Is Long-Term NSAID Use Harmful to Athletes?

Laird Harrison

Disclosures

October 28, 2015

A Problematic Treatment for Inflammation?

Ibuprofen. Aspirin. Naproxen. You'll find cheap anti-inflammatory drugs anywhere you find athletes sore from their workouts.[1] And popular health and fitness magazines are filled with recommendations for reducing inflammation. By some estimates, 30 million people worldwide use nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis.[2]

But to Francis X. Pizza, PhD, none of this makes much sense. "It's problematic to take them," says the professor of physiology at the University of Toledo in Toledo, Ohio. "And it's not effective. So why bother?"

For decades now, researchers such as Dr Pizza have shown that the drugs can slow the process of repairing and building muscles. In animal studies, the effects can be dramatic. When it comes to human beings, the findings are more ambiguous. But enough evidence has been accumulated that most experts are now recommending against long-term use, especially of prescription doses of NSAIDs.

Dr Pizza likes to point out that inflammation plays a key role in healing. "In general, most people look at the inflammatory response as a bad thing, meaning it contributes to the symptomatology, and you need to block it to prevent all those bad things from happening," he says. "The reality is the inflammatory response is a good thing. It's necessary for regeneration and repair as well as [muscle] hypertrophy."

The Physiologic Response to Injury

Damage to skeletal muscle sets off a chemical cascade in which cyclooxygenases (COXs), a family of enzymes, catalyze the conversion of arachidonic acid to prostaglandins, which are physiologically active lipid compounds found in nearly every tissue in humans and other animals.[2]

Various types of prostaglandin are present without injury. They play a wide range of roles throughout multiple systems, including platelet aggregation or disaggregation and gastrointestinal and kidney function.[3] But the prostaglandins produced in response to muscle damage execute specific, more temporary functions: They sensitize neurons to pain, recruiting cells that first clean up debris in damaged muscles and then synthesizing the proteins to repair and reinforce the damaged areas.[4]

NSAIDs block COX receptors, inhibiting the production of a wide spectrum of prostaglandins. Understanding this connection, researchers have tried feeding NSAIDs to rodents. A significant decrease in muscle hypertrophy was observed.

In one study, for example, researchers surgically removed the gastrocnemius and soleus muscles of rats, forcing them to rely more on their plantaris muscles. This normally causes rapid growth in the plantaris. But ibuprofen administration reduced plantaris muscle growth in rats by 50%-70%.[1]

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