Sorry it has been a little while since my last article. I was keeping busy providing medical coverage for the Captech Classic and the Xterra. It was good to see a lot of you out there. It really makes my job fun to have so many active patients.
I will be the first to admit, this article is a little bit of a soapbox issue for me. It relates to the overuse of anti-inflammatories (Advil, Aleve, ibuprofen, Naprosyn…) When I was in medical school, I wondered why so many athletes use anti-inflammatories. I found out in medicine there are two types of treatments, ones that have been tested through science and ones that we do because we have always done it that way. It turns out the use of anti-inflammatories is more of the latter. The makers of anti-inflammatories were brilliant with naming the class of medication as they did. These medications have been out for decades, and the reason they got their name is that in the body there is an inflammatory cascade that occurs in the body with an injury. Anti-inflammatories blocked part of this cascade in the laboratory and thus the name was born. It has become a staple of many athletes’ existence, and I'm here to tell you that you may be doing more harm than good. If you look back at the history of these medications they were originally studied as pain relievers, not as injury healers. They do an excellent job of relieving moderate pain, but this is where their use ends. Somewhere along the line people got the idea that it would actually helped injuries heal, or even worse prevent injuries. This is misguided and potentially even dangerous.
There is a relatively new movement in medicine called evidence-based medicine. This is where a group of physicians have gotten together and in a standardized fashion have looked at things we do in medicine to see if they're valid treatments. When they have looked at the use of anti-inflammatories they have made some surprising discoveries.
-- there is no evidence that use of anti-inflammatories decreases inflammatory chemicals in the bloodstream, meaning they are not actually reducing inflammation. This has been backed up in numerous studies.
-- in a rat study, rats had in their legs broken (couldn't find any human volunteers) and half of the group was given ibuprofen and the other half was given nothing. It took the ibuprofen group over twice as long to heal. Other studies have shown reduced healing rate with regular use of anti-inflammatories
-- intestinal bleeding related anti-inflammatory use kills more people each year in America than AIDS (over 16,000)
-- I have personally seen a marathon runner go in the kidney failure because of anti-inflammatory use.
-- a recent study shows that anti-inflammatory use before a marathon significantly increases the risk of hyponatremia. Hyponatremia is the big buzz in marathon running. This is when salt levels drop to potentially deadly levels in the bloodstream because of over dilution with water.

I often see athletes using these medications like candy without even thinking of the potential dangers. Another issue of concern is that the use of this medication before activity may also worsen the injury. Pain is a stimulus to tell you that something is wrong; this is why you take your hand off of a hot stove. If you blunt your body's ability to appreciate pain on a regular basis, you may lead to more damage in the long run.

So what good are these medications? That is a good question. If you look at the evidence, about the only thing this is useful for is pre treatment before physical therapy. There are several studies that have shown that people who used an anti-inflammatory before physical therapy progressed faster than those who didn't. This is because with the help of a trained professional, you are able to make further gains with each session. Other than that and relief of an occasional ache or pain, these medications certainly pose more risks than benefit. At an American College of Sports Medicine meeting last winter we had a lively debate on this topic. At the end of our debate the consensus was that for acute injuries, ice is the best things to use in the first 72 hours after an injury, and a pain medication as needed Tylenol (acetaminophen) was recommended. Following that, judicious use of anti-inflammatories is acceptable. Use of anti-inflammatories before an event was generally discouraged, and further studies are being done to see how much these medications slow healing. I know this goes against what a lot of you probably think, but remember people used to think the world was flat as well. Until next time, keep riding.

Matt Marchal MD