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

Back. I was grinning like an idiot on the way home. Very easy return: 5x500 row, 50 sit ups, 50 squats with no time limit.

My legs are feeling it; hopefully my abdomen will be in enough shape to go back tomorrow and do another easy workout. (First Saturdays of the month are the killers, so I'll skip that.)

Relieved and excited.

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.

Well, unfortunately, here is the thing: I found out this last week I have 3 spinal issues not working in my favor: 1. Multiple compound fractures in the thoracic region 2. Degenerative arthritis in my neck and in my thoracic region. 3. A lot of bone spurs on many vertebrae in the thoracic region. I found this out with some X-rays taken as part of another visit to the clinic. I discussed the with my doctor today (PCP) and he says it is pretty rare to have these issues for my age and gender. He says the state of my back is comparable to someone who has fallen off a ladder. Really. I am a bit bewildered about how I ended up with all these issues, but do know the physical artifacts have resulted in back pain (not soreness per say) in addition to basic inability to bend my back correctly when squatting or bending over with heavy weight. The PCP thinks it may be auto-immune related and the body is attacking the bone and connective tissue fairly aggressively. Much of the connective tissue is gone between many vertebrae according to the X-rays. I have an initial consult set up in January to discuss options and figure out what this thing is. I am tired of having constant back pain every day just from sitting or standing,even though I am keenly aware of my posture to prevent more pain. I am careful with my form when I work out. In fact, my PCP said to continue working out if it does not cause pain that cannot be managed. I did not have these back issues quite so severely before VSG, but I still had a lot of back uncomfortableness for a long time. I do not want to continue taking NSAIDs , yet I do not want pain all the time. It lowers the quality of life for me. I have been really good about eating nutritionally well, taking vitamins, etc post op.

Edited December 6, 201312 yr by Fiddleman

Sorry to hear that fiddle. Truly. I hope your options give you some relief. I understand your desire to get off NSAIDs. Have you considered acupuncture or some other holistic alternative medicine for temporary relief of pain? I'm considering doing acupuncture myself for my shoulder which has been bothering me for months. I'm also a big fan of trigger point early for pain relief. It won't cure you but might ease your pain.

You may not want to hear this but intense exercise does increase inflammation. The more inflammation you have, the more your joints and bones will continue to degenerate. I wonder if you could seriously consider easing up on the exercise until the consult? The rheumatologist will be able to advise you on now best to deal with the fractures as well.

Typically they will do blood tests to check on CRP, sedimentation rate, and rheumatoid factor. I would call the PCP and ask to have those tested while you wait. If your CRP and sed rate are elevated, you must consider lessening activities that would worsen inflammation. Luckily, you are already on an anti-inflammatory diet but increase fish oil to at least 2 gms if you aren't already there. Many report joint pain relief from Glucosamine, (but not chondritin ).

If it is determined you have inflammatory arthritis, you will likely be started on some combo of steroids for immediate pain relief, a DMARD (disease modifying agency) such as methotrexate which slow down disease progression,, and depending on the severity/symptom relief on a BMARD (biologic modifier) such as Enbrel, humira etc. There are agents that modify TNF or tumor necrosis factor, which is believed to cause the inflammation and self-attack. Highly effective medications, but recognize that they are all immunosuppressants.

The steroids often deliver immediate pain relief but the DMARD and BMARD take 2-4 weeks to properly kick in and you may be well advised to be on a modified exercise schedule then as well. Once the disease is under control, you will be able to return to an exercise schedule but it may be different to what you are doing now.

Essentially think of it as having a bad flu. Your body needs rest to recover as it is fighting itself. Intense exercise prevents you from healing. If there are fractures, I don't think intense lifting etc are wise. The analogy they gave me was that it's as though every cell in your body is on fire. The first thing to do is to cool and quench that inflammatory fire and do nothing to worsen it.

Please also consider that the endorphins from the exercise are masking your pain. Once you ease up on it, you may be in a better position to understand the true degree of pain your body is battling.

It's tough news to swallow, but we should be grateful we live in the age of BMARDs which are relatively new. Life will get back to normal,you may just need to take some care until the meds kick in.

((Hugs))

Also to Butter's point Acupuncture has been reported as being highly effective for pain relief. In one of the threads here, a poster said she would collect cans to pay for her acupuncture if she had to the controlled experiments by and large demonstrate that exact needle placement is irrelevant. It's the opiates from the needle prick that help.

The back mat you found will be particularly useful to you now.

Fiddle, wow, I'm so sorry about the diagnosis. Back pain is NEVER fun, and it sounds like you have more than your fair share of it right now. My own dad battled back issues for a very long time as a result from having a physically active job his whole life (he's NEVER had a desk job.) He spent many years researching and modifying the way he did things in order to ease his back pain. He finally opted to have spinal back surgery as eventually it was discovered that a few of his disks were "offset" and a nerve was being pinched to the point that his legs were going numb and he could barely walk. The surgery was NOT an easy one but we woke up from surgery feeling 100% better (the actual recovery time ended up being about 4-5 months) BUT when his Dr. and nurses asked about his pain level his answer was "what pain? I feel amazing!" because in all honesty he did NOT realize how much pain he had been living with...until it was gone. He felt like he got a new lease on life.

I'm not saying that this is what will happen to you and I certainly hope that it doesn't come down to surgery (usually that is the very last last last option for many people!) But I'm just sharing his story because the part about how he didn't realize how much pain he was in until he got some relief.

Gamergirl...wow, what an incredible insight to what Andy is dealing with and what great advice!!

Now that you have a diagnosis I'm sure you can start working on a solution. The one thing I would ask is if you have considered consulting a specialist. Your PCP may not have all the latest and greatest information regarding your specific problem and sometimes a specialist can help in that area.

I really hope you not only find some answers but also get some relief.

I cannot begin to express my gratitude for the information that everyone posted. Thank you.

Edited December 6, 201312 yr by Fiddleman

So sorry to hear of your trouble, Fiddleman.