Ibuprofen and Endurance Base Questions

I have trained using Ibuprofen when I had shin splints. Not a problem.

I have taken many types of pain killers and even the strongest ones don't kill my pain they just get me stoned but still with pain.

I am always getting hurt also. I get hurt when I first start and some times when I push myself.
Some times I get hurt just tying my shoe or sleeping. That makes me really mad. But whatever you do dont stop training just redirect your efforts toward an excersise that does hurt and stay away from the painfull ones while you heel.

I'll pop the pills if I hurt in the morning. I won't take them SO I can work out. I can't imagine anything good would come from that....

Are from are you extending your distances? I usually extend 5 min every couple of weeks on a long run.

>As an anti-inflammatory, does it help you heal?

Now that is an interesting question. There is no direct relationship between the healing process and NSAID's... but, there is a indirect relationship.

In my opinion, this indirect relationship is closely related to how you apply the use of NSAID's. If you use NSAID's correctly, then yes... NSAID's will help you heal (so to speak). The correct use of NSAID's is as a recovery aid... NOT as a performance enhancement.

On the other hand, if you use NSAID's incorrectly, then no... NSAID's will not help you heal and will most likely result in more injury. When NSAID's are used to progress performance instead of recovery by limiting inflamation (and the pain that is associated with inflamation), NSAID's become a masking agent. What is being masked is two things: Poor Training Methods and Detrimental Compulsive Behavior (...and not so much pain... it's just a symptom).


>Why is it that every time I extend the distance (part of Hal Higdon's Novice guide), I mess something up with my body and end up out of commission for a couple of weeks?

Two possible reasons... but probably both:

..Muscular imbalance AND/OR ...

..Poor technique resulting in repetitive use injury.

>Is this common?

It is probably more common than most think...
And, your probably doing a lot of little things wrong...

The body heals itself... the use of drugs only help or hender that ability.

FWIW Joe Moya

Edited by Joe M 2006-02-24 8:55 PM

It takes a lot of time for the body to fully be able to handle the rigors of long distance running unless you are naturally gifted with great biomechanics and can tolerate training volume well. The body needs to grow stronger in so many ways, doesn't happen overnight. If you have been on a steep volume ramp with limited history in running then you may be flirting with injury.

Joe here is a question for you if you don't mind. I am on a prescribed 1800 to 2400mg Ibuprofen per day after OATs knee surgery 10 weeks ago. My training volume currently is 12/14 hrs a week. Most of it on the bike, some swimming and limited walking /running.

I wanted to cut down on the Ibuprofen and was feeeling good, very good infact even after some long workouts. I went to 800mg for a couple of days and then cold turkey. Knee "blew up" on me (swelled enought to cause a limp) and every muscle I was weight training on became really sore. Ended up taking a day off and dropping my work load back to almost half with very light intensity.

All that came as a big surprize. I figured I was good to go.

PT guy says I just need to stay on the Ibuprofen for a few more weeks till my healing is up to the current training load. (same load for last 4 weeks) The other thought was to level off the training load and give myself some more rest days.

I know Ibuprofen is keeping the swelling down. How do I know it isn't masking the pain enough that I am working too hard?

Any thoughts on the continued heavy use of Ibuprofen and training loads? Thanks for your time.

Nob,

How did you go from 1800/2400mg to 800? Were you taking the 800 once a day, then stopping? if/when you plan to taper, it would be best to still dose yourself 3-4 times per day, reducing the dosage as needed. I.e. if you are taking an 800mg horse pill 3 times a day, you'll need to buy some over the coutner 200mg pills and start tapering yourself to 600mg 3 times day, 400 mg 3 times a day, 200mg 3 times a day when the time comes. Taking it once or twice a day will only result in big fluctuations of the level of drug in your bloodstream throughout the day. Regular dosign keeps the level more steady.

AMEN.

They are generic 200mg tables. 6 tabs every 4hr=2400, 4x4= 1600 4x2=800
Seemed like a reasonable taper. The taper was over a week and uneventful.
Problem going CT was the surprise.

Edited by Nob 2006-02-24 11:33 PM

How do I know it isn't masking the pain enough that I am working too hard?

You don't... sorta'... typically NSAID's won't mask pain... they simply inhibit swelling which in turns reduced the pain... NSAID's are not a drug that effects the neurological aspects of pain.

Any thoughts on the continued heavy use of Ibuprofen and training loads?

Yep... you don't do heavy training loads while injured... the Ibuprofen aspect is just that small but important portion of your training method that is helping inhibit your ability to think along the lines for the long term prospects for being healthy. How long of a processes is the idea of Recovery? - It is as long as it takes... and, it is defined by the body. It's not about 2 weeks, 2 months or 2 years or any pretermined time period. It will happen when it happens. The body determines that period of time - period. In short, I think you have an "expectation" issue.

How do you become healthy after an injury?

Pretty simple... you train up to your limits (or, you train down to your injury's requirements)... unfortunately, your key limitation are/is your knee(s)... which is probably much lower than the rest of your bodies. This difference is the mental aspect of the problem.

The solution... focus on the limit. Do only activity that does not inhibit the progression of becoming healthy... becoming a better athlete hinges on this single ability. It is not just about training the body as a whole. Nope, it's about allowing the body as a whole to slow down to the level of the weakest link. Basically, this is what I call - Physical Therapy as apposed to Athletic Training.

Unfortunately, this is much easier said than done because most athletes have the compulsion to train... it can be an addiction of sorts. Medically, there is probably a solution ... physcologically this solution is in conflict with your compulsive needs. This conflict can only be solved when you decide that the only way to become a better athlete is to become a healthier athlete. And, this will begin when you start by doing the very things that are no longer short sighted and takes the patients and dedication simular to training for an IM competition.

It never ceases to amaze me how some athletes can dedicate 110% of their time and effort to complete an IM... but, are totally frozen in place when it comes to solving both simple and complex injury issues. If they simply put the same discipline and effort into the therapy to get healthier they will actually become a much better athlete. But, for some reason... being healthy is not placed on the same level as being and/or looking fit.

Keep in mind, I'm not suggesting that you aren't putting effort into getting healthy and doing therapy... but, I do believe you have yet to change your expectations as to what effort and how much time it will actually take. You are like myself and everyother athlete (and for myself I use the term athlete VERY loosely) out there, we do not want to become out of shape. And yet, the fact remains... if you continue to have injury...you will become out of shape all the same but with potentially permanent injury results.

Reading your post... perhaps the biggest suggestion I could make (and, I could be waaay off base... so, take it with a grain of salt)... change your expectations. Stop training, Stay on the NSAID's and concentrate on recovery and physical therapy - period. That will be the fastest way toward becoming more active in the future. And, yet... ironically... most athletes don't believe this fact because they have yet to realize that the body determines the healing rate. It has no concept about race schedule, training schedules, etc.

Good Luck... and, hope to see you at an IM... if I do... it will because you began to concentrate on your limitations... you stopped and changed your current ideas about what exactly is training... and not because your trained more or harder. I call this wisdom.

FWIW Joe Moya






Edited by Joe M 2006-02-25 12:06 AM

I know there are people with much more medical background than I have on this thread already, but i just wanted to add my (non-medical) two cents.
I spent much of my college career injured, or flirting with injury. It took me a while to learn to trust myself at the expense of listening to my coaches. The only way that I could walk the fine line between training and sitting out was if I was not on pain killers at the time of my workout. I might take them afterwards (rarely) but I felt that I needed to know exactly what was going on with my body.
Everybody is entitled to their own opinion on this, obviously, but listen to your body. Since I find I can't 'hear' my body well after taking something, I don't. If this isn't a problem for you, don't worry.

Thanks Joe. I am doing 4 to 6hrs a week of PT. Been going light on the training volume for me and religiously watch my waking HR as an indicator of what is going on internally.

I've had this same converstaion with the Doc, my PT guy and my lovely wife and over and over with myself. The most important thing to me is to be 100% down the road not being in shape right now...no question I'm not where I'd like to be. But IU ma patient. I am walking and doin much more than the Doc thought I might originally I started the prescribed PT actually the day of surgery and have continued. The training time has been added as I could do it, to be limited by pain. I've tried to judge that on the "right" side. A pain level that has gone beyond a light workout load I have stopped, regrouped and toned it way down.

I was worried the Ibuprofen was masking pain and keeping me from really knowing where I am.
What you have written makes sense and helps me a lot, thanks, I really appreciate it.

NSAIDS do mask pain. They reduce swelling but are also an analgesic. They inhibit Cyclooxygenase 1 and 2 and thus Thromboxanes and Prostoglandins. These two classes of paracrine hormones DO have an effect on nerves by reduceing local pain paracrine and hormones. Thus Ibuprofen causes pain relief AND reduces swelling. That being said, if you take high doses of ibuprofen before long runs you may be putting your body at risk for injury. The level of pain required to achieve observable stimulus will be higher.
These same class of drugs also break down your stomach mucous by reduction of these same prostaglandins as well. That's why we tell folks not to take these drugs on an empty stomach. Now I'm a GI surgeon, not a Sports medicine DOc. I use these meds for patients all the time. I would not recommend taking large doses prior to running as sports enhancement. Taking NSAIDS after working out is fine. I take 600-800 mg after a run.

Just my 2c.

All this has been very helpful. I didn't injur myself exercising, but took a bad fall duriing the last snowstorm a few weeks ago which has nearly halted my training since it wasn't just one part that was injured. I have been very frustrated and by lack of motivation to do any physical activity using the parts that don't hurt. I just re-read Chris Carmichel's book, The Ultimate Ride, about crashing and how the body uses tons of energy to heal. I'm not so hard on myself now. I wanna get better!!!!

I was under the impression that while NSAID's have an analgesic effect... the dosage level is not sufficient enough to have the "same" effect nor is the process the same... as what would be simular to a narcotic effect of an opiate-like pain killers.

I was thinking more in terms of pain killers that block the message to the brain when I made my post. And, I tended to concentrate on the anti-inflamatory effect that NSAID's provide.

But, when you think about it... it really doesn't make any difference... whether it is a narcotic or non-narcotic approach to reducing pain. The net resutls is the same although the degree of the effect may not be the same.

Thanks for correcting my post... but, I feel we are pretty much on the same page... good post.

Joe

Edited by Joe M 2006-02-25 8:35 AM