Painkillers in IM (ITB) - do they work much? Also Nitro-Dur patches

Triathlon Forum
1

Ok so I am about to embark on the unknown of seeing how far I will get through IMNZ with an ITB ticking time bomb. I’ve had two shots of cortisone and will continue with the anti-inflams/stretching etc right up to the the night before.

Ortho advised to lay off the anti-inflams about 1 day out because they can unsettle the stomach. Though I’ve had someone I know tell me he popped a bunch right before (for achilles) and had no issues. So question time:
Anyone taken anti-inflams during the race and anyone had nasty side effects with digestion of race nutrition as a result? Typical pain killers (Advil, ibuprofren etc). Do these even have any effect for injury type of pain? The ortho seemed to imply that they are too mild to have an effect and whatever symptom they could treat you sort of should be able to run through it anyone (he was sounding like a HTFU Doc). He mentioned with ITB not to stop and let it cool down because it would be hell to get going again. He mentioned keeping it warm. As such would any type of deep heat type cream be of use to carry with me? I was previously prescribed Nitro-Dur (glyceryl Trinitrate) patches (1/4 does) for patella tendonitis. These increase blood flow to the tendon. Could these have a similar effect to deep heat over the ITB insertion point?
Cheers for any feedback
Mike

2

I am no medic, but I would NEVER do an IM with painkillers. If pain is too much, just don’t do it.

3

Not an Ironman, but shortly before a marathon my ITB flared up bad. I started taking Advil and Motrin. It killed the pain, so I kept taking it as necessary (whenever it hurt), The morning of the race, I took a few and at about halfway I took a few. It worked well…

Then I woke up the next morning and had a rash over 1/2 of my body. My lips were swollen and my skin was itchy. The Dr. said I had a reaction to the one of the painkillers. When I told her how much I had taken, she called me an idiot (not really, but I got her point).

Advil and Motrin will kill pain, but I would be careful to pay attention to recommended dosages.

4

I recommend you check out “ionto-stim”, a steroid based anti-inflamatory patch. They inject the steroid into a patch that sticks to your skin, and then using an electric current, ions, and some other physics crap, the medicine goes into your body. In the old days you had to hook the patch to a machine, but now they come with their own charges so you put it on and leave it for 24 hours. you could theoretically race with this.

I’ve also had great success with this where other methods, including cortisone, failed.

You sound like you’re in the qualifying ballpark, so if it’s important to you check it out. Travel w/ 4 patches, and take one every other day, the last the night before the race. you may have to coordinate w/ a local “physio”.

as for no running, leading up to IM Japan last year I was having horrible calf/achilles problems, reducing my running to once per week at the end. I tweaked it three weeks out, didn’t run for a week and then raced EAgleman, and then didn’t run again until 4 days before the race and then again the day before. Yes, I lost and you will lose aerobic fitness, but (if resting helps your ITBS, which I’m not sure it will or will not) by resting I gained peace of mind and allowed the muscle to heal and was able to crank off a 3:25.

Recommend you pace the bike very well, don’t over do it in trying to compensate for your perceived run weaknesses. You’ll be less sharp, but you’ll be running an IRonman marathon, not an open one. You just need to be able to push all the way to the finish, not crank out 20 minute 5ks.

Pace the bike well, eat well, hydrate well. Have a plan for the pain when it comes, handle it, and then move out and keep moving forward.

regarding NSAIDs, I’m told they affect bladder function, and urine production… not something I’d want to mess with over the ironman distance. However, put some advil in your T2 and run special needs bags. Carry some on the run in a film cannister. IM NZ is not the hottest race usually, and let metabolically stressful, so maybe you can get away with it.

Good luck!

5

That treatment you speak of sounds like what the guy I ride with was talking about. He had an achilles problem and spoke of something they hooked up and ‘burnt’ into him.

Some great advice, thanks very much. I will see if I can’t look into getting hold of what you speak of. Yes my training has been geared towards getting a slot. I’ve tried to be a lot more low key this time but there’s underlying pressure because I don’t think the wife is going to let me have another crack. Hence my aim to ride sub 5:10, run around 3:20. It’s encouraging to hear you speak of your experiences.

Cheers
Mike

6

Hmm not sure I’d want to go to that extreme, but I think I will carry a few for the run nonetheless. Must be a funny story to tell now that it’s behind you!

7

I guess it all depends on your age group and who shows up. I’ve done the course at NZ.

For NZ, and because it’s your last shot potentially, I’d say start right up front and center, and invest some energy getting a good start to get in with a good pack. When you come out of the swim you want to put yourself in the 5:10 train. I found there were alot of good swimmers from Australia, etc. there who bike well the year I did it. Get in with them and race a good tactical race keeping your pacing goals in mind and stay on a wheel. Eat eat eat. Since you’re taking a break from running, you won’t feel sharp when you hit the run, but if you fight through the malaise, you’ll find you can still move forward at a pretty decent clip. For me in fact, I felt great until 20k before I started noticing the loss of fitness. I still believe that if I only concentrated harder and pushed through I could have held my pace. Run course at NZ is two loops, and people start coming back to you start of the second loop when you hit the hilly section at about 5k and 25k, so that will be good motivation to concentrate on form, technique, and picking people off one at a time.

Seems to me alot of guys try to hammer the NZ bike course and set some kind of personal best but then shuffle in to a 4 hour marathon. With your run ability these are the guys that you are going to pick off to grab that slot.

8

Yeah DNF’s the course last year. 1:00 swim, 5:08 bike (slow transitions though cause I put on everything but the kitchen sink in T’s). Was running well for first 12k but then started feeling very flat which was surprising cause I had a good run buildup, much better than 12 weeks prior at Busso where I was doing good until about 28-30k so I lost the plot mentally. Did the first loop in 1:40 but that was with the last 5k floating up and just over 5:00/km pace (8min mile) and figured, at 8hrs flat, that I wasn’t going to replicate that 1:40 on lap two and didn’t (at the time) feel the desire to do any walking in the rain just to break 10hrs (as mentioned I was too focussed on the slot). At least this year I have low expectations so pressure is off.

Should be stronger on the bike (though lost focus with this injury over last 4-6 weeks) but swimming will struggle to match, maybe 3 mins slower but I can make this up with much quicker T’s. It would be ideal though to be able to swim 55-57mins as you see many of the top a/g’s in the (legal) train 5mins up the road and you struggle to make inroads on your own.

That climb back from the airport was a bugger into the wind. Great course though, so looking forward to it.

I agree with you that being mentally strong is so important. Had to get without that first breakthrough race.

9

I have raced on NSAID’s (ibuprofen, naproxen/allieve) etc a number of times.

my thinking:
-lets say they take down pain by one “point” ie a 7 goes to a 6. So why not take them? Figure it gives you that much less distraction/pain when going hard towards the end.
-ive never had problems with GI with them, but i do have an iron stomach
-i tend to favor naproxen/allieve bc it lasts for 12 hours vs 4- makes it a “take it and forget it” dose for racing so you dont have to take it in-race
-personally i dont buy the “yourae going to hurt yourself without knowing it argument.” When ive hurt myself, it hurt a LOT. no painkiller this side of morphine will make you not notice THAT. I just figure it makes the last hour a touch more endurable.

10

I had terrible ITBS going into AZ last year. I couldn’t run at all in the weeks prior. I did it anyway and popped a couple of advil in T2. I ran about 10’ slower than usual, right around 3.5h, but my IT band didn’t flare up at all. The run wasn’t fun, because there was a lack of fitness from the ITBS to begin with, but it was do-able.

The result, however, was not running regularly again until August - it took 4 mos before I could run without pain.

Good luck!

11

“I recommend you check out “ionto-stim”, a steroid based anti-inflamatory patch. They inject the steroid into a patch that sticks to your skin, and then using an electric current, ions, and some other physics crap, the medicine goes into your body. In the old days you had to hook the patch to a machine, but now they come with their own charges so you put it on and leave it for 24 hours. you could theoretically race with this.”

…and that would be doping.

Always refreshing to hear how easy the ethics go out the window (we are all against PED abuse in Triathlon, right?) and how people are willing to sacrifice their long term health for a purely “recreational” activity.

I personally could care less what you do to your bodies, but if one of you guys take the win AG and/or get/take a Hawaii slot, I would be really pissed.
Hope not to see the OP in Taupo!

12

Good questions. I’m an IMNZ veteran with two knee surgeries and a list of injuries you quite frankly wouldn’t beileve so I’ll spare you.

At IMNZ and IM Canada both I took Aleve *during *the run and immediately before getting iinto T2 off the bike. When I mentioned this here on ST and elsewhere some people voiced concern about a range of possible serious side effects from non-steroidal anti inflammatories. Those warnings/concerns are valid and should be heeded.

That said, I had my fastest ever Ironman on Aleve in Canada at about 10:45:something. My knees felt pretty good throughout the race, only hurting toward the end when I was trying to muster some effort to break 10:45 (didn’t make it).

I did not have G.I. issues at all taking Aleve, but I practiced in training to be sure it would not upset my stomach. I used it along with my regular nutritional program for Ironman in training, on long rides and runs.

It worked for me but there is some risk as wisely pointed out by knowledgable ST’ers here. If you elect to try this, do it in training first only *after *consulting a doctor and letting them know you are doing it. Be alert to possible detrimental side affects in advance and keep an eye out for them. If you have vastly different environmental conditions on race day be advised that may change your nutritional requirements and your gastro-function. In short: proceed with cuation and supervision if at all.

Now, If you are so soon after issues with your ITB perhaps you ought consider the option of racing another year. You may finish and have a fine race- but it may generate further, more serious and lasting injuries that could take much longer to recover from. It’s short term vs. long term. How long do you want to be in this sport? If this is your last great hurrah then you can go out with a bang and take up more pedestrian pursuits with less dependancy on repetitve motion. If you want to stay in endurance sports, well, it may be wise to sit this one out…

What ever you decide best of luck to you!

13

it’s not an ANABOLIC steroid.

did you sleep well before your last race? Body secrete growth hormone overnight? Did you eat carbs for breakfast, which are known to enhance performance? Perhaps you wear glasses, contacts, or have had laser surgery? Of course, you would NEVER have a cup of coffee in the morning before a race.

I guess your a doper too.

Give the OP a break.

14

Ok so I am about to embark on the unknown of seeing how far I will get through IMNZ with an ITB ticking time bomb. I’ve had two shots of cortisone and will continue with the anti-inflams/stretching etc right up to the the night before.

Ortho advised to lay off the anti-inflams about 1 day out because they can unsettle the stomach. Though I’ve had someone I know tell me he popped a bunch right before (for achilles) and had no issues. So question time:
Anyone taken anti-inflams during the race and anyone had nasty side effects with digestion of race nutrition as a result? Typical pain killers (Advil, ibuprofren etc). Do these even have any effect for injury type of pain? The ortho seemed to imply that they are too mild to have an effect and whatever symptom they could treat you sort of should be able to run through it anyone (he was sounding like a HTFU Doc). He mentioned with ITB not to stop and let it cool down because it would be hell to get going again. He mentioned keeping it warm. As such would any type of deep heat type cream be of use to carry with me? I was previously prescribed Nitro-Dur (glyceryl Trinitrate) patches (1/4 does) for patella tendonitis. These increase blood flow to the tendon. Could these have a similar effect to deep heat over the ITB insertion point?
Cheers for any feedback
Mike

15

Oh I’ll certainly be in Taupo, and I’ll certainly be taking a slot if I am good enough to get one. Taking painkillers is not enhancing my performance, it’s bringing my injury diminished performance back a little bit closer to where it once was. It’s not elevating my performance above where I physically was not able to get it to by training my ar$e off the good old fashioned way. I’ve never looked for short cuts in my training. But if these medications people have recommended can help me mask some of the pain and race close to where I know I can, then you better believe I’ll try it.

Tell you what, considering I am such a ‘drug cheat’ I’'ll bring you some special chill pills.

16

Cheers Tom,

Sitting this one out isn’t really an option. Convincing the boss to let me do another one (well she’ll let me do one more, either Kona or one in Oz) would be a monumental achievement. She was barking at me the other night saying “don’t think you’re going back to New Zealand next year!”.

I might try the Advil path a few people above have suggested. With luck that will keep the bomb squad away from the ticking in my knee!

17

I hope you don’t take Eric 35-39 advise …“When you come out of the swim you want to put yourself in the 5:10 train. I found there were alot of good swimmers from Australia, etc. there who bike well the year I did it. Get in with them and race a good tactical race keeping your pacing goals in mind and stay on a wheel.”
I am amazed no one flamed him. Race your own race and don’t be tempted to cheat even for a slot. I have used Aleve and Tylenol Arthritis medicin (extra strength) with some success. You will feel the pain but it may help dull it to the point that you will be focused more on your form then the pain. I woud not take any prescription meds (celebrex, voltaren etc) during the race as even mild anti inflamatories have affected my stomach in training and just make me feel like crap.

18

No worries
about the chills.
You already gave me plenty of those.
And some good “shudders” too.

But that is pretty much it, since life is too short to worry about perps.

Just hope you get what you signed up for.

19

I actually didn’t read Eric’s comment the way you imply and I honestly don’t believe he wrote what you think you read (if that makes any sense).

As a slow(er) swimmer, I know what he means when you are working your way through the field on your own and get about 5-10mins from a turn around to see a legal train going the other way. YOu recognise numbers from your group and wish you were up there amongst them because the one time I have been amongst some people pacing of each other I realise how much of a mental benefit it provided me.

Point taken about the anti-inflams, it probably isn’t worth the risk.

20

I’m not sure if this was mentioned already, I only skimmed the thread but it certainly should have been. BUT, as most know the medical danger for us all competing in these events is hyponatremia. Ibuprofen interfers with kidney function and can cause or accelerate hyponatemia.

Because of this potentially fatal condition, I wouldn’t recommend anyone take Ibuprofen, aspirin or Tylenol.

Hyponatremia – what is it?
Hyponatremia means a low concentration of sodium in the blood. When it occurs in triathletes, it usually happens during long or ultra-distance races in the heat but may occur anytime. It is estimated that approximately 30% of the finishers of the Hawaii Ironman are both hyponatremic and dehydrated. The longer the race, the greater the risk of hyponatremia.

Medications and hyponatremia
Aspirin, ibuprofen, and other non-steroidal anti-inflammatory agents interfere with kidney function and may contribute to the development of hyponatremia in triathletes. The same applies to acetaminophen (Tylenol). I have seen many athletes taking these drugs during Ironman races, and I strongly recommend against this practice. They won’t make you faster and may hurt you. Under tough conditions, your kidneys need to function at 100%. Other drugs that may contribute to hyponatremia are diuretics, narcotics, and certain psychiatric medications.