If there is one thing I love about my volleyball coach, it is the willingness to engage in conversations and ideas of sports performance and advocate varying points of view and opinions in regards to performance, recovery and behaviour. Often after a tournament and on the drive homeward (which can be of differing lengths and distance) we are allowed to engage in conversations about how we, who come from two different backgrounds, have dealt with the various impacts of high level training, performance and how our ageing bodies best dealt with the crazy stuff we asked of it.
Another engaged conversation in the car following a recent weekend away involved the topic of using anti inflammatory medication to deal with the great amount of inflammation that exists in your body after you’ve spent 2 days running intensely around a court and getting slammed on the ground, colliding with other players and generally putting your joints through an intense power filled game of repetitive actions. My coach (who has played at the highest level college volleyball in America and been in dedicated training and tournament schedules for long and intense seasons) advocates the good ol’ use of Ibuprofen and Anti Inflammatory medications for 2 days after tournaments to help with controlling the vast amount of inflammatory agents that exist in the sportspersons body. Conversely my view, is that there are other more natural ways to deal with inflammation without resorting to synthetic medication.
So - who was right?
NSAID’s have a role in reducing the production of prostoglandins - a biochemical that are part of the bodies immediate response to injury. They are part of the ‘initial response team’ that flood the site of any injury, jump starting the pain and inflammatory response and signalling other processes such as dilation of blood vessels to flood the area with blood and other factors needed for repair. Taking NSAID’s results in less of these prostoglandins and thus reduces the inflammatory processes and dilation of blood vessels.
In a study undertaken by the Proceedings of the National Academy of Sciences at Stanford University, an experiment on lab mice found that the reduction in prostaglandins resulted in a categorical change of how the body repairs muscle tissue and trauma. Prostoglandin E2 is a vital biochemical that stimulates the reproduction of stem cells that play a major role in creating new muscle cells that repair damaged tissue. After this tissue has been repaired the integrity of the muscle was stronger than previously measured.
This response sets up a vital parameter for the inflammatory process as it stimulates repair that is a long term focus resulting in stronger fibres. By inhibiting the production of Prostoglandins, the long term impacts may result in torn fibres and muscles NOT being repaired adequately to retain strength. The director for Stem Cell Biology at Stamford University Helen Blau, who oversaw the experiment concludes that ‘inflammation is part of the natural regenerating process and is not a bad thing’ In short – a bit of pain is good for gain.
There is also evidence to suggest that by inhibiting dilation of blood vessels during the regenerative process, (via reducing prostaglandins) an athlete may also be putting undue strain on the liver as it attempts to filter blood for the repair process. Reducing the blood flow (akin to a kink in the hose) can make the liver work harder. Thus renal issues may result from this restriction in the normal body process of inflammatory response.
Prostoglandins also are active in the intestinal tract where they are involved in the protection of the stomach lining. This is why some NSAID medication can result in upset or acidic stomach conditions, especially to those who are perhaps unused to this type of medication. I experienced this first hand when a doctor in San Francisco prescribed aggressive NSAIDs for my twisted pelvis which then saw me vomiting regularly for a week afterwards as my stomach went completely acidic. Long term use of NSAIDs can result in bleeding and irritation of the Gastro-Intestinal tract.
However the American Journal of Sports Medicine published a study in March 2017 that looked at the short term benefits of NSAID medication in reducing muscle soreness and blood creatine levels. This is a short term application and time sensitive application is very much the focus – ie direct application after acute injury. In this study the conclusions determined that NSAID application was appropriate for reducing strength loss, muscular soreness and blood creatine kinase levels in the short term. It was yet to be determined whether the NSAID application was prevalent for use after the initial injury and days afterward.
Another article of the Annals of Physical and Rehabilitation Medicine promote that the type of injury and even the location (with lower limb injuries being more readily receptive to repair) can also determine whether NSAID application is appropriate. It notes that in the case of fresh ligamentous injuries, the use of NSAID does seem to have a positive effect in the short term. However with bone fractures or even overload tendinopathy (chronic tendon issues) the application of NSAID medication is NOT indicated as this type of injury does not technically have a period of inflammatory phenomenon. It goes on to say that
“Finally, the studies do not show any significant interest in their use during acute muscle injuries.”
In all the studies though, it does agree that a short course of NSAID is the only application that can have some beneficial effect on the recovery of an athlete and the effectiveness of their recovery and return to action.
Of course there are other ways of taking recovery into your own hands and taking an active role in the managing of acute inflammation. My favourite of late is a good ol’ Magnesium bath. Soaking in epsom salts for a good 20min after a hard session actually has me bouncing back the next day (ok maybe not bouncing so much but able to follow up and work as well as play again). Naturopaths also promote the use of products such as turmeric, ginseng and ginger to help with inflammation in the body. Although the volume of these products needed to administer these properties in real terms is quite vast. However, one cannot deny the nutritional benefits of consistent ingestion of said properties. I’m also a big fan of my 30min stretching routine and a little bit of acute massage ball work to work through some more acute spots of issue.
So it does come down to how much you want to restrict a natural process that deals with an injury and if you want to reduce the pain associated with this process? Regular readers of my BLOG well know my view on pain and its role in determining what we do, how we recover and whether to continue with an activity. In this case, is a little pain worth the gain? Or do we administer a drug to help prevent the inflammation and the pain associated with post recovery.
Me thinks my coach may be setting me up for a lot of pain in the next training session with this article.