NSAIDs Can Help Decrease Inflammation and Pain but Impact Muscle Gains

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NSAIDs (non-steroidal anti-inflammatory drugs) including ibuprofen, naproxen, diclofenac, celecoxib and indomethacin can decrease pain. Take them for the shortest possible time as they can be harmful.

Should you use NSAIDs? If you must get back to work ASAP then consider the risks vs. benefits. Talk to your pharmacist and physician (MD).

NSAIDs can help decrease inflammation and pain

NSAIDs can Help Decrease Pain from:

  • Acute ligament sprain – use for < 5 days. NSAIDs reduce pain and swelling so you can return to activity faster.
  • Osteoarthritis (cartilage wear and tear)
  • Delayed onset muscle soreness. When taken for several days before muscle damaging exercise, NSAIDs may reduce soreness. Take with caution as they can wreck your strength gains (see below).
  • Muscle bruise (contusion). Short term use can decrease inflammation with no adverse effects on healing.
  • Tendonitis – reduces inflammation and helps recovery. NSAIDs may do more harm than good for chronic tendon issues.

How NSAIDs Impact your Strength Gains

  • Short-term low dose (400 mg ibuprofen) use may have no real impact on muscle strength or size.
  • Longer term, higher doses (1,200 mg ibuprofen) may compromise muscle growth and, when training was preformed with all-out max reps, strength gains were also compromised.
  • The elderly may benefit due to a decrease in inflammation from taking NSAIDs. Chronic inflammation, which is not uncommon in the elderly, impairs strength gains. NSAIDs help tame inflammation.
  • After muscle injuries, NSAIDs can help reduce strength loss, soreness and muscle markers of inflammation, particularly when lower body muscles are injured.

Why do NSAIDs Impact Training (Strength) Gains?

NSAIDs work by blocking COX enzymes. COX enzymes alter prostaglandin synthesis, mediators of inflammation and pain. Prostaglandins have other actions in the body including regulation of muscle protein metabolism. Decreases in the prostaglandin PGFare associated with decreased protein synthesis and reduced muscle fiber size. In one study, 1200 mg ibuprofen blocked protein synthesis after resistance training. Other studies show signaling responses in muscle are decreased for hours or days after resistance training when NSAIDs are used.

References:
Arthritis Res Ther 2013;15(Suppl 3):S2.
Annals of Phys and Rehab Med 2010;278-288.
Am J Sports Med 2004;32(8):1856-9.
Am J Physiol Endocrinol Metab 2002;282(3):E551-6.
Acta Physiol (Oxf) 2018;222(2).
J Physiol 2009;587(Pt 24): 5799-5800.
Am J Sports Med 2018;46(1):224-233.

 

What Causes Muscle Cramps? How Can I Prevent Them?

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Muscle cramp
There are two main types of muscle cramps. If you can identify which one you are experiencing you may be able to stop cramping sooner and prevent future cramps.

Localized Muscle Cramping

Localized muscle cramps happen suddenly when a muscle is overworked and tired.

They feel like: constant pain.

Risk factors include: several factors may contribute to localized muscle cramping including: older age, history of cramping, metabolic disturbances, poor conditioning (or increasing the intensity of your training before you are ready) and not stretching. 

Treatment: for this type of cramping should include passive stretching, massage, active contraction of the antagonist or opposing muscle group (for instance, if your hamstrings are cramping, contract your quads), and icing.

Prevention:  Stretching (hold your stretch for at least 30 seconds), using proper movement patterns (biomechanics) and making sure you are conditioned before increasing the intensity of your training.

Exertional Heat Cramps

Exertional heat cramps are due to extensive sweating and low sodium levels from not consuming enough sodium and/or losing too much sodium through sweat.

They feel like: initially you may feel brief, spontaneous contractions that take time to develop followed by debilitating, widespread muscle spasms.

Risk factors include: high sweat rate, little sodium intake (especially if you lose a lot of sodium through sweat or over consume water or other no or low sodium drinks).

Treatment: replacing both fluid and sodium losses as soon as you start cramping. You can use an electrolyte replacement product or table salt! IVs are sometimes used to expedite this process. Massage and ice can also help relax the muscles and relieve discomfort.

Prevention: if you are a “salty sweater” – you see white salt crystals on your clothes, face or other parts of your body, be sure to salt your food prior to training and competing and consume enough sodium in your sports drink to prevent excessive sodium losses.

If you know what type of cramps you are prone to, you can better incorporate prevention methods and have treatment options readily available to stop cramping as soon as possible [ice, sports drinks, electrolyte products, table salt (restaurant salt packets in a ziplock bag always come in handy), a good athletic trainer nearby etc.].

As a review, here are your prevention strategies for cramping:

  • If you have a history of heat cramping, know that your cramps will likely reoccur at some point during training or competition.
  • Make sure you are conditioned before increasing the load or intensity of your training.
  • Incorporate stretching or hot yoga into your training regimen.
  • Give your body time to adjust to changes in elevation, heat and humidity.
  • Salt your food!
  • Do not over-consume water or any other low or no sodium beverage or you’ll dilute your blood sodium level and set yourself up for cramps.
  • Weigh yourself pre- and post- training. For each lb lost, consume 20 – 24 oz of an electrolyte-replacement drink.
  • Work with a sports dietitian or athletic trainer (ATC) to develop a hydration-electrolyte plan that specifically meets your needs. Sports drinks do not contain enough sodium for salty sweaters and those prone to exertional heat cramps.

 

 

Got Knee Pain? Creatine May Improve Your Pain & Stiffness

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If you have knee pain, chances are you may have osteoarthritis. Osteoarthritis is the most common joint disorder and it’s the medical term for “wear and tear” on a joint.  Over time, the cushioning between your joints, your cartilage, can break down causing pain, swelling, stiffness and a limited range of motion.

The initial treatment regimen for osteoarthritis often involves over the counter pain relievers, physical therapy, glucosamine and chondroitin sulfate. But, a recent study shed light on the effectiveness of a popular sports supplement – creatine, for osteoarthritis.

In a randomized, double-blind, placebo-controlled study in postmenopausal women with osteoarthritis, the women were given either creatine (in a typical dosing pattern used with creatine – 20 grams per day for one week followed by 5 grams per day thereafter) or a placebo for 12 weeks. After the 12-week study finished, physical functioning and stiffness significantly improved in the creatine group. In addition, the group taking creatine significantly improved the muscle mass in their legs.

If you are in physical therapy and working on leg and glute (butt) strength to stabilize your knee and help minimize the pain of osteoarthritis, try creatine with your program. By adding creatine, you should see greater gains in muscle tissue and see them more rapidly. And, better functioning muscle means stronger knees and less knee pain. And, you don’t need to be a postmenopausal woman to reap the benefits from creatine. In fact, you’ve got a leg up if you are under 40, especially if you are a man (because your muscle tissue is primed for growth when you are younger and men have the hormonal profile to make great gains from strength training whereas women do not have the hormones necessary to “get big”).

If you want to try creatine, take the initial loading dose in 5 gram increments four times per day or 10 grams twice a day. Take more than that at one time and you may experience some stomach distress. Is creatine safe? You bet. Check out my article here about the safety of creatine.