NSAID's or Nonsteroidal Anti-Inflammatory Drugs are a common over the counter medication used to treat a variety of ailments. In layman's terms, NSAIDs work to inhibit an enzyme that mediates a pro-inflammatory response in the body. So, a stimuli or change that would typically lead to an inflammatory response is now somewhat buffered by the administration of this drug. This results in an acute reduction in inflammation offering pain relief in many cases.
NSAIDs such as Motrin or Tylenol are commonly used to treat headaches, muscle aches, arthritis and other inflammatory pathologies.
In the realm of training and sport, it is not uncommon for there to be sore muscles or nagging injuries. In many cases, our clients and athletes may resort to NSAIDs to alleviate some of the pain and it is important we know this.
Research from Davis et al (2015) found that 48% of male collegiate athletes and 52% of female collegiate athletes were taking NSAIDs during their season to deal with pain. This is nearly half the athlete population.
Furthermore, research by Wolf et al (2011) revealed that of football athletes taking NSAIDs, 37% were taking over the recommended dose on a regular basis.
Although the research confirms that higher dosages of NSAIDs are toxic and can lead to a variety of health concerns from GI Tract issues to impaired renal function, their effects on muscle tissue, strength and hypertrophy gains are much less understood.
NSAIDs and Muscle:
Inflammation is a natural process that occurs in the body in response to trauma in many cases. When talking about muscle specifically, a classic example of inducing inflammation would be to train a muscle. Training a muscle causes inflammation, which leads to adaptation and muscle growth on some level.
1. Muscle Protein Synthesis (MPS)
MPS is a very good indicator of muscle adaptation. So, if there is a link between NSAIDs and the muscle protein synthesis response from training, this could provide good information for professionals trying to optimize size and strength gains in athletes and clients.
To date, there are only four studies that give us a decent indication of NSAIDs effect on MPS.
NSAIDs in high enough doses (1200mg) seem to blunt the muscle protein synthesis (MPS) response post exercise as found by Trappe et al (2002). However, this research did not identify the mps response of contractile muscle protein, which is important if we are looking at NSAIDs' effect on strength and hypertrophy. Other research like that by Burd et al (2010), Peterson et al (2011) and Mikkelsen (2011) actually found no difference in protein synthetic rates.
Its looking like NSAIDs are safe from a muscle standpoint.
This is a graph from Petersen et at (2011) visually depicting the lack of correlation between NSAID's ingestion and FSR (Fractional Synthetic Rate = measures balance between protein synthesis and breakdown).
So the jury is out, NSAID's's don't seem to have an effect on MPS. Well ... Not so fast!
There are some issues with the current research as it applies to athletes.
- Research was conducted in general population or somewhat "active" individuals, not athletes.
- Research only tells us the acute effects of NSAIDs on MPS. What about chronic use?
- Research does not show us what an "over the recommended" dose response would be considering nearly 40% of athletes are not following instructions on NSAIDs labels.
Though the research seems fairly conclusive on NSAIDs' effects on MPS, further research should sample athletes over a season at potentially higher doses as it would be a better representation of the athletic population.
2. Muscle Hypertrophy
Though many studies on rats have shown massive decreases in muscle hypertrophy from NSAIDs such as Soltow et al (2006) demonstrating a 50% decrease in muscle size, human studies do not portray the same extent of findings.
In Schoenfeld's (2012) review of NSAIDs on Exercise Induced Muscle Damage, he references three human studies, one of which is extremely peculiar.
Findings by Krentz et al (2008) and Petersen et al (2011) showed no substantial decreases in muscle hypertrophy over a 6- and 12-week period but this was quite the opposite of what Trappe et al (2011) discovered.
Trappe et al (2011) showed a massive increase in quadriceps muscle volume following a 12-week resistance training program supplemented with NSAIDs. Nearly a 50% increase in muscle hypertrophy was shown!
What do we make of this?
If it isn't apparent already, it would seem that the findings of studies across the board are extremely conflicting. This makes drawing a conclusion near impossible with the research we have to date.
So, are NSAIDs detrimental for muscle and strength gains?
The research in humans would argue no. However, consider the following:
- Chronic use of NSAIDs was not studied.
- Athletes were not studied.
- Higher doses of NSAIDs were not studied.
- Trained individuals have less potentiation for growth, and blunting their inflammatory response could be suboptimal for hypertrophy and strength as they might require it for adaptation.
Further research is definitely needed in this field as there are large discrepancies between what has been found in humans and animal models.
Take Home Points
1. NSAIDs use in moderation on an acute level will not likely have any detrimental effects on muscle hypertrophy and strength, but chronic ingestion is much less clear.
2. Ingestion of NSAIDs over time may not pose complications for muscle development, but other health concerns should be noted (GI complications, Renal Function).
3. You cannot control NSAID's ingestion in your athletes or clients, but make recommendations to stay within the safe dosage and not to rely on them.
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Burd NA, Dickinson JM, Lemoine JK, et al. "Effect of a cyclooxygenase-2 inhibitor on post-exercise muscle protein synthesis in humans." Am J Physiol Endocrinol Metab 2010 Feb; 298 (2): E354-61
Peterson JM, Trappe TA, Mylona E, et al. "Ibuprofen and acetaminophen: effect on muscle inflammation after eccentric exercise." Med Sci Sports Exerc 2003 Jun; 35 (6): 892-6
Petersen SG, Miller BF, Hansen M, et al. "Exercise and NSAIDs: effect on muscle protein synthesis in patients with knee osteoarthritis." Med Sci Sports Exerc 2011 Mar; 43 (3): 425-31
Mikkelsen UR, Schjerling P, Helmark IC, et al. "Local NSAID's infusion does not affect protein synthesis and gene expression in human muscle after eccentric exercise." Scand J Med Sci Sports 2011 Oct; 21 (5): 630-44
Soltow QA, Betters JL, Sellman JE, et al. "Ibuprofen inhibits skeletal muscle hypertrophy in rats." Med Sci Sports Exerc 2006 May; 38 (5): 840-6
Schoenfeld, B. J. (2012). "The use of nonsteroidal anti-inflammatory drugs for exercise-induced muscle damage." Sports Medicine, 42(12), 1017-28. doi:http://dx.doi.org.proxy.library.brocku.ca/10.2165/11635190-000000000-00000
Krentz, J. R., Quest, B., Farthing, J. P., Quest, D. W., & Chilibeck, P. D. (2008). "The effects of ibuprofen on muscle hypertrophy, strength, and soreness during resistance training." Applied Physiology, Nutrition & Metabolism, 33(3), 470-475.
Wolf, D. A., Miller, T. W., Pescatello, L. S., & Barnes, C. (2010). "National Collegiate Athletic Association Division I Athletes' Use of Nonprescription Medication." Sports Health: A Multidisciplinary Approach, 3(1), 25-28. doi:10.1177/1941738110387515
Davis, B. (2015). "Non-Steroidal Anti-Inflammatory Drug Use in Collegiate" ... Retrieved August 22, 2017, from http://www.bing.com/cr?IG=5A87C1A4674F4728B54F55B4CC05482D&CID=1E3A1D5F057B600A1E9917B9047D6153&rd=1&h=R6uKHNAS2GV87IQwBFcJiN99NhMteRjOY7WIj7ErXrQ&v=1&r=http%3a%2f%2fpdxscholar.library.pdx.edu%2fcgi%2fviewcontent.cgi%3farticle%3d3482%26context%3dopen_access_etds&p=DevEx,5063.1