Tuesday, August 9, 2011

"Vitamin I"

IBI am a recovered Ibuprofen-aholic.

By and large, drugs have always seemed to affect me less than other people. To give you a sense of the scale we're talking about here, a couple of years ago, an outpatient procedure I was supposed to have couldn't be performed because eight times the normal amount of anesthesia failed to knock me out. Sleeping pills have never worked on me. Caffeine doesn't appear to have much effect either. Tripling the dosage of any cold or allergy medication is standard operating procedure, if things are bad enough that I even bother taking it.

When I was younger and suffering from debilitating menstrual cramps (not to mention routine soreness or the odd injury from running or gymnastics), I learned very quickly that taking things like Advil, Aleve, or Tylenol at the recommended doses was pretty much equivalent to eating candy for all the good it did. Even at higher doses, it was kind of six to one / half a dozen to the other whether any break in the pain that happened to occur was due to the drugs or would've happened on its own anyway. My doctor didn't want to prescribe anything stronger to a kid, so my mom would sometimes give me hydrocodone prescribed for her if it got really bad, just so that I could sleep / function / etc.

Though it didn't help with pain, I did still occasionally take Ibuprofen for its anti-inflammatory properties when I felt particularly sore or had a legitimate injury. When I was having a lot of knee pain several years back, my doctor prescribed 800 mg tablets of Ibuprofen. (Sidenote: This has never made any sense to me. OTC Advil tablets contain 200 mg of Ibuprofen and there is certainly no one stopping people from taking four of them at once. Plus, generic OTC Ibuprofen is usually cheaper per mg than the prescription stuff anyway.) When it didn't do much for the pain I started doubling it, which seemed to have at least some noticeable effect. (Not that I'm advocating this...Definitely DO NOT try this at home, kids.)

This kind of started a bad habit. If I was feeling sore from a run, I'd take 1600 mg of IB. Same thing if I was having weird pain I didn't understand. Sometimes I'd even take it before a run, under the impression that doing so would prevent inflammation and soreness afterward. My doctor happily refilled the prescription any time I asked. (Sure, I could've just taken the OTC stuff, but there was something a little unsettling about the idea of swallowing eight of the little red pills compared to just downing two of the big, white horse tablets. Upon reflection, I probably should have paid more attention to that unsettling thought.)

Then I started reading more about inflammation, pain, Ibuprofen, and how it works. Particularly, how it works in athletes, and how it works with regard to pain and inflammation that are not due to an acute injury.

First, the obvious:

1) Pain is how your body communicates with your brain. It informs us as to how our activities are affecting our bones, muscles, connective tissues, etc. Sometimes the message is, "Whew, that was a little tougher than we were used to! Maybe an easy day tomorrow." Sometimes it's, "Hey, we tweaked muscle/tendon/etc. xxx a little & need to rest it." Sometimes it's, "Seriously, bone/muscle/etc xxx isn't really strong enough for that right now. Back off." Shutting these messages off can be dangerous because it sometimes means we think we're stronger, healthier, or in better shape than we are, do too much, and wind up dealing with a more serious injury.

This is something I learned a lot about the first time I was in physical therapy. The way that PT put it: If the pain is not so bad you can't function, let yourself feel it, because what the pain does will be the best guide as to whether or not you should run, how much, how hard, etc. If it hurts so bad that you can't function without a pain killer, you shouldn't be running anyway. The time to turn that message off is when you already know you can't run due to an acute injury, and blunting the pain isn't going to tempt you to try.

Next, a few things that seem to be less well-known among runners (they were certainly unknown to me, up until a couple of years ago). This article does a pretty good job of explaining it all in more detail, but here are the 10-second summaries:

2) Taking painkillers before a workout doesn't prevent pain during or soreness after. When researchers poll endurance athletes at water stops during a race about how much pain they are experiencing and then over the next several hours and days about how much residual soreness they have, there is no difference between the responses of athletes who took painkillers and those who didn't.

3) Anti-inflammatories (like IB) can blunt the training effect. Training makes us stronger is because training is tissue damage, and our body responds to tissue damage with an inflammatory effect that helps muscles, bones, and connective tissues toughen up and become stronger. Anti-inflammatory drugs can inhibit that natural inflammatory response, essentially rendering your workout a waste of time. Kelly Starrett (DPT and awesome SF Crossfit coach) goes into more detail about this particular issue. (Love him, BTW.)

4) Anti-inflammatories (like IB) can actually INCREASE tissue inflammation when taken before or during a workout. Unlike the natural, beneficial inflammation that occurs after a workout that makes you stronger, chemically-induced inflammation can impair performance during a workout by adding to the stress that the body is already under.

5) Painkillers can impair kidney function when taken before a workout. Because kidneys are responsible for filtering waste out of the blood and regulating electrolyte balance, this can be a big deal during a hard workout or race (and the longer the event, the bigger the risk). If kidney function becomes poor enough, it can lead to hyponatremia, a situation where sodium levels in the blood drop below what is safe.

ice bathSo, you can maybe see why, at a certain point, I'd ask myself how badly I really need to be taking painkillers at all (barring, obviously, suffering some kind of heinous injury like breaking a leg or something). These days, I'm completely off of them -- I don't even take them for headaches. Instead, I've really taken K-Starr's advice to heart -- the best (and most side-effect free) strategies for managing routine soreness and mild tweaks are proper nutrition & hydration, ice (I mean really -- who DOESN'T love a good ice bath!?), stretching, massage, etc. I think it's a little easier for me because it takes so much of anything to have an effect anyway, but I also think that it's wise to treat drugs as the last line of defense whenever we can, rather than the first.

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