NSAIDs in Athletes

Photos: Tiger Woods (Sporting News) | John Mortimer (University of Michigan Bentley Historical Library)

by Dr. Brian Fullem

The Wall Street Journal published an article stating that Tiger Woods takes Ibuprofen every time he plays golf on the advice of his Doctor. The best quote of the entire article is this: “Please don’t emulate this,” said Robert Klapper, chief of orthopedic surgery at Cedars-Sinai hospital in Los Angeles and host of “The Weekend Warrior” on ESPN Radio. “You need to respect the pain, because what it’s telling you is to stop.”

Dr. Klapper is correct for several reasons. Chronic use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) can cause an ulceration of the stomach lining which can lead to bleeding, kidney failure, liver dysfunction and other less serious complications. NSAIDs have strong pain killing properties in addition to the anti-inflammatory component. The possible side effects go up with increased usage and increased dosage.

John Mortimer was a great steeplechaser and cross country runner from New Hampshire and he was a many time All-American at Michigan before continuing as a professional. He posted this on the LetsRun.com message boards about this in 2004: “Yes. In 2000 I was diagnosed with a Nephrotic Syndrome- specifically membranous nephropathy. The cause was from prolonged use of anti inflammatory (1 Aleve 3 times per day for 3.5 months) following 3 consecutive knee surgeries on a torn meniscus. Since then I have been under that care of one of the best Nephrologists in the country. I never stopped running or training, but I have been very limited in intensity and volume. But in the last 18 months, I have been on a course of medications that have been very effective in controlling many of the symptoms. Therefore, I have been able to run at a higher level.“

Many athletes are completely unaware of the dangers of these seemingly benign drugs. An article was published in a medical journal after surveying the athletes at the Brazil Ironman in 2008. 60% of the athletes had taken NSAIDs in the last 3 months, over half of those without a prescription or a Doctors advice. Most athletes were unaware of the side effects of the drugs apart from stomach complications. (Br J Sports Med. 2011 Feb;45(2):85-90. doi: 10.1136/bjsm.2009.062166. Epub 2009 Aug 6. Use of NSAIDs in triathletes: prevalence, level of awareness and reasons for use.Gorski T1, Cadore EL, Pinto SS, da Silva EM, Correa CS, Beltrami FG, Kruel LF.)

In my practice I rarely prescribe or recommend NSAIDS. I prefer ice as my main anti-inflammatory. When I do recommend an NSAID, it most commonly only for a 3-5 day trial and then cease the medications. The risks go down significantly when the drugs are only used occasionally but one dose could possibly cause any number of problems. When a runner is injured it is important to address the cause of the injury and not just treat the symptoms.

Dr. Brian Fullem practices at Elite Sports Podiatry in Clearwater, FL. He ran 14:25 for 5K while at Bucknell University. This is the continuation in a series of articles by Dr. Fullem, educating us about injury care, injury prevention & other health topics for athletes at all levels of performance. The following article is the first in a 3-part series of exerpts from Dr. Fullem’s recently published book, The Runner’s Guide to Healthy Feet and Ankles.

The Runner’s Guide to Healthy Feet and Ankles:
Simple Steps to Prevent Injury and Run Stronger

by Dr. Brian W. Fullem et al.
Link: http://amzn.to/2yuCBPQ

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