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The Bad News about “Vitamin I”

Originally posted on July 28, 2010

What is the first thing you do after you pull a muscle? How about after you fall or crash your bike? Is taking ibuprofen the first step in your first aid plan? If you are like most people, regular ibuprofen use is the norm. Even without pain, some think of “Vitamin I” as the way to prevent problems during exercise.   The latest advice: step away from that ibuprofen bottle. If you keep taking it, you may inadvertently inhibit your body’s healing response, andcompromise its healing potential. Not only will you delay healing, but you also increase your risk of re-injury.

Non-steroidal anti-inflammatory drugs, known as NSAIDs, have been available for over-the-counter use for years. They are consumed for a variety of minor ailments ranging from headaches to knee pain to any number of acute injuries. They are also prescribed for prevention of strokes and heart attacks. Common names for this class of medication are aspirin, ibuprofen (Advil), or naproxen (Aleve). Although effective for treating pain, new research has shown they may actually hamper normal healing, slowing recovery from injury and prolonging return to functional and recreational activities.  

NSAIDs, known as Cox-1 and Cox-2 inhibitors, are enzymes responsible for catalyzing several molecules such as prostaglandins. Prostaglandins and platelets are important precursors for inflammation, a necessary step in normal and timely healing. Believe it or not, medication commonly prescribed to treat minor pain and injuries is actually inhibiting the enzymes required for healing.    Since NSAIDs are not promoting healing, what are they doing? These drugs are effective for reducing pain. Imagine this scenario: A runner suffers a minor injury and takes ibuprofen, thinking it will help him heal so that he can return to his sport. Instead, the pain relief allows him to continue running while healing time is delayed due to these Cox-1 and 2 inhibitors. A minor injury has just become a significant setback, and the runner is sidelined for several weeks while he waits for the injury to heal.   Additionally, NSAIDs can have a profound effect on wound healing. Wound healing can be broken down into three phases: inflammation, proliferation and remodeling. The inflammatory phase lasts about four days, and is a critical step for wound healing. The action of small particles called platelets is needed to initially clot the injured site, bring in cells to help the body fight off infection and promote repair. After the platelets have done their job, the body can move into the next phase of healing, called proliferation.   So what can you do to decrease pain after an acute injury?

  • Acetaminophen (Tylenol) is available over-the-counter for pain and fever reduction but does not have the anti-inflammatory properties of NSAIDs.  Consider Tylenol to treat pain until the body moves past the inflammatory response.
  • Most of us have heard the acronym RICE for first aid.  Rest, Ice, Compression and Elevation can help decrease pain.  In certain situations, ice should be used cautiously as current research suggests it may have a negative effect on the body’s inflammatory response and could prolong overall healing time.
  • Avoid heat for an acute injury.  It increases blood flow to the area, exacerbating painful swelling
  • Though rest might sound right in the first day or so, graded or assisted movement may be just the way to decrease pain and promote healing.

The effects of NSAIDs on your body’s healing potential can be confusing. Alta physical therapists are experts in treating injuries, and can help you determine the most effective treatment strategy.   We can explain which phase of healing your body is in and when NSAIDs may or may not be safe to take.  Call today to make an appointment or click on the “Ask a therapist” link on our website if you have questions about NSAIDs or injuries.


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