NY Times article on Ibuprofren

Mike_Gemelli

"In other words, the ultramarathon racers who frequently used ibuprofen, an anti-inflammatory, wound up with higher overall levels of bodily inflammation."

“The idea is just entrenched in the athletic community that ibuprofen will help you to train better and harder,” Dr. Nieman said. “But that belief is simply not true. There is no scientifically valid reason to use ibuprofen before exercise and many reasons to avoid it.”

Full article:
http://well.blogs.nytimes.com/2012/12/05/for-athletes-risks-from-ibuprofen-use/

I only use ibuprofen for injuries...when its too painful to get around effectively. I don't think I've ever taken it prophylatically.

What are you thoughts?

oxo

Great subject for discussion! I've long thought, correctly or not, that NSAIDs can cause longterm damage to digestive pathways, but had not made the link between ibu in the gut and compromised nutritional uptake.

Personally, thus anecdotally, ibuprofen doesn't seem to help me through injuries per-se. Nor does acetaminophen, nor aspirin. But ibuprofen does seem to help palliatively with muscle soreness, especially as a prophylactic, for which I use it only for over-the-top days: a 2-2-2 regime of my own devise: two tablets the night before, two first thing in the AM, zero during. After finishing, I'll take another two as soon as I think I'm fully rehydrated. I've two or three of these days per year, the last, for concreteness, being 46 miles of continuous backcountry hiking with 14,000-15,000 feet of elevation gain, the later equating to up-and-down the Sears Tower 11 times. The next day, only my arches were sore (a footwear issue), though I was quite fatigued and starving for protein. That's typical. The 2-2-2 regime likely is not optimal. It is merely my current practice, which is to say it is not a prescription and one's mileage may vary.

The leading snippet in the NY Times article:

"In surveys, up to 70 percent of distance runners and other endurance athletes report that they down the pills before every workout or competition, viewing the drug as a preemptive strike against muscle soreness.

But a valuable new study joins growing evidence that ibuprofen and similar anti-inflammatory painkillers taken before a workout don’t offer any benefit and may be causing disagreeable physical damage instead, particularly to the intestines." (bold and underline mine)

I think it is worth noting a couple things. The 'new study' (link) does not say anything at all about possible benefit, only about "aggravation of exercise-induced intestinal injury by ibuprofen in athletes". Also, the 'new study' is not longitudinal, which is what would be relevant to chronic users, i.e. the context of the NYTimes article. Instead, 9 patients were tested in 4 scenarios. Exercise duration was 1 hour.

Mandai

Interesting topic. Just a thought: I feel that NSAIDs taken before/during a race is a form of cheating, unless there is a medical reason for it. I have ultra running background and never understood how runners would pop them like jelly beans.
Surprisingly, or rather somewhat sadly, the first "tip" I was given before my first long distance swim was to spike my drinks with liquid ibuprufen. Then I read in EC blogs that some EC swimmer also do take regular doses (like every 3,4 hrs). That confuses me as overcomming the pain should be the highest "reward" on finishing an ultra marathon or LD OWS. But I might have to eat my words here when my EC attempt is on

IronMike

I had a water bottle of drink mixture and one dose of kids liquid ibuprofen. I told my yaker to wait till I asked for it. That happened at 3 hours. I drank that bottle for the next 1.5 hours.

Now I don't know if that was why I wasn't unusually sore the next few days or if it was just good preparation. But I'll probably do it again my next big swim.

ssthomas

I only took 2 ibuprofen during my Catalina Channel swim, which was my first. At about hour 6, I could barely use my left arm because of inflammation in my shoulder and elbow. Hours 6-9 were pure, pain-filled torture. I don't typically have issues training, so I hadn't thought of the need to use ibuprofen during that swim. I couldn't raise my arms above my head afterward for about 3 days solid.

For my next marathon swim, MIMS, we put a dropper-full of children's liquid ibuprofen into my feed bottle starting at hour 3, so I was essentially taking 50mg of drugs every 1.5 hours (a typical Advil pill is 200mg). I had no shoulder issues or soreness the next day.

I followed the same plan for Tampa Bay and the English Channel this summer. About halfway through the EC, I was having some shoulder issues and I asked for one extra dose (100 mg for 1.5 hours), and the shoulder pain went away. I was only mildly sore the day following the English Channel.

I don't take things like this through training- I feel you have to listen to your body and if you have pain, perhaps rest is a good option. Also, maybe your stroke is messed up and you should be looking to do drills to correct stroke mistakes that are causing you pain. Overall, I think we do rely too frequently on meds to solve every ailment.

But, that being said- all bets are off in the middle of a channel, when you've trained for hours on end and sacrificed a lot. If there is a legal drug you can take to alleviate some pain and make you more comfortable, then I say go for it!

nvr2late

I agree with ssthomas, and find that I will occasionally use Advil for my shoulder pain after long swims. And I plan to include children's liquid Ibuprofen in my Channel kit - but another consideration in the use of Ibuprofen is the real possibly of acute renal insufficiency when using it under the condition of dehydration. Just be sure to be well hydrated if you are going to use Ibuprofen!

Mandai

Fair enough, you wouldn't want to spoil an important swim, I agree with that. My concern was more about competitive races/swims, where it becomes part of your "feeding" plan and rather to gain a competitive advantage.

firebah

I had the same experience as ssthomas. I did not take any during my Catalina crossing and the last 3 miles felt as if someone was slicing me with a knife with every left arm stroke. It took 2 days before I could raise my arm over head again. After my experience in Catalina I now have Aleve at hour 6 of marathon swims and have had no soreness at all during or after the swim. I have now completed Tampa Bay, English Channel, MIMS with no muscle soreness during or after the swim.

Mike_Gemelli

oxo wrote:

I think it is worth noting a couple things. The 'new study' (link) does not say anything at all about possible benefit, only about "aggravation of exercise-induced intestinal injury by ibuprofen in athletes". Also, the 'new study' is not longitudinal, which is what would be relevant to chronic users, i.e. the context of the NYTimes article. Instead, 9 patients were tested in 4 scenarios. Exercise duration was 1 hour.

Good points. I agree with you that the study you mention above probably doesn't represent the conditions experienced in endurance events. Besides the fact that the athletes only pedaled for an hour, the effort seems to be on the high side compared to an endurance athlete. The study reports one athlete's BPM as high as 192.

The study mentioned at the end of the article:
[url][/url]http://www.ncbi.nlm.nih.gov/pubmed/16554145
seems to be more applicable to marathon swimmers. In this study the athletes competed in a 160km race with 29 athletes took ibuprofen and 25 did not. here is a quote from the abstract:
"In conclusion, ibuprofen use compared to nonuse by athletes competing in a 160-km race did not alter muscle damage or soreness, and was related to elevated indicators of endotoxemia and inflammation."

While this study may come closer to approximating the experience of a marathon swimmer, one could make a case that certain variables could make for a different outcome. Some ideas that come to mind:
1. The relative high impact stresses that runners experience on their body lead to more damage than those experienced by a swimmer.
2. As mentioned by nvr2late, dehydration could be a factor. Although I'm not familiar with ultra distance running, my guess is that a swimmer with a support boat has much more access to water.

BTW - Thanks for all of the feedback. Besides having no experience with ultra distance running, I have only started scratching the surface of long distance swimming, so I appreciate all of the personal experiences you all contribute.

oxo

Thanks for pointing out that paper: Ibuprofen use, endotoxemia, inflammation, and plasma cytokines during ultramarathon competition.

I'll read it this weekend, but from a quick read this, fwiw, is what i took away. If one is a longtime ibuprofen user, then taking it the day before and during an ultra will not help you feel less sore than a non-user who does not take it before or during.

There are 4 relevant groups of which the paper covers only #1 and #4:

1) longtime-users who imbibe for the event
2) longtime-users who abstain for the event
3) non-users who imbibe for the event
4) non-users who abstain for the event

The paper shows #1 and #4 feel equally sore during the post-event week. The paper does not address athletes from group #3 who use it only for an event. Nor does it address whether longtime users would have more post event soreness if they uncharacteristically abstained (group #2) for the event.

heart

By the way: After my first 10k in the Applegate I had the same shoulder issues, and was gloomily contemplating canceling my 11-mile Portland river swim. Biceps tendon slipped out of its groove. People were recommending that I cancel the swim; @bobswims recommended that I take it easy and slow, which was good advice. An incredible massage therapist using trigger points and myofascial release patched me up over the course of that week - I saw her three times - and by the end of the week I was as good as new. It's not pleasant massage, but it does the job!