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The Case Against NSAIDs
Written By Calvin Sun

When I was in the Army, the panacea for all ailments was a couple of 800mg ibuprofen and a canteen of water. We called it “Ranger Candy” or “Vitamin M” and we joked that all the Army doctors graduated from the Motrin School of Medicine. In college, I learned that the old RICE acronym (Rest, Ice, Compression, Elevation) is sometimes spelled with an extra “I”… as in ibuprofen. My guess is that you have been told to take ibuprofen at some point in your life by a doctor, athletic trainer, or coach. I’m sure their intentions were good, but drugs like ibuprofen can be very detrimental to your health.

Ibuprofen is what is known as a non-steroidal anti-inflammatory drug (NSAID). People hear “anti-inflammatory” and immediately think that’s always a good thing. Inflammation is a normal part of the healing response to an injury or the microtrauma induced by intense exercise. NSAIDs are a class of drug that work by inhibiting the enzyme known as cyclooxygenase (COX). Inhibiting this enzyme prevents prostaglandin synthesis which in turn prevents inflammation and pain. This is how ibuprofen and other NSAIDs can provide temporary pain relief. Unfortunately, inhibiting this pathway causes other problems.

Prostaglandins are hormone-like messenger molecules that mediate the healing process. The inflammatory response facilitates muscle repair through phagocytosis of cellular debris and the release of chemoattractants and growth factors. In other words, this process MUST occur for your body to heal itself. Inflammation signals cells (phagocytes) that come and “take out the garbage”. At the same time, oxygen and nutrients are brought in to help facilitate healing. The COX-2 pathway has been found to be essential during the early stages of muscle regeneration. In fact, numerous studies have found COX-2 to be essential for healing of skeletal muscle, ligaments, bone, and even the liver.

Short-term pain relief comes at a very high cost. A study published in the Journal of Bone and Joint Surgery found that NSAIDs not only disrupted the healing process after exercise-induced injury, but there was a subsequent loss of muscle function compared to the control group of test subjects that didn’t take any NSAIDs. Test subjects treated with NSAIDs had diminished torque and force generation compared to the control group. Not ideal if your goal is to PR your clean and jerk.

You have probably experienced delayed on-set muscle soreness, or DOMS, at some point from exercising. DOMS is caused by microtrauma to your muscle tissue, it’s a normal part of progressive overload. The stimulus of exercise is what allows your muscles, tendons, ligaments, and bones to grow stronger. Don’t waste your workout by taking an NSAID. Better methods for dealing with DOMS include active recovery and compression modalities.

Acute soft-tissue injuries are another common scenario where you might be tempted to take an NSAID (a hamstring strain, a rolled ankle, etc). Don’t do it. Instead, use the updated protocol from Dr. Kelly Starrett: “Move safely when you can, what you can. Compress lymphatics and soft tissues (use bands, muscle contraction, clothing, normatec , etc.) Elevate when you can. MCE”.

NSAIDs can also cause a variety of other side effects including gastrointestinal bleeding, liver toxicity, and renal failure. The New England Journal of Medicine estimates at least 10 to 20 percent of NSAID users experience dyspepsia (indigestion). Another study published in Drug Safety, found that nearly half of all gastrointestinal bleeding cases were caused by NSAIDs. According to the medical journal, there are nearly 20,000 NSAID-related deaths per year among arthritis patients alone.

NSAIDs are serious medicine. If you are an athlete, these drugs should have no place in your daily life.

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1. Brenda A. Bondesen , Stephen T. Mills , Kristy M. Kegley , Grace K. Pavlath. The COX-2 pathway is essential during early stages of skeletal muscle regeneration. American Journal of Physiology – Cell Physiology. August 2004, Vol. 287, no. C475-C483DOI: 10.1152/ajpcell.00088.2004.

2. Chazaud B, Sonnet C, Lafuste P, Bassez G, Rimaniol AC, Poron F, Authier FJ, Dreyfus PA, and Gherardi RK. Satellite cells attract monocytes and use macrophages as a support to escape apoptosis and enhance muscle growth. J Cell Biol 163: 1133–1143, 2003.

3. Lescaudron L, Peltekian E, Fontaine-Perus J, Paulin D, Zampieri M, Garcia L, and Parrish E. Blood borne macrophages are essential for the triggering of muscle regeneration following muscle transplant. Neuromuscul Disord 9: 72–80, 1999.

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6. Elder CL, Dahners LE, and Weinhold PS. A cyclooxygenase-2 inhibitor impairs ligament healing in the rat. Am J Sports Med 29: 801–805, 2001.

7. Simon AM, Manigrasso MB, and O’Connor JP. Cyclo-oxygenase 2 function is essential for bone fracture healing. J Bone Miner Res 17: 963–976, 2002.

8. Almekinders LC and Gilbert JA. Healing of experimental muscle strains and the effects of nonsteroidal antiinflammatory medication. Am J Sports Med 14: 303–308, 1986.

9. Mishra DK, Friden J, Schmitz MC, and Lieber RL. Anti-inflammatory medication after muscle injury. A treatment resulting in short-term improvement but subsequent loss of muscle function. J Bone Joint Surg Am 77: 1510–1519, 1995.

10. Greene, J. Cost-conscious prescribing of nonsteroidal anti-inflammatory drugs for adults with arthritis. Archives of Internal Medicine. 1992; 152:1995-2002.

11. Hawkey CJ, Langman MJ. Non-steroidal anti-inflammatory drugs: overall risks and management. Complementary roles for COX-2 inhibitors and proton pump inhibitors. Gut 2003; 52: 600–8.

12. M. Michael Wolfe, M.D., David R. Lichtenstein, M.D., and Gurkirpal Singh, M.D., New England J Med 1999; 340:1888-1899.

13. Joan-Ramon Laporte, Luisa Ibanez, Xavier Vidal, Lourdes Vendrell, Roberto Leone. Upper Gastrointestinal Bleeding Associated with the Use of NSAIDs. Drug Safety. May 2004.

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April 8, 2014 11:33 am

It is incorrect to base your entire view of NSAIDs on isolated research studies that are over 10 years old. The current consensus is that short term use of NSAIDs does not interfere with soft-tissue healing, or muscle growth and development. See these studies: and

As with most medications, they are a tool to be used in moderation.

Calvin Sun
Calvin Sun
April 9, 2014 8:43 am
Reply to  Stefan

The meta-analysis you provided actually references studies as far back as the 1980’s…

That being said, I do agree with you. NSAIDs can be used in moderation. Though, moderation tends to be a foreign concept to many athletes. Is moderation taking just one ibuprofen every day? Or does moderation mean occasional use with no regard to dosage? My point is that athletes should not be abusing drugs.

Thanks for contributing to the discussion.

Steve Diaz
Steve Diaz
April 5, 2014 5:58 pm

Great article! thanks Calvin

Calvin Sun
Calvin Sun
April 7, 2014 5:36 pm
Reply to  Steve Diaz

Thanks Steve!

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