IU Health & Wellness: NSAIDs Misuse; Athletes and Winter Bugs

NSAIDS: TAKE 'EM EARLY AND OFTEN WHEN COMPETING? THINK AGAIN

Athletes' superstitions and rituals can help them get psyched up for contests, but when these rituals involve non-steroidal anti-inflammatory drugs (NSAIDs), which many athletes gobble down before and during events, they could be causing more harm than good.

"These agents are treatments for the symptoms of an injury, not the injury itself," says Stuart Warden, whose research at Indiana University focuses on musculoskeletal health and sports medicine. "They may allow an athlete to exercise or train at a certain level, but pain occurs for a reason. It is basically the body's mechanism of saying, 'Hang on, you've got some sort of injury that should not be ignored.'"

NSAIDs are recommended for use after an injury to reduce swelling or pain. Studies have found that many elite athletes, however, take these over-the-counter drugs -- and often several different kinds -- before contests and challenging workouts because they think they will reduce anticipated inflammation and soreness that could occur after the event. Warden says there is no scientific evidence for this prophylactic use of NSAIDs. Such misuse, however, can cause a range of problems, from interfering with healing and inhibiting the body's ability to adapt to challenging workouts, to the development of stomach ulcers and possibly an increased risk for cardiovascular problems, says Warden, assistant professor in the Department of Physical Therapy at Indiana University-Purdue University Indianapolis.

The larger the dose and the longer duration of NSAID use, the greater potential for these risks. Warden warned against the misuse of NSAIDs in an editorial published earlier this year in the British Journal of Sports Medicine.

"I want people, including recreational athletes, to think about the perceived benefits versus potential risks of taking NSAIDs, and to ask themselves why they are taking these agents," said Warden. "They need to ask, 'Do the benefits outweigh the risks?"

•Background. NSAIDs interact with the body's chemistry at a cellular level by inhibiting the cyclooxygenase (COX) isozymes. The COX isozymes are critical for the synthesis of prostaglandins, which have important functions in the gut and cardiovascular system, as well as during inflammation and the adaptive response of the musculoskeletal system to stress. NSAIDs may reduce pain and inflammation following injury by inhibiting COX isozyme-induced prostaglandin synthesis; however, as they circulate within the body indiscriminately, rather than localizing to the source of an athlete's specific aches and pains, they may produce undesirable side effects. With regular misuse, athletes face extreme and severe risks, such as the development of ulcers, potentially fatal problems with renal blood flow, and increased risks for cardiovascular problems. On a lesser scale, they could actually increase their risk for injuries because their bodies are less able to adapt to rigorous workouts -- and healing could take longer.

Warden said NSAIDs should be taken as directed -- in the recommended dosages and for no more than a week after an acute injury that involves swelling and pain.

"But to take the drugs before every run and throughout the year is a concern. You need to think of pain not as a hindrance, but as a signal that something is not quite right," he says, adding that, "NSAIDs should not be used at the expense of a thorough assessment of an injury by a trained professional, such as a physical therapist or physician."

Journal citation: "Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes," British Journal of Sports Medicine, August 2009. Vol. 43. No. 8.

HIGH SCHOOL ATHLETES NEED TO BABY THEIR IMMUNE SYSTEMS

New cases of the H1N1 influenza virus might have peaked but high school winter sports athletes still remain vulnerable to whatever illnesses their classmates and families care to share.

Intense basketball, wrestling, swimming and other winter sport practices and matches tune up bodies but also weaken immune systems, says Douglas McKeag, M.D., director of the IU Center for Sports Medicine at the Indiana University School of Medicine. Athletes' immune systems also can be weakened by cold winter temperatures and a staple of the holidays -- stress and a tendency to get less sleep.

"Winter athletes are much more prone to getting whatever happens to be being passed around," McKeag said.

McKeag offered these suggestions:

•Get vaccinated against both seasonal and H1N1 flu. "Remember a 'third wave' of H1N1is expected later this winter," said McKeag, the OneAmerica Professor of Preventive Health and Family Medicine. "Teenagers remain an extremely vulnerable age group." •Athletes with a fever above 100 degrees should not practice or compete. Taken to the extreme, any virus or bacteria can contribute to the development of myocarditis, or inflammation of the heart muscle, which is dangerous and can lead to sudden death. It stems from viremia or bacteremia, where a virus/bacteria enters the blood stream and circulates throughout the body. Sometimes it can attach to the heart, causing the inflammation of the heart. •Athletes can help their immune systems by keeping themselves well nourished and hydrated. McKeag notes, however, that rigorous exercise is an appetite suppressant, so as a result, many athletes do not eat as much for dinner after practices as they should. He suggests strategic snacking -- making sure they have healthy snacks in their backpacks and on hand earlier in the day to make up for the lost calories.