Ibuprofen and Running


As a competitive runner and a coach, I am always striving to find the perfect balance between recovery and adaptation. If you’re reading this post, you too have probably come across your fair share of injuries or tough workouts that made your legs feel like jello.

Like many runners before you, when faced with a slight twinge, inflamed tendons, or delayed muscle soreness from training, you may have popped a few over the counter non-steroidal anti-inflammatory drugs (NSAIDs for short, such as ibuprofen and Advil). I’m ashamed to admit it, but I spent the majority of my freshmen year in college taking enough ibuprofen to make the local CVS wonder if the science department was conducting an experiment on the effectiveness of Ibuprofen to subdue elephants.

While I, along with many other athletes, thought we were being tough and helping our training by reducing inflammation with Ibuprofen and Advil, recent research and analysis has shown that anti-inflammatory drugs can actually limit or cancel out the very training benefits we’re so desperate to achieve.

That notion flies in the face of everything you thought about the benefits of anti-inflammatory drugs, right? It’s not easy to do a 180 on what we thought was beneficial, so let’s take a look at the role of inflammation, the science behind that statement, and how you can take steps to maximize your training and recovery.

The role of inflammation

The word inflammation gets a bad rap with athletes of all sports. Say the word inflammation and fellow runners will immediately give you a sympathetic pat on the back. However, inflammation isn’t necessarily a bad thing. Inflammation is a protective attempt by your body to remove harmful stimuli and to initiate the healing process.

Without getting too scientific, after a hard workout or during the early stages of an injury, the body activates specific cells that attack the injured area by increasing blood flow, producing swelling, and stimulating the nerves that cause pain.

In short, inflammation is actually the beginning of the healing process and is critical to healing injuries and recovering from normal training bouts. While inflammation is the culprit behind pain and swelling, without it, the recover process would be much slower.

Anti-inflammatory drugs inhibit training adaptations

Since we now know that inflammation is actually an important step in the healing process, we can begin to appreciate how taking anti-inflammatory medications after hard workouts may inhibit training adaptations.

When you run, you actually create small micro-tears in the muscles with every step you take. The faster or harder you run, the more forcefully you contract the muscles and the more damage you incur. These micro-tears stimulate an inflammatory response, signaling the body to deliver resources such as blood, oxygen, and nutrients to begin the healing process. By taking anti-inflammatory drugs, you prevent the inflammation process from initiating the healing process.

Recently, numerous studies have confirmed this new theory on the harmful effects of anti-inflammatory drugs. One study on the effects of Ibuprofen on skeletal muscle showed that taking ibuprofen during endurance training canceled running-distance-dependent adaptations in skeletal muscle. Another study confirmed in the laboratory that the use of NSAIDs after exercise slowed the healing of muscles, tissues, ligaments and bones.

The research is clear. Taking anti-inflammatory drugs such as Advil and ibuprofen after a workout will result in slower recovery times.

Anti-inflammatory drugs to prevent pain

Another common reason runners use ibuprofen or Advil is to take the edge off the pain of racing or to help prevent a previous injury from bothering them during a race. If you thought you were the only one who has made this mistake, think again. In 2008, a study of Ironman competitors showed that 50% of racers used NSAIDs immediately prior to or during the race.

Unfortunately, the idea that NSAIDs will help take the edge of the pain of racing or prevent an injury from getting worse doesn’t hold up to science. Studies conducted on runners at the Western States 100 miler found that there was no perceived or actual difference between the runners using ibuprofen during the race and those who weren’t.

Finally, the use of NSAIDs to mask pain from an injury may allow you to continue training in the short-term, but will ultimately lead to a more serious and longer lasting injury down the road. I don’t think science is needed to confirm that running while injured isn’t a great idea. Unfortunately, it’s all to easy to mask the natural pain receptors of the brain to trick ourselves into thinking we can still train.

When is it good to take anti-inflammatory drugs?

The question then becomes, when is it appropriate for a runner to take Ibuprofen and Advil?

Like most real-life situations, too much of any one thing isn’t good. During the initial stage of an acute injury (such as a muscle strain, sudden bout of tendonitis, or an ankle sprain) NSAIDs can actually facilitate healing.

The exact reason for the difference in healing properties between “normal” inflammation and excess inflammation or not clearly understood by scientist. However, research does show that during the first 2-3 days of an acute injury, NSAIDs can help heal injuries.

What does this mean? If you have a sudden, acute running injury, taking ibuprofen or Advil in the first 2-3 days is advised. After that 2-3 day window, you should let your bodies own natural healing mechanisms take over.

The next time you’re about to pop the cap on a bottle of Advil before a race or after a tough workout, or you’re thinking about taking a few Ibuprofen to help heal your nagging IT band, think again. Not only is there no benefit to NSAIDs in those situations, but it could actually be hindering your recovery and performance.

If you have questions about anti-inflammatory drugs or want to share you’re experience, pleas don’t hesitate to leave a comment.

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References

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41 Responses on “Ibuprofen and Running

  1. I think I read in Advanced Marathon Training that Ibuprofen can actually be (fatally?) dangerous on long runs because of the combined effect of dehydration and the drug on your liver.

    • Yes, NSAIDs can actually be dangerous to your health when running. In addition to liver damage, they also thin the blood, which can cause issues. The scientific evidence on this for runners is a little sparse, which is why I didn’t cover it in this article. However, I am glad you brought it up.

    • Jami,

      Drinking Tart Cherry juice is a much safer option than using NSAIDs. From new research that has been published in recent years the best option would be to let the inflammation run its course but we do not live in an ideal world. We are usually in the middle of a training cycle or close to a big race when we encounter inflammation. Rather than take time off we fight through the inflammation and try to find remedies that will help ease the pain. That’s where the NSAIDS and natural remedies come in to play. From all of the articles I have read and the studies conducted drinking Tart Cherry juice is a much safer option than NSAIDs.

  2. I was an IB popper for about six months – since I took up running. I THOUGHT I was doing myself a favor – avoiding injury / pain as much as possible. The problem is that I could NOT tell if my body was in pain or not and so I continued running. I think my injuries were partially attributed to the inability to feel pain.

    After reading this article – and articles similar to this – I stopped (Cold turkey) taking IB. That was a month ago. Result? I have had ZERO injuries in the past month AND I can
    F-E-E-L the natural pain / recovery receptors in my body.

    I know when to take it easy (up to and including skipping a day of running altogether) and I know when my body is in the mood for an all-out workout. Even my toning has improved because I can F-E-E-L when my muscles have recovered enough to push forward or when I need to back off (i.e. I keep doing this and I’ll get injured).

    Articles like this blog need to be posted in EVERY gym – written on EVERY exercise contract. I did NOT know that I might (oh Hell – WAS) slowing down my body’s recovery. In turn, I was INCREASING my injuries which – indirectly – foreced me to take more IB.

    In the past month I have taken IB two times (three pills at a time for a total of SIX pills in a month – what I used to take in one day – more even.) I took it once because I was going to be on my feet all day at a festival (bad lower back) and I took it one more time because of another all-day-on-my-feet event. They had NOTHING to do with running.

    Getting off the IB kick has been OUTSTANDING for my workout. Thanks for an informative post.

    • Thanks for sharing your story, MaiLinda. I am glad you got of the IB and started to listen to your body and got healthy as a result. I think a lot of others will benefit from hearing your experience, so thank you again for sharing. Best of luck with your training and racing this summer!

  3. I’ve been a recreational runner for a few years, participating in 5 and 10Ks and using running to keep in shape. Earlier this year, I started to have heel pain, so I took six weeks off and started back up this past weekend. I woke up Sunday morning barely able to walk, went to the doctor and sure enough – plantar fasciitis. He prescribed anti-inflammatory medication, but a prescription. I no longer have any pain, but I’ll listen to his “no running for three weeks” advice while I do my stretches and heal. Since I don’t have pain, I figured I don’t have inflammation, so I took myself off of the medication. I don’t see a reason to take it when I can walk perfectly fine without any pain whatsoever. I can’t wait to run again!

    • Thank you for sharing, Kaira. Here is what I suggest for treating plantar fascia pain:

      1. Heat your foot in warm water (up to the ankle.achilles) for 10 minutes.
      2. Stretch your calves (upper and lower). Hold each stretch for 30 seconds, repeat 2-3 times.
      3. Massage the bottom of your heel. I like using a golf ball and running my foot and arch over the golf ball. You want to deep massage on the toes, arch, and heel. You should massage for 5-10 minutes.
      4. Ice your heel and arch area for 10 minutes after each run or any time during the day.
      5. Sleep in a strassburg sock or a night splint (a little more money, but more comfortable) if you can get one. This prevents the foot from tightening at night, which means lots of pain in the morning and tearing from the fascia. It will be uncomfortable at first, but will get more normal as you wear it more.

      • I had plantar facitis. It was SO painful.
        I found the best way to deal with it is,
        1) before you get out of bed in the morning religously take your right foot in your left hand
        2) With your left hand bend your foot towards you gently
        3)With your right hand massage your right heal with your thumb. The movement shoulf be firm and move your thumb from your heal up your foot.Do it 20 times, then repeat to the left foot etc.
        4) You must do it 10 times to each foot Before you get out of bed.
        5) It sounds a lot but takes about 10 minutes.
        6) Believe me it is the most beneficial 10 minutes of your day!!!!!!!!!!

  4. I’m a pharmacist (and also a runner), so I found this article very interesting. You bring up a good point about the properties of NSAIDs which you supported very well with the research available. I would recommend to your readers who need something for soreness or minor injuries to take acetaminophen (Tylenol) instead of NSAIDs like ibuprofen, naproxen, or aspirin. Acetaminophen does not have the same anti-inflammatory characteristics as NSAIDs, but is pretty much strictly a “pain reducer”. While taking acetaminophen, make sure to limit your intake to no more than 4000mg a day, as daily amounts in excess can cause liver damage.

    • Thanks for your your comment and expert opinion, Casey. Tylenol is definitely a good choice, but I also caution runners not to mask pain too much. Sure, a temporary issue like a blister or even a sprained ankle is ok, but relying on pain killer to get through a run shouldn’t be something a runner does more than a few times.

      Thanks for the max dosage recommendation, I think that will help a lot of runners out.

  5. thanks for the info. i am currently recovering from rotator cuff tendonitis. i took 12 weeks off to let the inflammation drop off and am now starting to return to exercise. since i spent 12 weeks trying to stop the inflammation i have assumed it’s my biggest enemy and want to make sure it doesn’t come back. while i try to figure out what my shoulder can handle work out wise my plan is to come home from a work out, apply ice and take 800 mg of ibuprofen and then wait for them both to wear off and hope for no pain and no inflammation. if no pain or inflammation, i’ll plan to stop ice and ibuprofen take a day off to rest and add 10 percent to my work out the next day and repeat the single dose of ice and ibuprofen as a preventative measure and wait and see again. does this sound like a good plan while i try to get back to normal or am i overdoing it?

    • Hi Scott, I think this sounds like a good plan. It’s a nice balance between getting the inflammation our but letting the body heal on its own. Good luck with the recovery!

  6. Hi, I’m not a runner but I have had an injury due to a fall that requires an inflammatory tablet to which the doctor advised me to go on Advil. Since I have read your blog I feel I shouldn’t be taking this medication – that I should just take a couple of headache tablets 4 times a day.
    My injury was to my ankle (sprained left) and also twisted my back. I’m on other medication so I don’t know how they would interact with them. So I thank you for what you have said and I am going to let my ankle/back right them selves.

  7. In the last 6 marathons, I’ve taken Advil on the first night after the race. From a recommendation of a friend, I took it because it allowed me to sleep all through the night without waking up from the muscle soreness/pain while I try to get comfy. This is the only time I pop IB. The soreness the next few days are bearable and I don’t need the Advil. The question is, is this the same acuteness you talk above in the article, or something entirely different? Am I hampering the healing process this first night? Thanks for a very informative article.

    • Great question, Aileen. This is a specific case and it’s not too much concern, especially since it helps you sleep. You’re not inhibiting the recovery process that much by taking one dose of Ibuprofin. As long as you’re not using it everyday or masking an injury with it, you’ll be ok.

  8. I have developed headaches that set on during a run and last all day. It doesn’t matter whether I run 30 min or much more. It isn’t a dietary issue. It has been recommended to me by my doctor to take ibprofen before I run. The idea is that blood vessels are dilated inappropriately causing these awful headaches. So far it has worked and I have been able to run again. I am hoping that it is a temporary thing. I would appreciate any thoughts. I simply cannot run without it.

    • As much as it may not appear logical to you, you must increase your water intake,for sure before, during, and after your exercise. -AND- no chugging either – If your Dr. says it’s something related to vasculature dilation, then maybe try and become less hypovolemic by drinking a little more water for your exercise which in turn could benefit the extra vascular capacity that your body is creating during exertion. I would always get headaches cycling cause I never felt like I needed to drink water – they were the worst pulsating kind of headaches ever. But I drank more often, even when I felt like I didn’t need to, little sips over the course of a two hour ride – and I am very happy and headache pain free after workouts.

  9. @maria – im sure your doc suggested this but do you think this might be related to dehydration? Dependent on your body weight you should be drinking between 2-3 ltrs a day.

  10. Hi, I have achilles tendernitis and it drives me crazy of a morning, it takes about ten mins before i can walk properly and it aches at night, there is no tear there but ultrasound showed 8mm thickness difference to my other achilles, how can this be treated?

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  13. I am currently training for a marathon and my legs get so sore after 20 kms. Would Tylenol and perhaps starchy foods help me achieve 22 more kms?

  14. My doctor has prescribed an NSAID,ketoprophen, because of arthiritis (ankylosing spondylitis). This is an extended release NSAID that breaks down, not in the stomach, but further down the tract. I’m on the smallest dosage 200mg, so are there options? Marathon PR of 3:33 two years ago and the last two marathons have been at 3:40. Might this by why? 42 years old.

  15. Thank you for a great article! I’m a new runner and have definitely tried the NSAID trick a couple of times, so this is good to know!

    I’ve been experiencing some pain in my knee and it was recommended that I try a glucosamine MSM 1,400mg/day. Based on the information here that sounds like it may not be helpful, though. Have you come across anything about this supplement in your research?

  16. I may have left this a bit late but I can’t find a direct answer to my specific problem and you seem to be able to handle all angles. I have an arduous 54 hilly bike race this weekend. I have been suffering from neck and shoulder discomfort for at least a year with no apparent solution. In a practise ride last weekend I was really hurting in the last few miles. Would taking 800mg of ibruprophen or 1000mg of paracetemol before I leave be a good idea just to see me through but not affect my performance?

  17. I am not a runner but I have had some injuries in past doing squats. Recently they are coming back to haunt me. Should I take advil or not and for how long

  18. Great Article- I just had an MRI and found out I have Capsulitis in my big toe and second toe- Dr. put me on Steroids and anti-inflammatories for 6 days. I just finished the last dose and it still hurts a bit which makes me nervous to even try running again yet. Does that mean my inflammation is still there?
    My Dr. also gave me 800 milligram Ibuprofen so I’m not sure I want to keep taking those, but this is so new to me that I would like to know if any of you have this problem, or if you have any advice that would help me sooooo much.

    thanks :)

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  21. I broke my tib and fib 4 mos. ago. I’m regaining strength and flexibility and my doc recommended ibuprofen during this time. What’s your suggestion at this point? I hike, uphill mostly as downhill is still a killer, and do PT exercises and drive for a living. These three things can inflame my injury. Stainless plate, pins and screws are now present. Could the ibuprofen inhibit my full recovery?

  22. I am currently dealing with Osteitis Pubis resulting of ignoring my core weakness/instability while running and playing Australian Rules Football. I also had a small indirect inguinal hernia which was impeding my recovering and have recently had this repaired.

    My surgeon (a runner himself) advised that I take a 2 week course of IB during my rest period which I have just started to aid in the OP recovery. My plan is to complete this course without any activity and stop using the IB once I return.

    My surgeons opinion supports your post about not using IB as a pain mask but its worth noting that IB should not be completely ignored during your recovery. The key is to stop taking IB before prematurely assessing your injury and returning to activity.

    For me, good Injury management is about doing everything you possibly can to recover before getting back into it. The extra time sitting out is painful however coming back early and doing more damage is much worse.

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  24. Hello Coach, i have a friend that has massive quad pain that prevents her from running. She has tried taking time off, Icing, Ice baths, Foam rolling, soft tissue massage, better stretching, and even e-stim to try to help her with the pain. (Not all at once haha) I just wanted to know what you think she might be missing, she does not take anti-inflammatory medicine at all.

    Wanted to know what you think? She is a high school level athlete and more rest is a hard a hard Pill to swallow.

    Thanks for reading

  25. I can tell you when to take them: when an injury is very slow to heal and turns chronic. Sometimes after all modalities have failed I have cleared a months-long injury with a two day ibuprofen cycle. The NSAID disrupts the inflammation cycle and ends the pain somehow. I don’t know the science behind it, I just know that it works for me. Cycle = 600mg every 5 hours for two to three days straight, sometimes a week for more egregious injuries

  26. I’m new to running. I just started it about 4-5 weeks ago. At the beginning, I can’t run more than 200 m without running out of breath. At the last run, I was able to run about 2km before running out of breath.

    The problem is, I was diagnostic for RA when I was about 13yo, since then there were few times when it got worse and stop me from physical activity for couple of weeks to months. But soon after medication it get better and most of the times, its almost like there is nothing wrong with my joints.

    I’ve been in remission for years, but getting overweight, so I start running. Sometimes, its hard to decide, whether its the early symptom of RA, or just another common soreness. Especially in my first few days of running, there are times when I decide to take Voltaren 50mg or Deflamat (both diclofenac) or ibuprofen, depend on how bad it felt.

    I’m not sure how wise is that decision now but from my experience, taking NSAID when early RA symptom shows is something that help me to stay in remission for years.

    On second note, after I read this article (about a week), I try to avoid taking NSAID and so far no sign of RA on rampage.

  27. Thanks for the great article!!! I have an injury in my inner left knee and it hurts when running (not walking), or if I turn my body to the right and forget to lift my left leg (I realize not ideal mechanics, but something I can’t change overnight). I think this would be be considered more of a chronic injury since I don’t recall one specific incident when I injured it. I’m try to figure out if it is inflamed or not since there’s no noticeable signs. Since I don’t see anything I’m assuming there is none or it is only minor. My question is to find my best course of action regarding the use of Ibuprofen. The pain has bee there on and off few a few weeks, but I think I aggravated it in the last week or two with some rigorous runs of 8 – 13 miles. Do you think I should take ibu? I’m also wondering about the heat v. ice. It seems like heat is the way to go, but I think it causes a little throbbing and also increased sensitivity right afterwards. Is this normal? I know I’m asking a lot, but I’ve got a marathon in 2 weeks and want to get the most bang for my buck in a short period of time.

    Thanks,

    Scott

  28. Thanks for the article. I’ve been taking 3-4 ibuprofen before running for the last year since I started running. I don’t normally read much about running, but I was pushing myself by trying to do 50 miles in a week and have a some knee pain so I decided to do some research.

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