Anti-inflammatory drugs for muscle pain and injuries – Why you should think twice

Non-steroidal anti-inflammatory drugs (NSAIDs) like Naproxen and Ibuprofen are very effective for relieving muscle pain in various scenarios. However, this article highlights the drawbacks of using anti-inflammatories for muscle pain, whether it’s shortly after an injury or to deal with muscle soreness during or after sport. Remember, if you need more help with an injury, you're welcome to consult one of our physios online via video call.

In this article:

1. Anti-inflammatories to relieve muscle pain (injuries and DOMS)

2. Anti-inflammatories to enhance performance

3. How we can help

We've also made a video about this:

We also have an article about the use of anti-inflammatories for tendon pain, if you’re interested in that.

Anti-inflammatories to relieve muscle pain (injuries and DOMS)

People use NSAIDs to relieve muscle pain in two scenarios: First, pain caused by an acute muscle injury, and also for that general muscle pain you get a day or two after a hard match, race, or training session.

In both cases, this is not a good idea.

Anti-inflammatories for acute muscle injuries (strains and tears)

Inflammation plays a crucial role in how your body heals a muscle injuries.

When you strain or tear a muscle, the cells that make up your muscle fibres get damaged. Two things then happen during the first three to seven days after the injury: inflammation sets in, and a blood clot forms in the muscle – very much like an internal scab.

Think of the injured part of the muscle like a building that’s been demolished to make way for a new one.

The role of the inflammatory cells is to absorb the damaged cells and get rid of them – to clear away the debris, in our analogy. The role of the internal scab is to act like scaffolding for the new cells that replace the damaged ones to attach themselves to – i.e. to erect the new building.

This cleaning-away-and-rebuilding process can take up to three weeks after the injury.

By taking anti-inflammatories for an injured muscle, you inhibit the inflammation and therefore the process of getting rid of the damaged cells. This has a knock-on effect on the formation of new cells to rebuild the injured part of the muscle, and so the whole healing process is compromised.

Yes, anti-inflammatories do reduce the pain caused by such an injury but it may have a negative effect on your recovery. However, if you can’t stand the pain, it is better to speak to your doctor about taking something like paracetamol instead.

Anti-inflammatories for muscle soreness after sport or exercise

When we exert ourselves physically, our muscle cells get micro-damage. This is normal and not as bad as it sounds. Our bodies then repair our muscle fibres to be a bit better than before, and this is how we gradually get fitter and stronger through exercise.

When we overdo the exertion, it can cause some muscle pain in the day or two afterwards, and this is known as DOMS (delayed-onset muscle soreness).

Here also, inflammation plays an important role in the process that allows us to grow stronger in response to a workout. The research suggests that if you regularly take NSAIDs for DOMS, you may deprive yourself of the training benefits and not gain as much muscle strength as you would otherwise.

Anti-inflammatories to enhance performance

Some people also take anti-inflammatories to alleviate or avoid muscle pain during sport, especially endurance races, in the hope that it will enhance their performance.

A recent review of the available research found no evidence that this ploy works. It analysed 23 studies involving a total of 514 athletes and found that there were “neither significant difference in the maximum performance between NSAIDs and control groups nor in the time until exhaustion nor in self-perceived pain”.

Therefore, we don’t recommend that athletes take NSAIDs to enhance their performance because they are known to be bad for your kidneys and stomach lining, especially if you were to dehydrate during an endurance event.

How we can help

Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.

We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.

References:

1. Järvinen TA, Järvinen TL, Kääriäinen M, Kalimo H, Järvinen M. Muscle injuries: biology and treatment. Am J Sports Med. 2005 May;33(5):745-64. doi: 10.1177/0363546505274714. PMID: 15851777

2. Baldwin Lanier, A. (2004). Treating DOMS in sport with NSAIDs. International SportMed Journal, 5(2), 129-140

3. Cornu, C., Grange, C., Regalin, A. et al. Effect of Non-Steroidal Anti-Inflammatory Drugs on Sport Performance Indices in Healthy People: a Meta-Analysis of Randomized Controlled Trials. Sports Med - Open 6, 20 (2020). https://doi.org/10.1186/s40798-020-00247-w

4. Schoenfeld, B.J. The Use of Nonsteroidal Anti-Inflammatory Drugs for Exercise-Induced Muscle Damage. Sports Med 42, 1017–1028 (2012). https://doi.org/10.1007/BF03262309

5. Trappe TA, White F, Lambert CP, Cesar D, Hellerstein M, Evans WJ. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab. 2002;282(3):E551-6