Don't believe what I'm writing? Consider the following patients I treated recently. I had a runner who runs ultras and another newbie runner who just started running during the circuit breaker/ lockdown because he couldn't go to the gym. Both had a combination of mild injuries and muscle soreness and instead of taking a break they both gulped down a couple of Ibuprofen tablets and occasionally stronger non steroidal anti-inflammatory drugs (NSAIDs) so they can keep running and training.
Here's what I read. 46% of runners recruited (total 109 runners) recruited during the 2016 London Marathon registration planned to take an NSAID during the race. Of those 109 runners returning for data collection, 34% had already taken an NSAID on the morning of the race while more than half the runners completing the study (16 out of 28 runners) had taken an NSAID.
Only 13 of the 28 runners (13) correctly stated the risks of taking NSAIDs while only 10 runners (35%) knew the correct safe dose.
NSAIDs while helpful with masking your pain while exercising can cause stomach ulcers, acute kidney injuries and also a risk of strokes and heart attacks (depending on dosage and how long they are taken).
Under duress of a long distance endurance event, risks may increase. Reduce blood flow and motility in the stomach make tummy problems common even without NSAID use. Muscle damage from racing may increase protein in the blood which can lead to acute kidney damage. This may be worsened by NSAID use. Hyponatremia can also be heightened by use of NSAIDs.
Researchers in UK, surveyed 806 runners in the Parkrun there to find out about usage in a diverse group of runners. A third of these runners raced marathon distances or higher. Almost 90% of the runners surveyed used NSAIDs (most used Ibuprofen, which does not require prescription by a doctor).
More than half the Parkrun runners took NSAIDs before a run or a race.The longer the run, the more likely they were to take NSAIDs before or during the run. One in ten runners took them during a run and more than 65% took them after a run.
33% of the ultra runners compared to 17.5% of marathon runners took NSAIDs during the event. This is of concern a the longer events already put extra stress on their stomach and kidneys as it is.
Those who do not log longer distances used NSAIDS so that they can keep exercising with pre-existing pain, ongoing medical issues or current injuries. Those who ran further (>40km a week) were more interested in reducing inflammation, soreness, pain and performance enhancement/ improvement.
Almost half the surveyed runners used NSAIDs without any advice from a healthcare professional thought almost all said they would read the advice if it was provided to them.
I, too have taken NSAIDs on the night before and the day of a race. Tried it twice, although I thought they didn't make much of a difference to my performance. Hence, I didn't take them after.
If you're using NSAIDs to run through pain and injury to meet your training/ racing targets, it is counterproductive to the long term health benefits of running especially since NSAIDS can affect healing and recovery. Using NSAIDS occasionally before or after your weekly run is definitely less risky compared to frequent, regular usage during demanding training. Needless to say, they should be avoided while your body is under sustained physiological stress during races.
References
Rosenbloom CJ, Morley FL et al (2020). Oral Non-steroidal Anti-inflammatory Drug Use In Recreational Runners Participating In Parkrun UK: Prevalence Of Use And Awareness Of Risk. Int J Pharm Pract. DOI: 10.1111/ijpp.12646
Whatmough S, Mears S et al (2017). The Use Of Non-steroidal Anti-inflammatories (NSAIDs) At The 2016 London Marathon. BJSM. 51:409. DOI: 10.1136/bjsports-2016-097372.317
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