Has anybody tried taking some over the counter NSAID like Advil before your race or long workout? Does it have any poor effect on your performance or can it cause any health issues? Is this not wise to do? I have never tried this, but was thinking about doing this for my upcoming race to manage some knee pain issue. Thanks very much
ive done it and performance was normal.
took two advils about 3 hours before race start.
Based on some articles/research out there I’ve seen NSAIDS = bad for endurance athletes.
And it is not “managing” knee pain issues, it is simply masking it. It doesn’t make it any better and since you have less awareness of the pain you may even damage yourself more.
“Fix the problem, don’t cover it up.”
yes, and I’ve had better luck with Naproxen than Ibuprofen during ‘racing’ situations.
Some problems you just can’t fix, or can’t fix NOW. These are great temporary solutions for that.
Anecdotally, arguably a majority of pro hockey/football players take anti-inflammatory pills before their competitions.
I take a minimum of two advil before every run–including races. Longer runs, I will take 3 or 4 total. I have done it for years, and am still alive.
And yes, I am “managing” knee issues. There is no fixing.
I take Advil before every workout or race. I know it’s probably cheating and might catch up with me in the next 35-40 years but by then all I’ll have to do is walk to win my age group anyway.
I take Naproxsin on the morning of training/race days that are going to be hard or long days. I have lots of broken bones in my back and bad hips from getting hit by a car. It allows me to workout without the back pain and hip pain. It definiately helps my aero position, it allows me to be lower longer. I currently ride with just over 20cm of drop, it helps alot.
The concern with taking Advil before a race, especially long-course, is the increased incidence of hyponatremia. All NSAIDs (non-steroidal anti-inflammatory drug)affect kidney function, thereby predisposing to this dangerous and sometimes fatal condition. If you are taking Advil, Ibuprofen, or another NSAID (including aspirin) to mask pain during an event, Tylenol (acetaminophen) is a safer option.
Sharon
I don’t for training, since I want to know if something’s flaring up before I overdo it. Also don’t bother for shorter races. But for longer events (either races or some other type of ride/climb where I have extra time/$$ invested) I’ll usually take at least a couple Ibu at the start, then a couple more around lunch if it’s an all-day gig. Curious about whether the naproxen is any better, but then the Ibu seems to work OK so I haven’t bothered to change it up.
Naproxen sodium is also an NSAID – see warning above regarding hyponatremia.
Sharon
I had been thinking NSAIDs decrease renal function, leading to hypernatremia if anything?
From the Merck Manual:
“Certain drugs (eg, cyclophosphamide, NSAIDs, chlorpropamide) potentiate the renal effect of endogenous ADH, whereas others (eg, oxytocin) have a direct ADH-like effect on the kidney. A deficiency in water excretion is common in all these conditions.”
So, NSAIDs increase the effect of ADH – anti-diuretic hormone, which causes the kidneys to retain more water, thereby diluting the body’s sodium, and leading to HYPOnatremia.
Sharon
I took ibuprofen for the first time before a race a couple weeks ago. Never took it even in training before.
Right after the race and for the next 12 hours I just about pooped myself inside out. I’m not doing that again.
2 follow-up question, then… 1) If i’m understanding your explanation correctly, couldn’t the potential hyponatremia be minimized at least somewhat by ingesting additional salt/electrolytes to counter the dilution? And 2) I’ve always been under the impression that acetaminophen was fine for masking pain, but did not have the same anti-inflammatory properties.
- I do not know if that would help – it is not my field of expertise. I do know that most medical personnel cringe at the massive ingestion of ibuprofen at IMs. My friend who has a PhD in Chemistry and does Ironmans herself feels these folks are biochemical disasters waiting to happen… Here is an article on this subject:
Wharam PC, Speedy DB, Noakes TD, Thompson JM, Reid SA, Holtzhausen LM: NSAID use increases the risk of developing hyponatremia during an Ironman triathlon. Med Sci Sports Exerc38 :618 –622,2006 - It is true that acetaminophen is only a pain reliever, and has no anti-inflammatory properties. However, since the anti-inflammatory drugs (NSAIDs) are the cause of concern here, taking acetaminophen will at least help with the pain, even if it won’t have an anti-inflammatory effect, and won’t subject you to possible illl effects, such as death.
Dr, Noakes was on the forum a while back – he would be MUCH more qualified to speak to this issue.
Sharon
From the Merck Manual:
“Certain drugs (eg, cyclophosphamide, NSAIDs, chlorpropamide) potentiate the renal effect of endogenous ADH, whereas others (eg, oxytocin) have a direct ADH-like effect on the kidney. A deficiency in water excretion is common in all these conditions.”
So, NSAIDs increase the effect of ADH – anti-diuretic hormone, which causes the kidneys to retain more water, thereby diluting the body’s sodium, and leading to HYPOnatremia.
Sharon
Ah, gotcha. The human body is so cool.
I’m hearing there are drugs other than NSAIDs that you could use to control the pain. These other drugs are said to be safer.
My understanding is that NSAIDs can cause further damage to the kidneys if used when the body is already under alot of stress(eg ironman race). The body can heal itself in most cases afterwards but i personally wouldn’t risk it.
If I had severe knee pain when racing and if triathlon meant so much then doing 70.3 slowly would be more my game.
Damaged knees is one of the worst sort of injuries and I am thinking running would be pretty hard on them. Look after your knees.
Ibuprofen does not have any measurable anti-inflammitory affects until it has been taken at an anti-inflammation dose for 7 days. An anti-inflammitory dose is 1800 to 2400 mg per day. One of my training mates is a chronic pain doc and the mis-use of ibu to reduce inflamation when it doesn’t actually do this (unless taken for a week) is her pet peeve. When you take a couple of pills before a workout or race you are just getting the analgesic (pain masking) effect. For analgesia Tylenol is a much safer drug because it is much less toxic on the kidney.
The mechanism of kidney toxicity for NSAIDs (ibu is an nsaid) is this (in a very simplified way). When your blood volume deceases (such as when you’re losing volume from sweat during many hours of physical effort) your kidney constricts certain blood vessels to maintain the internal pressure it needs to filter the blood. It does this by releasing a chemical called angiotensin into the blood. Angiotensin acts to constrict all the blood vessels in your body to maintain systemic blood pressure but it expecially acts on some very specific blood vessels in the kidney. The catch is that angiotensin can have such a strong constricting effect on these kidney blood vessels that it will actually shut down blood flow to parts of the kidney. This is VERY BAD! Without a constant supply of blood (and the oxygen it carries) kidney cells start to die. So your kidneys need a way to protect a safe minimal blood supply in the setting of high systemic vasoconstriction (the vasocontriction you created by being volume depleated after sweating for 8 hours). The kidney does this by releasing prostaglandins which oppose the action of angiotensin and work to dilate the kidney blood vessels. This is typical of how our body works - opposing systems under complex feedback working to maintain a delicate balance. So, where do NSAIDs enter the picture? NSAIDs work by shutting down the enzyme that allows prostaglandin synthesis. This enzyme is involved in the generation of many chemical mediators that participate in the pain sensation process. So shutting down the enzyme makes us less sensitive to pain (the analgesic effect). But, without the prostaglandin to protect kidney blood flow, if you are highly volume depleted, you are at risk of cutting off the suply of oxygen to the kidney and causing acute kidney injury when kidney cells die from hypoxia. Most of us won’t get volume depleted enough to have this happen because we are careful to take in lots of water and salt during our efforts - but, the risk is there and is very real and very serious. Also, if you have any underlying kidney disease that you don’t know of (a common enough situation as we can loose about 80% of kidney function before we start to feel really sick), you may be more susceptible to this injury.
This explaination leaves out a lot of detial but hits the most important parts of it.
I have an exam on Kidney disease on Friday morning - who knew slowtwitch could help me study…
Shane
Ibuprofen does not have any measurable anti-inflammitory affects until it has been taken at an anti-inflammation dose for 7 days.
On the packet of the OTC Ibroprofen tablets it just recommends a 3 day dosage/course. When I use the full dose for 3days I get the gastro-intestinal side effects. When ever I have used or prescribed it the anti-inflammatory effects seem/appear to kick in within 3 days, so 7 days seems a bit long? Not saying you are wrong but a 7 day course of such a strong drug seems like alot ; that is unless the injury was in an area that couldn’t be treated by the RICE method as well.
G.
The week time line for ibuprofen to show anti-inflammation action seemed long to me as well. I took her word for it as it is her area of practise but now that you comment on it I’d like to have a look at the research for myself. I’ll see her next week and I will ask for a reference then. I’ll make a note to post here next week with what I find out.
Cheers,
Shane