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Motrin Mayhem

More Research On Effects of Exercise and NSAID Medications

Millions of Americans take a non-steroidal anti-inflammatory drug (NSAID) every day.  Many use these over the counter drugs to reduce the discomfort / pain of fitness activities.  Big Pharma marketing makes the use of these chemicals look harmless.  In the commercial, the lady pops three pills and glides effortlessly through her run.  The basketball player takes his gel capsules and bounds through the game with his buddies.  Most of us view these drugs as harmless and beneficial.  Ongoing studies have shown that the use of NSAIDs as a pre-exercise activity preparation can limit your muscle recovery and damage your internal organs.  A recent New York Times *article by Gretchen Reynolds should scare everyone away from medicating with NSAIDs prior to a training session.

Exercise induced inflammation is a critical biochemical process that helps us recover from a bout of training. You do not get fitter while training, you get fitter during recovery from a bout of exercise.  The inflammatory biochemicals that make you sore and stiff after a vigorous exercise session are called prostaglandins.  NSAIDs work by interrupting the chemical assembly line that makes various prostaglandins.  No prostaglandin production means you have no delayed onset muscle soreness (DOMS), so you feel better.  Prostaglandins are the chemical signal that tells your muscle cells to get busy repairing and reinforcing your skeletal muscle cells.  No prostaglandins, no beneficial adaptation during recovery.  Take a NSAID before training and it’s like you never exercised at all.

Prostaglandin production creates vasodilation– more blood can get where it needs to go during a session of exercise.  The studies cited in the New York Times article have demonstrated that inhibited prostaglandin production creates diminished blood flow to your kidneys.  Limited kidney function dramatically blunts progress toward all fitness goals.   It is very difficult to run further, get stronger, or become leaner while undergoing dialysis.

Take the time to read the article by Gretchen Reynolds and rethink that pre-exercise NSAID protocol. You can view the article here: https://www.nytimes.com/2017/07/05/well/move/bring-on-the-exercise-hold-the-painkillers.html?

*Bring On the Exercise, Hold the Painkillers, Gretchen Reynolds, New York Times, July 5, 2017

Barbara O’Hara, RPh.

Training Modifications That Help With Your Medication

Statin medications are amazingly effective at lowering blood lipids and have, undoubtedly, lengthened lives.  More doctors are recommending their patients start on these drugs at younger ages.  For a long time, we have known that a common side effect of cholesterol lowering statin drugs is severe muscle soreness after exercise.  Recent research on animal models has demonstrated that statin medications inhibit the beneficial muscle adaptations that occur with exercise.  If you are taking a statin drug, take the time to read Gretchen Reynolds’s interesting article in The New York Times, “A Fitness Downside to Statin Drugs?”  Over the years, I have found certain exercise modifications help reduce the muscle soreness symptoms in physical therapy and fitness clients who are taking statins.  The following recommendations may work for you.

Delayed onset muscle soreness is more pronounced with two types of training:  eccentric type muscle contractions (the muscle lengthens against resistance) and deceleration activities (landing from a jump, hop, or stride).  I have found that managing eccentric muscle contractions and reducing deceleration activity allows clients taking statins the ability to perform beneficial training with less discomfort.

Manage Eccentric Muscle Contractions

Eccentric contractions (the muscle lengthens against resistance) create more micro trauma to the muscle fibers, and it takes longer to recover from a bout of training that involves more eccentric repetitions.  Controlled pace, bodybuilding type muscle isolation training delivers eccentric loading in an effort to stimulate a hypertrophy response in the muscle.

Performing isometric strength training (no movement of the joints) completely eliminates the eccentric portion of an exercise.  Sled pulling and pushing has no eccentric component and many statin medicated fitness clients say this fairly intense fitness activity is well tolerated.  A suspension trainer works well to preferentially unload the eccentric portion of a squat or lunge movement pattern.  Strength training with resistance tubing creates an accommodated force curve that reduces eccentric loading of the muscles.  At FFAC, we have a Surge 360 that is a concentric only device that works all directions of a push or pull with no eccentric muscle stress.  A good fitness coach can find multiple ways to reduce the eccentric involvement of an exercise activity.

Reduce Impact

Impact activities produce high intensity, eccentric muscle contractions.  Land from a jump off a box and your quadriceps, hamstrings, and gluteal muscles must create a quick, coordinated contraction that slows your interaction with gravity.  Deceleration eccentric exercises create more muscle damage and repeated deceleration events are notorious for creating higher levels of delayed onset muscle soreness.

If you want to perform “cardio exercise,” choose the elliptical, Ski Erg, or one of the many types of bikes.  If you possess the mobility, use a Concept 2 rower.  Stay away from the impact of treadmill running and avoid jumping rope, jumping jacks, and any activity that involves both feet leaving the ground.  Medicine ball throws can be performed with minimal impact and produce an excellent muscular and neurological training response.  Avoid box jumps, Olympic lifts, and any other activity that creates an impact on your body.

Talk to Your Doctor

I have worked with many people who had a discussion with their doctor and a simple alteration of their statin medication resulted in far fewer side effects.  I am always surprised by how often patients are reluctant to report their symptoms of severe muscle soreness to their physician.

So those are the hints that have come from years of my work with physical therapy patients and fitness clients.  Stay off the wheel and stay healthy.

Read the NY Times article here: https://www.nytimes.com/2017/01/04/well/move/a-fitness-downside-to-statin-drugs.html

-Michael S. O’Hara, P.T., OCS, CSCS

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