anti-inflammatory / ice / swelling

[Rideski]

I know I've previously read here some discussion about NSAIDs preventing healing, can't seem to find any search hits on ibuprofen , NSAIDs, etc.

Feel free to bump if there's a big thread about it.

Here is an article / concept about ice and nsaids disconnecting the healing process. Certainly not my area of schooling, so interested in myths vs reality vs modern thoughts.

http://www.mobilitywod.com/2012/08/p...ng-sooo-wrong/

[powtario]

Ortho's don't like NSAIDs because it impairs fracture healing. Tylenol is a good place to start for pain, just don't go over the rec'd dose.

[hutash]

Ortho's use NSAIDs all the time for fractures, mine certainly does post knee Sx. In vet med use use them post surgery. There is a theoretical reason not to use NSAIDs because inflammation is part of the healing process...no damage response/no healing, but in practical use, reducing the over abundant inflammatory response actual promotes healing. RICE does reduce inflammation, but I can see over icing could slow things down, but the pain and discomfort is more of an issue then a slight delay in healing.

[MagnificentUnicorn]

Some of the orthopods I work with don't like NSAIDs in regards to tendon healing. I've heard that a lot of the ideas behind that have been debunked though.

[Rideski]

What is the word on immobilization vs some limited light use in best prevention of scar tissue?

Here is the follow up video to the one above, I'm only half way through this one.
http://www.mobilitywod.com/2013/07/c...-a-year-later/

[MagnificentUnicorn]

My docs have always said move as much as tolerated unless there is some sort of soft tissue repair or an unstable fracture.

[LightRanger]

I swear when I did my tib-fib the ortho said no ibu because the latest research said it has a small deleterious effect on bone regrowth. That was 2009 though, and I think the correlation was pretty weak.

He also gave me a low-intensity pulsed ultrasound device to use on the fracture site 2x/day.

[auvgeek]

This isn't my area either, and I have only anecdotal evidence to offer. If anyone has any hard evidence—scientific, peer-reviewed journals, etc—I would love to see them. Last I checked, I could not find a single journal supporting the use of ice or NSAIDs in aiding recovery, but I also couldn't find anything supporting the theory that they hinder recovery. To my knowledge, there hasn't been a study that actually produced meaningful results. (Edit: there was one paper I remember being relevant that concluded or implied something about icing being ineffective, but it would take me some time to find it; time I don't have right now.)

My story: I stopped using NSAIDs in 2010 after hearing rumors about it causing issues on some rock climbing forums, and I stopped icing in 2011. After discussing it with her at length and doing her own research, my girlfriend stopped in 2013. We now use compression and heat (mainly epsom-salt baths). I feel SO much better. There are a lot of variables in that: I'm also eating much cleaner now and sleeping more. But we were talking about it recently, and neither of us could imagine going back to using ice or "Vitamin I;" we just feel better without it. For example: In high school, I used to take 4 ibuprofen 3x/day to help deal with tendonitis from climbing in the flexor tendons in my wrists, as per a doc's recommendation. It lingered through college, even after I stopped climbing much. After getting rid of ice/NSAIDs and getting some serious massage done from a CHT, my wrists feel much, much better. But again, too many variables for it to mean much.

So just anecdotal evidence from me, but I'm convinced (until I read a compelling argument about why I might be wrong) that it's better for my own personal health. YMMV, and I'm certainly not saying that, "This works for me, so it must be right or work for you."

in practical use, reducing the over abundant inflammatory response actual promotes healing.

Curious about this statement. Could you offer a source?

[XavierD]

I use NSAIDs, multiple times a week, and will continue to do so.

[Rideski]

If anyone has any hard evidence—scientific, peer-reviewed journals, etc—I would love to see them.

Here is one from the previously linked vid.
http://www.ncbi.nlm.nih.gov/pubmed/22820210

[charles martel]

Ortho's use NSAIDs all the time for fractures, mine certainly does post knee Sx. In vet med use use them post surgery. There is a theoretical reason not to use NSAIDs because inflammation is part of the healing process...no damage response/no healing, but in practical use, reducing the over abundant inflammatory response actual promotes healing. RICE does reduce inflammation, but I can see over icing could slow things down, but the pain and discomfort is more of an issue then a slight delay in healing.

Yes, both my orthos, shoulder and knee, and accompanying PTs used NSAIDS. All of them disputed the online stuff I read abut NSAID inhibiting healing. Both said the benefits are beneficial in healing and therapy.

But, get your local doc to tell you what's what for you, Rideski.

[Cocximus]

Check out naproxen NSAID. Great for tendonitis and all the stuff you mess up in weird ways climbing on top of the usual. Naproxen saved a few trips,

[auvgeek]

Yes, both my orthos, shoulder and knee, and accompanying PTs used NSAIDS. All of them disputed the online stuff I read abut NSAID inhibiting healing. Both said the benefits are beneficial in healing and therapy.

What was their argument?

XavierD (and anyone else who uses NSAIDs): What is your reasoning behind doing so?

[XavierD]

What was their argument?

XavierD (and anyone else who uses NSAIDs): What is your reasoning behind doing so?

pain ain't healthy, and my body is more or less starting to brake down from overuse (and I'm 25... fuck). Sometimes I wake up and my left hip just hurts, or my right knee. Also inflamed muscles are more likely to pinch inflamed nerves, than non inflamed muscles pinching off non inflamed nerves.

I haven't had any bad results from using it.

I also view Mr. Mobillity wod as not necessarily the go to for everything body mechanic related. I disagree with him on some shit, especially where he seems to take a universal view on how everyone's body should respond.

[old goat]

Here's a nice review article on the subject: http://www.rheumatologynetwork.com/a...letal-injuries
the biggest concern seems to be fracture healing but the results of the studies are mixed and if there is an effect it probably means taking the NSAIDS for a long time. But frankly, despite concerns about addiction I always felt narcotics were safer than nsaids--having seen enough bleeding and perforated ulcers and dead kidneys from the NSAIDS. Just don't drive and be aware of the potential for addiction so use as directed. One of the keys to narcotic use is that after an acute injury is over, limit their use with a long enough interval between doses to allow blood levels to minimize. This prevents tolerance and habituation. And if you do get hooked on drugs, I'd rather it be on drugs prescribed by your doctor, at least you won't be stealing the CD player from my car to pay for heroin. (It's an old car.)

[Orthoski]

Anti-inflammatory medication have been observed to decrease bone healing in rat femur models as well as human spine fusions:
http://www.ncbi.nlm.nih.gov/pubmed/17332098
http://www.ncbi.nlm.nih.gov/pubmed/19884440

As one can see from review studies, however, the data in humans in regards to fractures isn't great:
http://www.ncbi.nlm.nih.gov/pubmed/22552671

Most fractures and fusion procedures will still heal despite the use of NSAIDs, but if something goes on to heal poorly (aka, nonunion), one might not want to look back and wonder if one shouldn't have used NSAIDs. Many orthopedic surgeons therefore recommend against their use, at the very least in fractures they worry about (i.e., fractures that have a built-in rate of not healing).

[powtario]

And if you do get hooked on drugs, I'd rather it be on drugs prescribed by your doctor, at least you won't be stealing the CD player from my car to pay for heroin. (It's an old car.)

Actually the rise in heroin addiction and the total number of opiod related deaths and the shitshow that entails is directly related to perscription initiated opiod dependence.

For severe pain in the short term Tylenol and NSAID's will offer surprisingly good pain relief taken properly, in my opinion opioids should generally not be taken longer than acute incidents (1-2 weeks) because the side effects outweigh the risk.

Popped ulcers from NSAID's aren't nice, but that is generally people popping WAY more than suggested in the under 65 age group. For superficial joints (basically not hips) topical NSAID's, especially diclofenac work wonders.

Naproxen has the nice benefit 12 hourly dosing instead of 6 like Ibu.

To clarify from earlier, in the short term I think NSAID's are good for pain control in acute post fracture and postop, but defo not for the entire 6-8 wk period.

[SkiBall]

Here's a nice review article on the subject: http://www.rheumatologynetwork.com/a...letal-injuries
the biggest concern seems to be fracture healing but the results of the studies are mixed and if there is an effect it probably means taking the NSAIDS for a long time. But frankly, despite concerns about addiction I always felt narcotics were safer than nsaids--having seen enough bleeding and perforated ulcers and dead kidneys from the NSAIDS. Just don't drive and be aware of the potential for addiction so use as directed. One of the keys to narcotic use is that after an acute injury is over, limit their use with a long enough interval between doses to allow blood levels to minimize. This prevents tolerance and habituation. And if you do get hooked on drugs, I'd rather it be on drugs prescribed by your doctor, at least you won't be stealing the CD player from my car to pay for heroin. (It's an old car.)

Yet.
123456

[charles martel]

What was their argument?

XavierD (and anyone else who uses NSAIDs): What is your reasoning behind doing so?

I am not a medical doc and don't really know. However, these folks are a a university medical center and work regularly with professional, elite and weekend athletes.

All my docs have told me to take with a grain of salt anything I read online, including peer reviewed medical stuff. the later because i am not a doc and don't know the literature and diagnosis processes.

[hutash]

Anti-inflammatory medication have been observed to decrease bone healing in rat femur models as well as human spine fusions:
http://www.ncbi.nlm.nih.gov/pubmed/17332098
http://www.ncbi.nlm.nih.gov/pubmed/19884440

As one can see from review studies, however, the data in humans in regards to fractures isn't great:
http://www.ncbi.nlm.nih.gov/pubmed/22552671

Most fractures and fusion procedures will still heal despite the use of NSAIDs, but if something goes on to heal poorly (aka, nonunion), one might not want to look back and wonder if one shouldn't have used NSAIDs. Many orthopedic surgeons therefore recommend against their use, at the very least in fractures they worry about (i.e., fractures that have a built-in rate of not healing).

I haven't read the papers, but the most common reason for delayed/non-union is over use...too much wiggling around while trying to heal. Pain is one of the things telling is to not move around. Suppress it with NSAIDs or opioids, and healing will slow if you move around too much. Short of bone plates, most fracture repairs allow a certain amount of movement at the fracture site (a little movement is good, too much is bad).

Bottom line, is it sucks to be in pain, so use what you need within reason, and don't over do it during healing.