T Nation

NSAIDS

If one has a training injury (eg. shoulder pain), NSAIDS will act as a painkiller, I know this. but I’ve also heard that NSAIDS may prolong the healing process. This argument holds that inflammation is part of the healing process. What are your views on this? Would it better to just bear with the pain? Prolonging the healing of an injury is NOT what I would want to do. I don’t care about the pain.

Also, how does iceing help an injured bodypart?

Another question: I have a shoulder injury. Nothing serious, just strained some ligaments there. Now, say if I were to use infrared heat on it, would it be good? I mean, the heat would penetrate deep into the tissues and dilate the blood vessels, thus promoting circulation there and healing. Is this true?
Another question: how effective are heparin-based/containing creams as compared to anti-inflammatory creams like Voltaran (sp)?

Thanks!

This issue has been addressed several times, so you may want to check the search engine for more info, but I am in the camp that is against NSAIDS. It is true that you can always find a big guy who uses NSAIDS, but this doesn’t mean they don’t adversely affect recovery. There is sufficient evidence to suggest that NSAIDS do prolong or inhibit recovery following intense or injurious exercise.

The intersting thing is that it may not even be as a result of inhibiting inflammation. Some studies have shown that NSAIDS actually result in increased neutrophil invasion. The thought here is that the NSAIDS may inhibit prostaglandin production, and shift to an increase in leukotriene production which shares a common upstream pathway. Leukotrienes are potent attractants of inflammatory cells, so this could actually exacerbate the injury.

It is difficult to actually say what is going on, many of the studies are contradictory. To me though, prostaglandins are growth factors themselves within certain contexts, inflammatory cells (macrophages in particular) release a pharmacopia of growth factors which you couldn't afford to purchase youself. So, if you need to deal with the pain take some tylenol or aspirin. Tylenol has been shown to posses some anti oxidant properties so this helps a bit and doesn't affect inflammation.

I have to take off, but I'll come back later to the other stuff if you'd like.

Mark, I ain’t dat educated to talk like dat der Steve fella’. Just funnin’ ya Steve. Mark, I’ll give you what I have found. I like clients to take NSAIDS for the first couple of days after an injury or strain. I do this for its anti-inflammation only…pain?, just deal with it…ok, just kidding. I let then take up to 800mg twice a day. I like ice from day one, as many times as they can use it throughout the day for 15-20 minutes at a time with an hour inbetween icings. Use this protocol until you feel the injury is healed. I like for ice to be used postworkout within the hour, for 15-20 minutes, for at least a week after you stop feeling twinges. I don’t have a problem with infrared heat, just follow up with ice. I like infrared heat only after the swelling has gone down completely. Yes, it does introduce blood to the area, but in an injured state we want healing first. Take a simple cut on your finger. Run your finger under hot water, what happens? Now run it under cold water or apply ice. Same with a burn. Hot water or ice? Back to NSAIDS, they will, over prolonged periods, prevent the healing process. But, we are not going there right? Use it for immediate reduction in swelling and an anti-inflammatory, short periods, 1-4 days. And finally back to ice; Ice will reduce swelling, stop blood flow to the injured area and when removed allow fresh blood to the injured area which removes the old blood. Without ice you get a pooling of the old blood without its removal, which slows down the healing process.

Bodz you &)^()(*(^!!!

Just kidding. In fact I am glad you responded. Because I was in a hurry when I originally read the message, I got the impression that the NSAIDS were for lifting pain. In retrospect it appears as you they were intended for an acute joint injury. My apologies.

I still stand by my contention that NSAIDS inhibit muscle recovery, but for joint injuries they are of value. At this point, if the injury was incurred when the original post was made, it is a mute point anyway, but stick with Bodz recommendations for joint injuries in the future and you should be fine.

A bit more with regard to the initial question. How does ice help the injury? Well, because inflammation is designed primarily to fight infections and invaders, the inflammatory cells produce some pretty nasting chemicals. The thought behind icing is that the cold prevents these products from being produced. I prefer to alternte heat and ice after the first hour or two. The heat will improve circulation and remove debris and accumulating inflammatory cells, then the ice will again prevent production of reactive species. Hope you heal up quick.