One frequent request I receive while providing medical assistance at events is for aspirin.  With the array of supplies under the Archer PT tent which are at the ready, most athletes who ask are rather taken back when I reply that I don’t have any.  There are two reasons for this.

First, as a licensed Physical Therapist it is actually against my practice act to issue medications – EVEN over the counter medications.  And second, taking aspirin is not recommended, and studies show that it is not actually effective, in relieving pain for endurance athletes.

Why NSAID’s Are Not A Good Choice

At one event two years ago I witnessed one of the ways in which taking aspirin, which comes under the category of NSAID’s – Non-steroidal-anti-inflammatories – can backfire.  It was a charity cycling event where a group of massage therapists were working to relieve muscle spasms for the riders after their long day on their bikes.  I was called over by one of the massage therapists who seemed rather alarmed.  When I got to the table, I saw that the woman she had been working on had a large wound on the side of her leg where her skin had just peeled back like a water-logged nectarine.  And it would not stop bleeding.

The wound occurred during the massage itself, but it was obviously not due to the massage therapists’ technique.  I quizzed the cyclist on the table regarding any prior incidents, medical conditions, etc., with nothing she mentioned giving a clue as to why that happened.  Until I asked what medications she might be on – and she mentioned that she had taken quite a bit of aspirin that day in order to relieve knee pain so she could complete the ride.

Now I won’t spell out how many she had taken, because I would like to dissuade the clever among you who are reading this from subtracting from that amount and figuring that for YOU it would be OK to just take so many less...  No dice.

What had happened to this particular cyclist was that she had taken enough aspirin while participating in an endurance event that it made her blood super-thin, and even left her skin vulnerable to what would normally be a fine amount of friction during her massage.  So if she had been so unfortunate to have been in a crash during the event, she could have been in big trouble from what would normally have been an insignificant wound.  I don’t want to think of what would have happened if she had cut a blood vessel or had a head injury.

Other medications under the NSAID category are ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT).  The following was excerpted from an article on About.com and gives other reasons why taking these drugs is not a good investment:

NSAIDs and Athletic Performance

So, does taking an NSAID really improve athletic performance? Does it prevent or reduce muscle soreness? So far, the research doesn’t support the use of NSAIDs for athletes. Here’s what they have found so far:

1. Several studies have found little actual performance benefit of taking ibuprofen and warn that it may mask pain, which can lead to increased risk of injury.
2. One study concluded that taking 400 mg ibuprofen four hours before exercise reduced the perception of muscle soreness but didn’t actually prevent muscle cell injury as which indicated by creatine kinase, a protein found inside muscle cells that is released when they are injured.
3. Further studies have cautioned that the use of NSAIDs during ultra distance exercise, such as an Ironman Triathlon, is associated with an increased risk of exertional hyponatremia . [Low sodium concentration in the blood.]  Researchers believe that this effect is likely due to altered renal (kidney) function. The issues related to altered kidney function in athletes are not hard to imagine. Poor fluid transport and restriction can lead to dehydration, hyponatremia and at the extreme, kidney failure.
4. The most convincing real-life study may have been the one conducted during the running of the 100-mile Western States trail running race. Researcher David Neiman measured the influence of ibuprofen use during the grueling race by studying runners in three groups: a control group, a group taking 600 mg of ibuprofen one day before and on race day and a group taking 1200 mg of ibuprofen one day before and on race day.

The Study Findings

·      Both groups taking ibuprofen had higher plasma levels of markers (serum C-reactive protein, plasma cytokine and macrophage inflammatory protein) for muscle damage.

·      Reported delayed onset-muscle soreness was the same across all groups.

·      Serum creatine kinase levels was the same across all groups.

·      Race times did not differ among the groups.

·      Ratings of perceived exertion did not differ among the groups.

 “The bottom line was ibuprofen use by endurance athletes did not affect performance, muscle damage or perceived soreness but it was associated with elevated indicators of inflammation and cell damage.  …using NSAIDs…may, in fact, cause a serious health risk in some endurance athletes..”

by Elizabeth Quinn

http://sportsmedicine.about.com/od/medicationanddrugs/a/NSAID_endurance

One Exception

If you have been advised by your doctor to take a baby aspirin, or any other medication(s) prior to or during your endurance event, please do so.  There are some cases where this can help reduce the risk of a stroke or heart attack in those who are at higher risk for cardiovascular disease.  Please check w/ your doctor if you have any questions regarding this!

Rather Than Using Aspirin…

Instead of using aspirin as a means to avoid soreness, consider the following:

1. Train

Prepare before your event.  If the course will be hilly, train on hills.  Make an effort to strengthen your muscles before you ask them to work for hours on end.

1. Be realistic about the consequences of participating in an endurance event. 

If you are running a marathon or an ultra marathon, biking 100 miles, etc. you are going to feel it.  A certain amount of soreness is part of the endurance experience.

1. Be realistic about your body.

An actual conversation at a recent endurance event:

“Hey – I had broken my toe last week, and I was wondering if you could check it.”

The orthopedic surgeon who was present and I looked at one another…

“I’m pretty sure it’s still broken after you just ran 26 miles on it.”

Seriously people – you are going to hurt anyway during an endurance event.  But please do not go into it knowing that you already have an injury and will only further injure yourself by participating in the event.  Fractures and torn tendons will not miraculously heal after you’ve pounded on them for hours.  It is terrible to have put so much time and effort into your training only to be set back by an injury.  But you can use the time and effort in your recovery to learn how to be a better athlete than you were before the injury occurred.  Learn to race better again another day, and for many years to come.

1. Learn your nutritional and hydration needs

Practice and keep notes on what does and does not work for you in various temperatures and conditions.  Track what clothing, food, and fluids are the best and which are the worst for your body on a given training day.  Your body does not like to operate while dehydrated!  Proper food and fluid intake will go a long way in decreasing soreness.

1. RICE

I’ve said it thousands of times, “Ice is your friend.”  And so is rest, compression and elevation.  Simple, organic, effective.

1. A good support crew

Having good friends and family members around at the finish line or to pace alongside you at an event is a wonderful bonus to the entire experience.  Remember to be the support that other athletes will need too – volunteer!

1. Massage

A good therapeutic massage allows you to feel looser and encourages you to move

around more quickly after your event, speeding your recovery.

1. Walk / Stretch / Yoga / Sleep

            I don’t advise that you try these all at once, but these things do help.