Interesting article: NSAIDS actually inhibit healing

**Spats** · 06-24-2006, 08:25 PM

NSAIDS = Motrin, Advil (ibuprofen), Aleve (naproxen), aspirin, etc. But not Tylenol (acetaminophen) -- thanks for the reminder.

http://www.caringmedical.com/sports_injury/nsaids.asp

**upallnight** · 06-25-2006, 12:46 AM

After my recent knee surgery, the nurse told me "No NSAIDs!"
2 weeks later, the doc told me to take 3200mg/day.

Scary.

**ctarmchair** · 06-25-2006, 06:42 AM

Tylenol is not a NSAID.

Basic point is seemingly correct for NSAIDS as regards soft tissue injuries, for bone they seem to be fine. They seem to inhibit inflammation too well and therefore futz up the first part of the healing process. Basically for a sprained ankle, etc. Tylenol or aspirin are what docs are trending to recommending.

Tylenol and your liver if you're even a slightly more than moderate drinker is a different story.

**Vinman** · 06-25-2006, 11:41 AM

inflammation is a necessary process for the body to heal. Unforunately it has gotten kind of a bad rap.

NSAIDS can be useful after the process has kind of stalled and become chronic. But I have been using OTC anti-inflammatory meds with my athletes less and less. Instead I try to manipulate the inflammatory process with things like ice and heat, ultrasound and electrical stimulation.

ct is correct though Tylenol is not an NSAID it is an anagesic only. It has no effect on the inflammatory process.

**Elkhound Odin** · 06-26-2006, 07:14 AM

Anti-inflamatories of any type should not be used for 3-4 months (probably longer) after a spinal fusion. They inhibit bone formation at the fusion point. My wife found out the hard way when her 1st fusion failed a few years ago. She was popping Advil daily for pain relief. No one told her otherwise.

**BeanDip4All** · 06-26-2006, 08:33 AM

Interseting but I find it a bit misleading, to get to the exercise point you need to reduce the inflimation - that's what anti-inflamatories are for, not a long term treatment; you can't have proper motion unless you decrease the swelling, since the swelling is the bodies way of fighting off the injury (extra fluid/ blood) it stands to reason that the anti-inflmatories are weakening the bodies response hence weakening the muscle.

However, if the swelling isn't taken out of the joint after the injury the rehab takes longer - it's a 2 step back, 5 step forward process.

**upallnight** · 06-26-2006, 09:27 AM

it's amazing with all the money invested in sports medicine that something as simple as this dogma of icing (see other article on that site) is possibly wrong and harmful.

on that site:
mobility = good (see their "MEAT" recommendation)
natural inflammation = good

like TL said, there's a trade-off. there must be some optimal point on that continuum of getting inflammation down and regaining mobility...but maybe not "too much, too soon."

**Spats** · 06-27-2006, 12:17 PM

Originally Posted by Vinman

ct is correct though Tylenol is not an NSAID it is an anagesic only. It has no effect on the inflammatory process.

Thanks. I always get ibuprofen (Motrin) and acetaminophen (Tylenol) confused. Edit made.

**Spats** · 06-06-2007, 04:55 PM

Bumping because the article is still true and important.

Squatch · 06-06-2007, 09:02 PM

Originally Posted by Spats

Bumping because the article is still true and important.

additionally (although i have no citation) they also inhibit the muscle breakdown and regrowth that comes from lifting, training, etc.

no pain, no gain i guess.

**truth** · 06-09-2007, 04:02 PM

Just pour 'tussin on whatever is hurting. Shit cures everything.

**yentna** · 06-10-2007, 11:34 AM

When I hurt my rotator cuff a few weeks ago, the docs told me "no NSAIDs", since they slow healing for those types of injuries. First I'd heard of it - and I'd been practically subsisting on ibuprofen for days before getting checked. Oops...

**telemike** · 06-21-2007, 06:30 AM

no NSAIDS and no RICE = pretty much what my ortho and PT have been telling me

that was news to me.......

**Velodog2** · 06-21-2007, 01:34 PM

That was an enlightening article for me as I have been managing my chronic conditions (back and shoulder) with naproxen for years, at the same time as I have become a bit of a body builder.

But the frighteningest thing of all in there, if I read it right, was that those things DECREASE the strength of tendons???? I've got to go back and double check that. Scary. I've never been injured skiing until this year when I fully tore my acl in march. In the back of my engineers head I keep thinking, hmmm, ok, accidents happen, but .... why now? What has changed?

**amyzilla** · 06-21-2007, 04:40 PM

I've gotten ulcers from NSAIDS.

**altagirl** · 06-21-2007, 04:50 PM

Originally Posted by amyzilla

I've gotten ulcers from NSAIDS.

Me too. With my first knee injury, the Army put me on 800mg of motrin (x3, so 2400mg/day) for oh... 2 years straight until my stomach couldn't take it anymore. (and they kept yelling at me to take it anyway.) Now my stomach is a wreck if I take anything like that.

I can't find it now, but I read something recently too that said not only do NSAIDs interfere with healing, decrease tendon strength, etc. but they eat away cartilage too. PERFECT!

With the last several knee surgeries I hardly took any NSAIDs, but that was because my stomach can't handle it anymore. Though apparently that's a good thing for the rest of my body. Then my doc gave me celebrex during the last rehab period and that gave me bizarre side effects (shooting pains in my arms and shoulders) that I threw it all away after 2 days on that. Fuck it. If icinig, elevating and massage doesn't bring the swelling down, I'll just have to wait.

**amyzilla** · 06-22-2007, 01:34 AM

I was on Vioxx when I was in high school because I had back problems, and I got ulcers from that (not a big deal since it's not on the market anymore). Then I was on Naproxen and later Piroxicam (sp?) for swelling since my more recent surgeries. They irritated my stomach, but my doc put me on small doses, so I kept taking them anyway. Then I got an ulcer again, whoops.

Does anyone know of natural anti-inflammatories that won't give us ulcers?

**telemike** · 06-22-2007, 05:04 AM

I use Arnica Montana - homeopathic pills and topical ointment

**altagirl** · 06-22-2007, 08:01 AM

Originally Posted by amyzilla

I was on Vioxx when I was in high school because I had back problems, and I got ulcers from that (not a big deal since it's not on the market anymore). Then I was on Naproxen and later Piroxicam (sp?) for swelling since my more recent surgeries. They irritated my stomach, but my doc put me on small doses, so I kept taking them anyway. Then I got an ulcer again, whoops.

Does anyone know of natural anti-inflammatories that won't give us ulcers?

Fresh pineapple is good. Also turmeric and ginger. You can buy turmeric and bromelain supplements, but I think the fresh pineapple is better.

(Plus, it's nice to have a reason to eat fresh pineapple...)

Apparently olive oil has natural anti-inflammatory properties as well.

I also take SAM-e supplements. That seems to help the most significantly for joint pain. It's also good for improving your mood and it's good for your liver. I can deal with those side effects.

**haydukelives** · 06-22-2007, 08:31 AM

the first hit on google came up
oking, and bone

Clinical bottom line

There is no good clinical evidence that NSAIDs or coxibs inhibit bone healing, with the possible exception of long-term use. NSAIDs and coxibs use appears to increase bone density, and does not increase fracture risk. Smoking reduces bone density and significantly impairs healing after surgery or trauma.

A PDF version of this document is available .
Introduction

Bandolier updates a previous review from December 2001. In the intervening years additional information has entered the literature, though little of it in the form of large, randomised trials. The conclusion, then and now, is that apart from ketorolac, and possibly indomethacin, there is not much evidence that NSAIDs or coxibs make any difference to bone healing after surgery or trauma, unless perhaps continued for months. A more detailed look at smoking has been added. Smoking appears to have major effects on bone function, on risk of fracture, and on bone healing. The size of the effect would be a major confounding factor in investigations looking at coxibs or NSAIDs.
medical literature is full of contradictions. i wouldnt base any decisions on one article

**Spats** · 06-26-2007, 01:37 PM

The article is aimed at ligament and tendon injuries, not bone injuries.

Originally Posted by ctarmchair

Basically for a sprained ankle, etc. Tylenol or aspirin are what docs are trending to recommending.

Yes to Tylenol, but aspirin is an NSAID.

Opiates are the best thing for pain relief without inhibiting healing. Unfortunately our government has decided that it's more important to stop people from abusing them than it is to let people treat themselves in the most effective way possible.

Moral: unless you have a stash of prescription opiates left over from your last injury, stick to Tylenol and don't drink.

**Velodog2** · 06-27-2007, 06:55 AM

My ortho gave me 70 percocets after my acl recon on the 14th. Damn. I used like 2 in the first week. Went to see him again last night and he asked me twice if I had enough painkillers, lol. Wonder if he has stock in drug rehab concerns.

If nsaids are in fact bad for the things being discussed, I would certainly not assume that 'natural' or homeopathic anti-inflammatories are going to be in any way better, unless it's simply because they are less effective. Aspirin originally came from willow bark and is as natural as it gets.

**altagirl** · 06-27-2007, 07:31 AM

Well, the most effective natural anti-inflammatory is icing and elevating.

And maybe it's just me, but eating pineapple and olive oil seems like a way more "natural" part of my diet than eating willow bark. There are plenty of natural poisons out there too. Obviously natural doesn't always equal good for you.

And I don't think there's anything wrong with taking aspirin or other NSAIDS on rare occasions, when you really need them. But in our society, they are WAY overprescribed, and people expect to have injuries and surgery with no pain or swelling whatsoever. They want to overtrain, pop a pill and be ready to go the next day. It just doesn't work like that. Go ahead, go crazy with the NSAIDS all the time, or take steroids, or have gastric bypass surgery to solve all your problems without doing the work. Sure they're effective, just don't expect the magic, no-effort or patience on my part solution to come without side effects in the long run.

**Velodog2** · 06-27-2007, 10:28 AM

Well, just to belabor the point a lil more, if the premise is that a degree of inflammation is a normal and desirable component of the healing process and inhibition of the inflammation works against that healing, then any substance, be it olive oil, willow bark, aspirin, or naproxin, is going to have that undesirable side effect in direct proportion to its effectiveness as an anti-inflammatory.

Damn, that was a sentence

I have to seriously question their statements about ligament weakening due to nsaids, especially to the extent that they describe. Seems like we'd be having a huge number of injuries as a result if it were true.
Mike

**Vinman** · 06-28-2007, 09:50 AM

inhibition of inflammation is not the goal with NSAIDS, the goal is control inflammation. The inflamm process is indeed a necessary part of healing, but it is also a process that can get out of control easily espcially if we don't allow the injured tissues a chance to rest and heal on their own.

In fact there are times when we actually like to stimulate the inflammatory response to give it a jump start when things have become stagnate. We use things like friction massage to actually cause some microtrauma to an area of chronic injury. This will cause a bit of inflammation and jump start the process in an attempt to let the body take over again.

As far as ligament weakness, to my knowledge NSAIDS do not cause weakness of normal tissue. Cortico-steroids on the other hand can cause weakness of ligament/tendon/muscle tissue especially in repeated injections to the same area.

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Interesting article: NSAIDS actually inhibit healing

all those referrences are a decade old

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