PAIN RELIEVERS ANd inflammation: Their effect on injury prevention, healing and muscle growth

We have all taken some kind of pain reliever to help us recover from an injury, get though a grueling workout, or perhaps even prepare us to face another one; but what if doing so can actually delay healing, halt muscle growth and cause unwanted side effects? 

​*All nutritional and fitness info must be discussed with your doctor before any changes to diet or exercise regime are implemented. ​​

Inflammation has become a household term, used with distain along with words like disease, cancer and pain.  And while Chronic Inflammation is definitely a bad thing and can wreak havoc on the body, Acute Inflammation is not in of itself a bad thing.  
 
Acute Inflammation
 
Acute inflammation is the body’s initial response to the sudden onset a specific trauma or harmful stimuli, and generally lasts for several days, perhaps a few weeks.  The function of inflammation is to initiate tissue repair to the damaged cells, and without inflammation our wounds would never heal. 
 
The swelling we experience around an injury is caused by the histamines that rush to the injured cells like 911 responders; once the histamines come into contact with the damaged cells they react by swelling and doubling in size, making them more permeable to blood plasma.  The blood plasma then seeps into the swollen (inflamed) cells resulting in an increase in blood flow to the injured area; this brings a greater concentration of the proteins and antibodies contained in the plasma that promote healing.  
 
Chronic Inflammation
 
Chronic inflammation however is long term, lasting several months or even years and can eventually cause several diseases and conditions, including some cancers, rheumatoid arthritis, hay fever, cardiovascular disease, asthma, depression and weight gain.   
 
It can result from:
·         Failure to eliminate whatever was causing the acute inflammation
·         The immune system attacking healthy tissue mistaking it for something harmful
·         A long term persistent irritant
 
Essentially, acute inflammation heals, chronic inflammation destroys; its causes and treatments should be discussed with a doctor and reduced as much as possible.
 
NSAIDs
 
Non-Steroidal Anti-Inflammatory Drugs – NSAIDs – are commonly taken to relief pain, reduce inflammation and bring down a fever, including: ibuprofen (Advil, Motrin), asprin, naproxen (Aleve), diclofenac (Voltaren), and celecoxib (Celebrex).   They work by reducing chemicals called prostaglandins that are produced within the cells of the body and have several important functions.  Prostaglandins support the blood clotting function of platelets, protect the lining of the stomach from acid, as well as promote the inflammation that is necessary for healing.   Unfortunately, with the inflammation comes pain, swelling, heat and potentially loss of function, causing us to reach for relief in the form of NSAIDs. 
 
NSAIDs work to reduce prostaglandins in our body by inhibiting their production by the enzyme cyclooxygenase - COX.  Once COX is blocked from producing prostaglandins the inflammation (and pain) is reduced, however unfortunately so is the prostaglandins ability to protect the stomach lining and support blood clotting, hence the NSAIDs possible side effect of stomach ulcers and bleeding. 
 
Exercise and inflammation
 
Exercise, particularly resistance training, essentially damages the muscles causing acute inflammation.  When we perform resistance training we aim to stress our muscles, damaging them enough to cause them to grow in order to adapt to the increased workload we are throwing at them. 
 
This muscle damage causes an activation of the inflammatory process as the histamines, blood plasma and proteins rush to repair the area.  This increase in blood flow to the damaged and inflamed area brings an increase in the blood proteins needed to repair, and grow the cells.  Without this inflammation the body would be less effective at healing itself, resulting in longer recover time and less muscle growth. 
 
Another function of the prostaglandins is to stimulate pathways responsible for muscle protein synthesis, which is necessary to replace protein used by our muscles, keeping them in a positive nitrogen balance (more protein in vs out).  A positive nitrogen balance equals muscle growth (accompanied by sufficient resistance training), negative nitrogen balance equals muscle loss.  Taking NSAIDs and blocking COX from producing prostaglandins means that the body has impaired protein synthesis, equalling less muscle growth (and even potential muscle loss). 
 
NSAIDs and muscle growth
 
With all these factors indicating that NSAIDs should interfere with muscle growth one would think that the research would clearly support this, and early research on rodents has consistently shown that NSAIDs impair protein metabolism and reduce muscle development.    
 
However, follow up research on humans is mixed, perhaps in part because of studies performed on untrained, elderly subjects.  For example, this study performed on 50-70 year old subjects with knee osteoarthritis found an actual increase in hypertrophy (muscle size) with the use of NSAIDs; the theory explaining this is that elderly unconditioned adults are prone to low grade chronic inflammation  - which inhibits muscular development – which the NSAIDs helped relieve allowing for muscle growth. 
 
On the flip side, this study in the American Journal of Physiology on 24 males aged an average of 25yrs, showed suppressed protein synthesis after resistance exercise while taking maximal daily doses of analgesic drugs (1200mg). Interestingly enough, the study tested both ibuprofen (Advil) and acetaminophen (Tylenol) against a placebo, with both methods of pain relief showing decreased protein synthesis, even though acetaminophen is not an NSAID: “The primary findings of this study were that ibuprofen blunted the protein synthesis response that is normally seen after the type of exercise used in this study; surprisingly, acetaminophen also had a similar effect on protein metabolism.” 
 
And then there is this study on 24yr old adults taking moderate doses of ibuprofen (400mg/day) after performing bicep curls for 6 weeks, and showed no noticeable effect on bicep muscle size or strength vs a placebo. 
 
NSAIDs and recovery
 
If you are turning to pain relief to decrease the symptoms of DOMS in order to recover faster from resistance training the studies are also mixed.  The study mentioned above also recorded perceived levels of post exercise muscle soreness (DOMS) and found no difference between 400mg of ibuprofen and a placebo taken post exercise.  However, this study on subjects (aprox. 25yrs old) examined the effects of ibuprofen vs placebo on DOMS, muscle damage and muscular performance, and found less muscle soreness in the ibuprofen group, however no difference in performance and range of motion after 24 and 48hrs.  They concluded: “The results of this study reveal that intake of ibuprofen can decrease muscle soreness induced after eccentric exercise but cannot assist in restoring muscle function.”
 
NSAIDs and injury prevention
 
While it might seem like a good idea to take a pain reliever to work around an injury or prevent the possibility of an injury I always prefer my clients not to do this.  If we are injured, be it acute inflammation (sprain etc.) or chronic inflammation (tennis elbow, arthritis, back pain) we need to be sure that what we are doing is not aggravating the condition.  Taking a pain reliever will dull the pain we would otherwise be feeling while performing a specific movement and potentially cause even more damage.  I know from experience taking ibuprofen while suffering from tennis elbow that after the pain reliever had worn off it was obvious I had been performing movements that had made my condition worse even though I didn’t feel it at the time. 
 
It is a better idea to find ways to work around your injury instead: modify hand position or leg stance, remove certain movements from your program or switch the exercise to another one that will work the same muscle but in a way that doesn’t cause pain.   This, combined with rest, physio etc. will enable you to get back to your regular routine much faster.  
 
With all this in mind, the occasional use of a pain reliever will probably not hinder your goal of muscular hypertrophy enormously, however long term maximal doses might.   If you are taking NSAIDs on a regular basis to help you power through a tough workout or to try to avoid the DOMS that will surely follow, you might want to reconsider. 
 
If you are working that hard on your training you certainly wouldn’t want to risk doing something that might render it less effective!
 
​*All nutritional and fitness info must be discussed with your doctor before any changes to diet or exercise regime are implemented. ​​

​*All nutritional and fitness info must be discussed with your doctor before any changes to diet or exercise regime are implemented. ​​​

Change nothing and nothing will change; without change, there can be no progress!

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