Are painkillers hurting your performance?

For many athletes from beginners to professionals, taking painkillers has become a pre- or post-event ritual. One study found that almost 60 percent of racers at the 2008 Ironman Triathlon in Brazil reported using non-steroidal anti-inflammatory painkillers (often referred to as NSAIDs) at some point in the three months leading up to the event, with about half of them taking a pill during the race. Many athletes take these medications as a way of relieving discomfort during and after a workout or athletic event, and also before exercising to prevent pain. But can overusing painkillers compromise your health and performance?

What happens to your body during exercise?

When you exercise, the muscle fibers in your body start to break down. You feel muscle soreness, inflammation, and pain. In assessing exercise-related pain, there are four important biomarkers to consider: creatine kinase, testosterone, C-reactive protein (CRP), and white blood cell count (WBC).

Creatine Kinase - Damaged muscle cells release an enzyme called Creatine Kinase (CK) into the blood. The level of CK in your blood shows how much your muscles and skeletal system have been worked during exercise. Muscle damage sounds bad, but when muscle cells repair themselves, they become stronger.

Testosterone - Research has shown that repeated heavy endurance exercise without adequate rest can cause a significant decrease in testosterone, which plays a key role in development and maintenance of both muscle mass and strength. Without enough testosterone, bones can become weaker and more likely to fracture or break. Testosterone also contributes to the body’s maintenance of energy levels, so this hormone can increase your energy during workouts and help improve your endurance.

CRP - Part of your body’s normal response to exercise is inflammation. One of the best measurement tools for inflammation is CRP, a protein in the blood. Levels of CRP rise and fall in response to inflammation, so knowing your CRP tells you a lot about what’s going on in your body.  

White blood cells - These components of your blood play an important role in your body’s immune system, searching the blood for invading viruses, bacteria, and fungi. Since white blood cells fight off infection, you might think that an elevated white blood cell count is actually beneficial, but this is not necessarily the case. Although a high white blood cell count isn’t a specific disease, it can indicate another problem, such as infection, stress, inflammation, trauma, allergy, or certain diseases.

InsideTracker measures CK, testosterone, CRP and white blood cells in your blood. If your levels are out of the optimal zone, InsideTracker may be able to help you to reduce your use of pain medication by suggesting simple changes to nutrition, exercise, lifestyle, and supplements to help reduce soreness and inflammation.

NSAID’s are non-steroidal anti-inflammatory drugs, such as ibuprofen (Advil and Motrin), naproxen sodium (Aleve), and ketoprofen (Orudis KT). These drugs work by preventing the body from producing prostaglandins, which are naturally occurring compounds that induce pain in the body. Prostaglandins also protect the stomach lining, create collagen, and regulate blood pressure. Painkillers block all prostaglandins, which is an issue because they block those that protect the stomach lining in addition to those that cause pain. As a result, NSAIDs can sometimes cause stomach pain and gastrointestinal bleeding, and the risk of those conditions increases with long-term use of these painkillers. Other side effects may include heartburn, rashes, nausea, decreased heart health, stomach ulcers, and kidney problems (with long-term use).

The answer to this question may seem obvious, but athletes turn to painkillers for a wide variety of ailments. Sore throats, colds, and stomach upsets are often treated with painkillers to allow athletes to continue to perform during temporary bouts of sickness. Many athletes suffer injured muscles, ligaments, and tendons that can compromise their performance. If the injury is not too serious, people often take painkillers to continue to train and compete throughout their injury and recovery. While this may seem like a good idea, taking medication to suppress pain can lead to over-training syndrome and result in further injury. Pain and injury are signs that you should pay attention to; ignoring a potential injury risks delaying recovery and aggravating your joints or muscles.

In 2006, researchers studied the physical stress placed on racers during the Western States Endurance Run, which is a 100-mile test of strength and stamina. Scientists anticipated that the distance and altitude of the race, held in the Sierra Nevada Mountains in California, would have a negative impact on the muscles and immune system, but bloodwork revealed that the use of painkillers had the most significant negative impact on the body. The runners who had taken painkillers before and during the race had much more inflammation than the athletes who hadn’t taken any painkillers. The medicated athletes also displayed some kidney impairment and low-level endotoxemia, a condition in which bacteria leaks into the colon from the blood.

So, although athletes may think that painkillers will prevent and treat pain while they are working out, this study showed that they might actually have the opposite effect! Furthermore, the study showed that NSAIDs actually didn’t lessen athletes’ perception of pain during exercise or decrease muscle soreness after. The runners using painkillers reported having legs that were just as sore as the athletes who didn’t use any. Moreover, many studies show that NSAIDs actually slow the healing of muscles, tendons, ligaments, and bones. Since prostaglandins help to create collagen, which are the building blocks of most tissues, when painkillers block prostaglandins these medications can actually inhibit the healing of tissues and bones.

Therefore the use of NSAIDs should be reserved for the short-term treatment of pain from an acute injury. For instance, athletes can use painkillers safely when restricted to the minimal dose up to 1 week following injury when inflammatory signs and symptoms (such as swelling and pain during resting) are present. Taken during this stage, NSAIDs may help reduce pain following injury, and there is evidence to suggest that short-term use limits the negative effects that painkillers may have on tissue healing. Consult with your physician before taking NSAIDs to be sure they are appropriate for you and for your injury. 

Several studies have discovered that painkillers actually offer little performance benefit to athletes and may even increase the risk of injury since they mask pain. One study concluded that painkillers didn’t actually prevent muscle injury, which was indicated by creatine kinase. Ironman triathlon participants even showed that the use of NSAIDs during ultra-distance exercise is associated with an increased risk of exertional hyponatremia, which is a state of depleted sodium that is believed (in this case) to be due to altered kidney function caused by the painkillers. A sodium imbalance in the body can have all sorts of implications on your performance because sodium helps to transmit nerve impulses throughout your body and also works to allow your muscles to contract and relax.

It’s important to not confuse the normal aches and pains that frequently accompany an intense workout with injury. If you believe you are actually injured, it’s important to consult with a physician before you begin to self-medicate. Your doctor may suggest taking a NSAID during rehabilitation (in addition to physical therapy, rest, or icing) to control the pain and inflammation that might interfere with healing. Otherwise, it’s best to use the lowest recommended dose for no longer than a week. 

The best treatment for exercise-related discomfort is often an appropriate training regimen, a healthy diet, and plenty of rest. But you also need to find out what is happening inside your body. InsideTracker will help you to find which biomarkers are out-of-range, what your results mean, and how to bring each biomarker into your optimal zone, based on your age, gender, athletic activity using simple interventions such as food, supplements, training modification and lifestyle changes.

Why do athletes use painkillers?Can using painkillers be harmful?Do painkillers improve your performance?How can athletes relieve and prevent pain without taking NSAIDs?

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