Impact Of Pain Medicine On Post Workout Muscle Growth

[Fiddleman 4,376]

NSAIDs are not good for those looking to benefit from Protein synthesis (aka muscle growth) following exercise that breaks down the muscle.

I want to share the following study below with others as I found it very enlightening. I have been researching this connection between protein synthesis and pain medicine in order to understand my own lack of progress after months and months of "doing the right thing" in the gym and with my diet.

I have been taking therapeutic doses of ibuprofen and some use of Tylenol to deal with back and neck inflammation unrelated to exercise. After finding this information, I have stopped taking the pain medicine cold turkey despite having to deal with the inflammation.

In order to combat these back and neck pains, I am turning exclusively to posturing focus, when standing or sitting, and very focused physical therapy at home with rollers, lacrosse balls and yoga stretching. It does help, but requires a lot more time and focus.

Does anyone know how long it will take for the effects of COX-1 and COX-2 inhibitors to leave the body? Will months and months of taking high doses of ibuprofen cause a permanent change in the body with regards to these enzymes?

Here is a study outlining the effect of NSAIDs such as aspirin, ibuprofen, and acetaminophen on muscle growth.

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If you are one of the many people who take a few Advil aspirin,or any other NSAID after a workout or in the days following to alleviate muscle soreness, think again! There is recent research that conclusively shows that taking NSAIDs after exercise-induced muscle damage significantly reduces levels of the prostaglandin, PGF2-α, which is intimately involved in the protein synthesis that occurs post-exercise; we work out, tear down our muscles, and the anabolic process of tissue repair and hypertrophy is dependent on levels of this prostaglandin.(1,2). It has been known for some time that maximal, prescription-level doses of NSAIDs will inhibit skeletal muscle protein synthesis, as the study in reference (2) below was performed in 1982. Most of these studies, however, utilized in-vitro systems where cultured myocytes were exposed to a stretch-stimulus to induce tissue damage and then protein synthesis was measured with-and without the presence of a high concentration of NSAID. As those of us in the field of pharmacology have (painfully) witnessed time-and time again, in-vitro systems are rarely representative of what actually occurs in-vivo. Because of this the notion that NSAID use after a workout might decrease muscular gains was passed off as an artifact of the experimental systems used; and not representative of what somebody would experience when taking over the counter doses of NSAIDs.

A group in 2001, however, using eccentric contractions in human subjects to induce muscle damage, showed that post-exercise NSAID use drastically reduced the increase in protein synthesis normally seen in response to muscle damage. This study is relevant to real workouts because the researchers used a model for muscle damage that is very similar to what what happens during a normal weight training workout and the doses of NSAIDs used in the study were normal therapeutic doses, not unlike those that most people would take for a headache or after a tough workout for soreness.(3) The results of this study were that, in the untreated subjects, post-exercise muscle protein synthesis (24 hours post-workout) increased in upwards of 76%, while subjects that received either acetaminophen or ibuprofen saw no significant increase at all. The implications of this study are huge; if you are into taking a few Advil after a tough workout to alleviate soreness, think again; you may be severely hindering your progress.

It is important to know the mechanism behind such a phenomena because it may be possible that we can use this to our advantage. NSAIDs inhibit the enzyme COX-1 and COX-2, which basically take a common substrate, arachidonic acid, and through a cascade of biochemical reactions create a number of prostaglandins. Some Prostaglandins cause inflammation and are largely responsible for the pain response we get after a workout. Reducing prostaglandin synthesis by inhibiting the COX enzyme can reduce pain and inflammation, but at the same time reduction of the specific prostaglandin, PGF2-α has a dramatic effect on the ability of muscles to hypertrophy(2,4). Intuitively, this makes sense, because inflammation is intimately involved with the healing process. Although there are certainly situations when reducing inflammation is beneficial, after a weight training workout is clearly not one of them.

The pathway is outlined below and as you can see, inhibiting COX will have the effect of reducing PGF2-α, inhibiting the ever-so-important protein synthesis that occurs to repair the muscle and allow it to hypertrophy. So there you have it, convincing evidence that NSAIDs after a workout inhibit muscle gains. The next question you may ask is: How can we use this to our advantage? (i.e. by somehow increasing PGF2-α levels). Glad you asked! This will be coming in a future post; sign up for our feed or to receive posts by email to get this cutting edge info as soon as it is published. Until then, keep training hard and continuing to learn; the day you think you know it all is the day that you stop making gains.

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Here is another link for your reading pleasure on the same topic:

http://adisonline.com/sportsmedicine/Abstract/2012/42120/The_Use_of_Nonsteroidal_Anti_Inflammatory_Drugs.3.aspx

[Fiddleman 4,376]

Anyone found this interesting? I think it is really relevant. Applies to all pain medicine, not just nsaids.

[Butterthebean 8,146]

I think it's interesting. My knee jerk reaction is to say if someone needs NSAIDs immediately after exercise perhaps they're over doing it. I can understand taking it for DOMS but that should be outside the 24 hour window they mentioned.

Today when I was leaving the gym, I was sitting in my car about to leave and I saw a guy walk out of the gym...he looked like he was in his mid 30s but was walking like he was 90. It was way beyond fatigue. I thought exercise should not make you feel this way. It should leave you fatigued, but also invigorated, refreshed, emboldened.

But then I thought how I felt after my long run yesterday and...yep...I looked just like him. Of course, I know I'm over doing it as well.

[Fluffnomore 1,235]

One of my CF coaches posted an article recently about recovery, and it basically said that NSAIDs, icing, heat, etc are not as helpful as stretching/movement of the affected area. I will see if I can find that. This is really interesting information.

ETA: here it is. More of a blog post than research but also an interesting read:

http://athleticmedicine.wordpress.com/2013/11/07/why-ice-and-anti-inflammatory-medication-is-not-the-answer/

[Fiddleman 4,376]

One of my CF coaches posted an article recently about recovery, and it basically said that NSAIDs, icing, heat, etc are not as helpful as stretching/movement of the affected area. I will see if I can find that. This is really interesting information. ETA: here it is. More of a blog post than research but also an interesting read: http://athleticmedicine.wordpress.com/2013/11/07/why-ice-and-anti-inflammatory-medication-is-not-the-answer/

very useful information as another point of view. Many different points of view lead to a more educated and discerning decision making process. Thanks for sharing.

For myself, I think taking NSAIDs or some other pain medicine post workout was a knee jerk reaction when soreness hit and may have contributed to a prolonged healing process and lack of progress across months of working out. I had always taken nsaids for my chronic back issues and taking it after the grueling Cross fit workouts just made sense as a means to eliminate soreness completely or good enough. Definitely a learning experience for me to not take them. I think my justification for using NSAIDs regularly stems from never being in this situation before. That is, being in a situation of constant soreness derived from working out like an athlete for many months (following attainment of goal weight in February 2013), but without the guidance or experience to know when to take off season rests or when to recover for more than a day or two or how to manage the recovery process more effectively. I made a deliberate decision to stop using NSAIDs last week as a post workout strategy. Surprise- I have done several hard met cons and lifting days since then, and, actually feel better overall in the period before the next workout. I no longer feel so fatigued long after the workout (bed time for example), but rather, as BTB states above, invigorated. I am finding I do not need the nsaid to control inflammation as much as I thought I did, but, instead, need to continue a keen focus on stretching, mobility and good posturing outside of working out. I am still using fish oil and contrast showers to feel my best, but not taking ibuprofen when the soreness hits (30 minutes post workout). The mobility work (roller, lacrosse ball, yoga) seems to be the magic to reducing the lactic acid build up, so I feel aligned with the view point of the article.

[gamergirl 4,610]

I thought it was a very interesting article. Increase/reduction of 76%? That's huge. Say it was artificially inflated and it's only half that. Still, a third of a difference is enough to convince me not to take it. I don't know that all post exercise pain is indicative of overdoing it. Some amount of pain is narural/necessary after weights. The pain is likely simply symptomatic of tear down/build up and one could argue that without it, no muscle growth is occurring. Edited artists tusk(?) to artificially inflated and nautical to natural

Edited December 4, 2013 by gamergirl

[scarlet333 386]

I thought we were supposed to avoid NSAIDS totally with the sleeve. Not good for the stomach lining. This was one of the prohibited things post surgery according to my doctor.

[Butterthebean 8,146]

I thought we were supposed to avoid NSAIDS totally with the sleeve. Not good for the stomach lining. This was one of the prohibited things post surgery according to my doctor.

It seems some docs ban NSAIDs forever, and others don't. Kinda like soda. I think they are erring on the side of caution since our stomachs are so small. We can't afford an ulcer.

[Fiddleman 4,376]

Yup, my doctor did not ban NSAIDs for life, just during first 6 months.

[aroundhky 1,174]

I think it's interesting. My knee jerk reaction is to say if someone needs NSAIDs immediately after exercise perhaps they're over doing it. I can understand taking it for DOMS but that should be outside the 24 hour window they mentioned.

Today when I was leaving the gym, I was sitting in my car about to leave and I saw a guy walk out of the gym...he looked like he was in his mid 30s but was walking like he was 90. It was way beyond fatigue. I thought exercise should not make you feel this way. It should leave you fatigued, but also invigorated, refreshed, emboldened.

But then I thought how I felt after my long run yesterday and...yep...I looked just like him. Of course, I know I'm over doing it as well.

You crack me up Butter....always interesting reading your posts. I'm guilty of it at times too. Mine are more like the mornings after my deadlifts days. I used to beat myself up for doing this telling myself I have to stop pushing it so much at the gym. It also doesn't help that I have a cracked L3 in my back from an old sports injury years ago. But then there were times (various surgeries, vacations, etc) when I just didn't work out for a while...sometimes a couple of weeks at a time. What I found out was my joints and overall body aches were just as bad when I rested for more than a day or two at a time and I felt awful in other ways as well. I came to the conclusion that if I'm going to ache and feel bad, I might as well do something and get strong/stay strong if I'm going to ache anyway. I just need to be smarter doing it and that has helped me some.

[Butterthebean 8,146]

I totally get it. I'd rather ache from running than ache from sitting.

I've been swimming every other day for the last 2 weeks. I swim like a 1 legged camel. It's not pretty. I swallow a lot of Water. Thank goodness it's calorie free. And it's not aerobic, not yet. At each end of the pool I have to stop and catch my breath. But I can't swim any slower or I'll sink. I'm just waiting for my form and stamina to catch up to my pace so it may become aerobic.

But my point is, afterward I don't ache at all. Anywhere. I'm so tired I can barely lift my arms but nothing hurts. Pretty amazing. I can see this being very sustainable long into the future.

[Fluffnomore 1,235]

Today's the day that I go back to CrossFit after 6 weeks off. I plan to sit here, whimpering, and re-reading this thread when I get home tonight around 6:30.

[Fiddleman 4,376]

Today's the day that I go back to CrossFit after 6 weeks off. I plan to sit here, whimpering, and re-reading this thread when I get home tonight around 6:30.

That is good to hear. Try and ease back into it after 6 weeks off AND being a new post op. No killing the WOD or PRing a lift today. I look forward to reading about your cross fit journeys as a post op. Kudos for getting back into it so early. Be careful!

[Fluffnomore 1,235]

I'll be lucky if I get through the warmup. I think we're doing some maniacal EMOTM clean followed by three burpees. Yay, burpees.

Fortunately the coach knows about the VSG and the hernia; he's not going to let me go crazy even if I was so inclined. I'm that person who loves the fact that I have worked out, but usually dreads going. And mutters "I'm crazy" all the way over...

[M2G 1,836]

I am in the camp of resisting taking pain meds unless I'm physically HURT. I get sore all the time from my trainer just whipping us into shape but I won't take something for being SORE..if that makes any sense.

I do like being sore as it tells me that I'm getting a good workout, but I certainly don't feel like SORE and PAIN are the same thing.

I think if you are in PAIN from your workout that might mean that you have overdone it, torn something, pinched something, etc. Being physically active shouldn't put you in constant pain.