

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Updated January 10, 2008

Athletes and pain relievers
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Amateur and elite endurance athletes constantly seek new ways to recover faster, and to compete harder and longer. Some have turned to over-the-counter pain relievers to help reduce muscle pain after exercise and aid recovery. More recently endurance athletes have been using ibuprofen and other non-steroidal anti-inflammatory drugs (NSAIDs) before and during competition in an attempt to compete at the highest intensity for the longest duration.

But, does this work and is it safe?

NSAID’s are nonsteroidal anti-inflammatory drugs. These include aspirin, ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT). NSAIDs prevent the body from manufacturing prostaglandins. Prostaglandins are substances produced naturally by the body that act as mediators for a variety of physiologic functions including protecting the stomach lining, and regulating blood pressure. They also mediate pain and inflammation.

NSAIDs block all prostaglandins; those that cause pain as well as those that protect the stomach lining. Therefore, taking NSAIDs can sometimes cause stomach upset or gastrointestinal (GI) bleeding. The risk of stomach irritation or GI bleeding increases with long-term use of NSAIDs.

NSAIDs and Athletic Performance
So, does taking an NSAID really improve athletic performance? Does it prevent or reduce muscle soreness? So far, the research doesn’t support the use of NSAIDs for athletes. Here’s what they have found so far:

Several studies have found little actual performance benefit of taking ibuprofen and warn that it may mask pain, which can lead to increased risk of injury.

One study concluded that taking 400 mg ibuprofen four hours before exercise reduced the perception of muscle soreness but didn’t actually prevent muscle cell injury as which indicated by creatine kinase, a protein found inside muscle cells that is released when they are injured.

Further studies have cautioned that the use of NSAIDs during ultra distance exercise, such as an Ironman Triathlon, is associated with an increased risk of exertional hyponatremia. Researchers believe that this effect is likely due to altered renal (kidney) function. The issues related to altered kidney function in athletes are not hard to imagine. Poor fluid transport and restriction can lead to dehydration, hyponatremia and at the extreme, kidney failure.

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The most convincing real-life study may have been the one conducted during the running of the 100-mile Western States trail running race. Researcher David Neiman measured the influence of ibuprofen use during the grueling race by studying runners in three groups: a control group, a group taking 600 mg of ibuprofen one day before and on race day and a group taking 1200 mg of ibuprofen one day before and on race day.

The Study Findings

  • Both groups taking ibuprofen had higher plasma levels of markers (serum C-reactive protein, plasma cytokine and macrophage inflammatory protein) for muscle damage.
  • Reported delayed onset-muscle soreness was the same across all groups.
  • Serum creatine kinase levels was the same across all groups.
  • Race times did not differ among the groups.
  • Ratings of perceived exertion did not differ among the groups.

The Bottom Line on NSAID Use During Sports
The bottom line was ibuprofen use by endurance athletes did not affect performance, muscle damage or perceived soreness but it was associated with elevated indicators of inflammation and cell damage. It’s a reasonable assumption that using NSAIDs has no positive effect on sports performance. It may, in fact, cause a serious health risk in some endurance athletes.

When is It Safe to Use NSAIDs?
The use of over the counter pain relievers, including NSAIDs, should be reserved for moderate use after intense exercise. A proper warm-up and good sports nutrition including adequate hydration may be more important, more helpful and certainly safer for reducing soreness than any medications.

Sources:

Donnelly AE, Maughan RJ, Whiting PH. Effects of ibuprofen on exercise-induced muscle soreness and indices of muscle damage.

Rahnama N, Rahmani-Nia F, Ebrahim K. The isolated and combined effects of selected physical activity and ibuprofen on delayed-onset muscle soreness. Journal of Sports Science. 2005 Aug; 23(8): 843-50.

Wharam PC, Speedy DB, Noakes TD, Thompson JM, Reid SA, Holtzhausen LM. NSAID use increases the risk of developing hyponatremia during an Ironman triathlon. Medicine and Science Sports and Exercise. 2006 Apr; 38(4): 618-22.

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