Post-exercise recovery: first, do no pharma

When it comes to improving performance, most of the focus is on the hard training that is necessary to stimulate progress. However, hard training is only half of the equation; it is the recovery that follows hard training which ultimately results in improved performance. Beyond the value of recovery from a performance perspective, training hard often leaves athletes sore and tired, something understood to be a necessary component of training but avoided whenever possible.

Minimizing downsides

As awareness of the importance of recovery has improved, and considering athletes have always sought to minimize the negative effects of hard training, the use of non-steroidal anti-inflammatory drugs (NSAIDs) among athletes has become quite common. These drugs are typically used to treat pain and fever, as both have an inflammatory component. However, as inflammation also occurs both systemically and within the muscle as a result of hard training, athletes sometimes use these drugs to combat the stiffness and soreness that follows challenging workouts.

Beyond symptomatic relief, the thought process is that the sooner pain and inflammation go away, the sooner one can train hard again. And the more often hard training sessions are performed, the faster and more significant the improvements can be made. The problem with this line of thinking is that inflammation is actually a critical part of the adaptive process. 

Inflammation and adaptation

While it may be no fun to experience, inflammation and the associated cellular process help rebuild the tissues to be stronger and more resilient. Therefore, removing the inflammation may actually prevent the desired adaptations from occurring. And when you look at the emerging evidence, there’s a consensus that NSAIDs may compromise muscle growth (hypertrophy) when taken chronically – almost certainly as a result of disruption in natural inflammatory processes⁽¹⁾.

Beyond the potential negative impact on muscle hypertrophy, as their name implies, NSAIDs are drugs, and they are not without side effects, particularly for gastric health. When taken for long periods of time, these side effects may become problematic – see this article. Moreover, while the chronic use of NSAIDs may not be a great idea, it’s not even clear if NSAIDs actually have a positive impact in the short-term. Much of the research is mixed, with little consensus for a positive effect of NSAIDs. While it’s assumed that they can speed recovery in the short-term, this hasn’t consistently been demonstrated to be the case. Moreover, it’s not clear if different NSAIDs have different impacts on recovery from exercise, especially when taken prior to exercise.

Considering the prevalence of NSAID use in athletic populations, it’s important to provide clarity as to whether these drugs are actually creating the intended effect. As there are documented long-term consequences to their use, there should be documented short-term benefits to justify taking these drugs to assist with recovery from exercise. With clearer information, athletes can make more informed decisions as to whether to use these drugs.

New research

For more clarity, we can turn to a recent study by a group of researchers from the US Army⁽²⁾. The researchers compared three different types of NSAIDs: ibuprofen, flurbiprofen, and celecoxib. Ibuprofen is available over the counter, whereas the other two drugs are available via prescription only. Importantly, the research was performed using a ‘placebo-controlled randomized, double-blinded, cross-over study design’. Let’s break that down because it’s important with regard to the validity of the study:

·       To compare the impact of the various NSAIDS versus doing nothing at all, a placebo was included where the subject took an inert pill that had no effect at all.

·       A cross-over design signifies that all subjects performed each version of the experiment, taking all three NSAIDS as well as the placebo. This ensures that the subjects in each group were the same, eliminating the possibility that the results could be influenced by the selection of the subjects.

·       The order in which the various NSAIDS and placebos were taken was randomized as well to ensure that any influence of repeated testing or familiarization of the testing protocol was removed as well.

·       Finally, the research was performed in a double-blind fashion in that both the researchers and the subjects were ‘blind’ as to which treatment was happening during each testing session.  No one knew which pill the subject was taking.  This removed the possibility that the beliefs or expectations of the subjects and the researchers could influence the results of the study.

Overall, the purpose of this methodology was to remove as much bias as possible from the experimental design. As you can see, the experimenters went to great lengths to produce quality research that was less likely to produce misleading data.