Abstract
The objective of this article is to examine the use of NSAIDs for attenuating exercise-induced muscle injuries (EIMI), with an emphasis on their safety and usefulness for improving muscle function and reducing soreness. NSAIDs are some of the most widely consumed medications in the world, and NSAID use as therapy for EIMI has increased dramatically over the last 20 years. However, there is a lack of agreement concerning NSAID effectiveness for this purpose. The lack of consensus about the efficacy of NSAID use in relation to EIMI has spawned a recent interest in sports medicine research regarding NSAIDs.
The application of a variety of methods used to induce, assess and quantify muscle injury has contributed to the inconsistency among the findings regarding the efficacy of NSAIDs for EIMI. Therefore, future studies should focus on the evaluation of muscle injury and function, with the use of better functional measurement tools and more uniformity in the assessment tools used. However, from review of the current literature, it is concluded that NSAID use for brief periods of time is beneficial for short-term recovery of muscle function and is an important laboratory tool for the study of EIMI.
References
Wallace J. Nonsteroidal anti-inflammatory drugs and gastroenteropathy: the second hundred years. Gastroenterology 1997; 112: 1000–16
Robinson DR. Prostaglandins and the mechanism of action of anti-inflammatory drugs. Am J Med 1983 Oct 31; 75: 26–31
Vane J. Inhibition of prostaglandin synthesis as a mechanism of action for aspirin-like drugs. Nature 1971; 231: 232–5
Williams TJ, Peck MJ. Role of prostaglandin-mediated vasodilation in inflammation. Nature 1977; 270: 530–2
Vane JR, Botting RM. Mechanism of anti-inflammatory drugs. Scand J Rheumatol 1996; 25Suppl. 102: 9–21
Sirois J, Richards JS. Purification and characterization of a novel, distinct isoform of prostaglandin endoperoxide synthase induced by human chorionic gonadotropin in granulose cells of rat preovulatory follicles. J Biol Chem 1992; 267: 6382–8
Griffin M. Epidemiology of nonsteroidal anti-inflammatory drug-associated gastrointestinal injury. Am J Med 1998; 104(Suppl. 3A): 23S–9S
Hernandez-Diaz S, Garcia-Rodriguez G. Epidemiologic assessment of the safety of conventional nonsteroidal anti-inflammatory drugs. Am J Med 2001; 110(Suppl. 3A): 20S–7S
Koch M, Dezi A, Ferrario F, et al. Prevention of nonsteroidal anti-inflammatory drug-induced gastrointestinal mucosal injury. Arch Intern Med 1996; 156: 2321–32
Wolfe MM, Lichtenstein DR, Singh G. Gastrointestinal toxicity of nonsteroidal anti-inflammatory drugs. N Engl J Med 1999; 340(24): 1888–99
Perneger TV, Whelton PK, Klag MJ. Risk of kidney failure associated with the use of acetaminophen, aspirin, and nonsteroidal anti-inflammatory drugs. N Engl J Med 1994; 331: 1675–8
Farquhar WB, Morgan AL, Azmbraski EJ, et al. Effects of acetaminophen and ibuprofen on renal function in the stressed kidney. J Appl Physiol 1999; 86(2): 598–604
Henry D, Page J, Whyte I, et al. Consumption of nonsteroidal anti-inflammatory drugs and the development of functional renal impairment in elderly subjects: results of a case-controlled study. Br J Clin Pharmacol 1997; 44: 85–90
Sandler D, Burr F, Weinberg C. Nonsteroidal anti-inflammatory drugs and the risk for chronic renal disease. Ann Intern Med 1991; 155: 165–72
Page J, Henry D. Consumption of NSAIDs and the development of congestive heart failure in elderly patients: an under-recognized public health problem. Arch Intern Med 2000; 160: 777–84
Greene GA. Understanding NSAIDs: from aspirin to COX-2. Clin Cornerstone 2001; 3(5): 50–60
Mitchell JA, Akarasereenont P, Thiemermann C, et al. Selectivity of nonsteroidal antiinflammatory drugs as inhibitors of constitutive and inducible cyclooxygenase. Proc Natl Acad Sci U S A 1993; 90: 11693–7
Cryer B, Feldman M. Cyclooxygenase-1 and cyclooxygenase-2 selectivity of widely used nonsteroidal anti-inflammatory drugs. Am J Med 1998; 104(5): 413–21
Slatis P, Ruusinen A. Orthopedic diseases and trauma in Finland: trends in consumption of health services 1970–1985. Acta Orthop Scand Suppl 1991; 241: 13–6
Asmussen E. Observations on experimental muscular soreness. Acta Rheumatol Scand 1956; 2: 109–16
Davies CT, White MJ. Muscle weakness following eccentric work in man. Pflugers Arch 1981; 392: 168–71
Armstrong RB, Ogilvie RW, Schwane JA. Eccentric exercise-induced injury to rat skeletal muscle. J Appl Physiol 1983; 54: 80–93
Lieber RL, Friden J. Morphologic and mechanical basis of delayed-onset muscle soreness. J Am Acad Orthop Surg 2002; 10: 67–73
Dedrick ME, Clarkson PM. The effects of eccentric exercise on motor performance in young and older women. Eur J Appl Physiol 1990; 60: 183–6
Manfredi TG, Fielding RA, O’Reilly KP, et al. Plasma creatine kinase activity and exercise-induced muscle damage in older men. Med Sci Sports Exercise 1991; 23: 1028–934
Roth SM, Martel GF, Ivey FM, et al. High-volume, heavy-resistance strength training and muscle damage in young and older women. J Appl Physiol 2000; 88(3): 1112–8
Roth SM, Martel GF, Ivey FM, et al. Ultrastructural muscle damage in young vs older men after high-volume, heavy-resistance strength training. J Appl Physiol 1999; 86(6): 1833–40
Morgan DL, Allen DG. Early events in stretch-induced muscle damage. J Appl Physiol 1999; 87(6): 2007–15
Warren GL, Ingalls CP, Lowe DA, et al. What mechanisms contribute to the strength loss that occurs during and in the recovery from skeletal muscle injury. J Orthop Sports Phys Ther 2002; 32: 58–64
Leiber RL, Thornell LE, Friden J. Muscle cytoskeletal disruption occurs within the first 15 minutes of cyclic eccentric contraction. J Appl Physiol 1996; 80: 278–84
Patel TJ, Cuizon D, Mathieu-Costello O, et al. Increased oxidative capacity does not protect skeletal muscle fibers from eccentric contraction-induced injury. Am J Physiol 1998; 274 (5 Pt 2): R1300–8
Leiber RL, Friden J. Muscle damage is not a function of muscle force but active muscle strain. J Appl Physiol 1993; 74: 520–6
Leiber RL, Friden J. Selective damage of fast glycolytic muscle fibres with eccentric contraction of the rabbit tibialis anterior. Acta Physiol Scand 1998; 133: 587–8
Gibala MJ, MacDougal JD, Tarnopolsky MA, et al. Changes in human skeletal muscle ultrastructure and force production after acute resistance exercise. J Appl Physiol 1995; 78: 702–8
Lieber RL, Woodburn TM, Friden J. Muscle damage induced by eccentric contractions of 25% strain. J Appl Physiol 1991; 70: 2498–507
O’Reilly KP, Warhol MJ, Fielding RA, et al. Eccentric exercise-induced muscle damage impairs muscle glycogen repletion. J Appl Physiol 1987; 63: 252–6
McBride TA, Stockert BW, Gorin FA, et al. Stretch-activated ion channels contribute to membrane depolarization after eccentric contractions. J Appl Physiol 2000; 88: 91–101
Grounds MD. Phagocytosis of necrotic muscle in muscle isografts is influenced by the strain, age, and sex of host mice. J Pathol 1987; 153: 71–82
MacIntyre DL, Reid WD, McKenzie DC. Delayed muscle soreness: the inflammatory response to muscle injury and its clinical implications. Sports Med 1995; 20: 24–40
Tidball JG. Inflammatory cell response to acute muscle injury. Med Sci Sports Exerc 1995; 27: 1022–32
Friden J, Leiber RL. Segmental muscle fiber lesions after repetitive eccentric contractions. Cell Tissue Res 1998; 293: 165–71
Malmsten CL. Prostaglandins, thromboxanes, and leukotrienes in inflammation. Am J Med 1986; 80: 11–7
Hurley JV. Acute inflammation. New York: Churchill Livingstone, 1983
Ferreira SH. Prostaglandins, aspirin-like drugs and analgesia. Nature 1972; 240: 200–3
Rodemann HP, Waxman K, Goldberg L. The stimulation of protein degradation in muscle by Ca2+ is mediated by prostaglandin E2 and does not require the calcium-activated protease. J Biol Chem 1982; 257: 8716–23
Ebbeling CB, Clarkson PM. Exercise induced muscle damage and adaptation. Sports Med 1989; 7: 207–34
Peeze Binkhorst FM, Slaaf DW, Kuipers H, et al. Exercise-induced swelling of rat soleus muscle: its relationship with intramuscular pressure. J Appl Physiol 1990; 69: 67–73
Warren GL, Lowe DA, Hayes DA, et al. Excitation failure in mouse soleus muscle injured by eccentric contractions. J Physiol 1993; 468: 487–99
Balnave CD, Davey DF, Allen DG. Distribution of sarcomere length and intracellular calcium in mouse skeletal muscle following stretch-induced injury. J Physiol 1997; 502: 649–59
Ingalls CP, Warren GL, Williams JH, et al. E-C coupling failure in mouse EDL muscle after in vivo eccentric contractions. J Appl Physiol 1998; 85: 58–67
Warren GL, Ingalls CP, Shah SJ, et al. Uncoupling of in vivo torque production from EMG in mouse muscle injured by eccentric contractions. J Physiol 1999; 515: 609–19
Warren GL, Lowe DA, Armstrong RB. Measurement tools used in the study of eccentric contraction-induced injury. Sports Med 1999; 27(1): 43–59
Baldwin AC, Stevenson SW, Dudley GA. Non-steroidal anti-inflammatory therapy after eccentric exercise in healthy older individuals. J Gerontol A Biol Sci Med Sci 2001; 56(8): M510–3
Barlas P, Craig JA, Robinson J, et al. Managing delayed-onset muscle soreness: lack of effect of selected oral systemic analgesics. Arch Phys Med Rehabil 2000; 81: 966–72
Bourgeois J, MacDougall D, MacDonald J, et al. Naproxen does not alter indices of muscle damage in resistance-exercise trained men. Med Sci Sports Exerc 1999; 31: 4–9
Donnelly AE, McCormick K, Maughan RJ, et al. Effects of a non-steroidal anti-inflammatory drug on delayed onset muscle soreness and indices of damage. Br J Sports Med 1988; 22: 325–8
Donnelly AE, Maughan RJ, Whiting PH. Effects of ibuprofen on exercise-induced muscle soreness and indices of muscle damage. Br J Sports Med 1990; 24: 191–5
Dudley GA, Czerkawski J, Meinrod A, et al. Efficacy of naproxen sodium for exercise-induced dysfunction, muscle injury and soreness. Clin J Sport Med 1997; 23: 1–6
Francis KT, Hoobler T. Effects of aspirin on delayed muscle soreness. J Sports Med 1987; 27: 333–7
Hasson SM, Daniels JC, Divine JG, et al. Effect of ibuprofen use on muscle soreness, damage, and performance: a preliminary investigation. Med Sci Sports Exerc 1993; 25: 9–17
Kuipers H, Keizer HA, Verstappen FTJ, et al. Influence of a prostaglandin-inhibiting drug on muscle soreness after eccentric work. Int J Sports Med 1985; 6: 336–9
Lecomte JM, Lacroix VJ, Montgomery DL. A randomized controlled trial of the effect of naproxen on delayed onset muscle soreness and muscle strength. Clin J Sports Med 1998; 8(2): 82–7
Lapointe BM, Fremont P, Cote CH. Adaptation to lengthening contractions is independent of voluntary muscle recruitment but relies on inflammation. Am J Physiol Regul Integr Comp Physiol 2002; 282(1): R323–9
Mishra DK, Friden J, Schmitz MC, et al. Anti-inflammatory medication after muscle injury: a treatment resulting in short-term improvement but subsequent loss of muscle function. J Bone Joint Surg 1995; 77(10): 1510–9
O’Grady M, Hackney AC, Schneider K, et al. Diclofenac sodium (Voltaren) reduced exercise-induced injury in human skeletal muscle. Clin Sci 1999; 32(7): 1191–6
Pizza FX, Cavender D, Stockard A, et al. Anti-inflammatory doses of ibuprofen: effect on neutrophils and exercise-induced muscle injury. Int J Sports Med 1999; 20(2): 98–102
Sayers SP, Knight CA, Clarkson PM, et al. Effect of ketoprofen on muscle function and sEMG activity after eccentric exercise. Med Sci Sports Exerc 2000; 33(5): 702–10
Semark A, Noakes TD, St Clair A, et al. The effect of a prophylactic dose of flurbiprofen on muscle soreness and sprinting performance in trained subjects. J Sports Sci 1999; 17(3): 197–203
Fiatarone MA, Evans WJ. The etiology and reversibility of muscle dysfunction in the aged. J Gerontol 1993; 48: 77–83
Miles MP, Clarkson PM. Exercise-induced muscle pain, soreness, and cramps. J Sports Med Phys Fitness 1994; 34: 203–16
Newham DJ, McPhail G, Mills KR, et al. Ultrastructural changes after concentric and eccentric contractions of human muscle. J Neurol Sci 1983; 61: 109–22
Ploutz-Snyder LL, Tesch PA, Dudley GA. Increased vulnerability to eccentric exercise-induced dysfunction and muscle injury after concentric training. Arch Phys Med Rehabil 1998; 79: 58–61
Nosaka K, Sakamoto K, Newton M, et al. How long does the protective effect on eccentric exercise-induced muscle damage last? Med Sci Sports Exerc 2000; 33(9): 1490–5
Clarkson PM, Ebbeling C. Investigations of serum creatine kinase variability after muscle-damaging exercise. Clin Sci 1988; 75: 257–61
Hortobagyi T, Denahan T. Variability in creatine kinase: methodological, exercise, and clinically related factors. Int J Sports Med 1989; 10: 69–80
Meltzer HY. Factors affecting serum creatine phosphokinase levels in the general population: the role of race, activity, and age. Clin Chim Acta 1971; 33: 165–72
Jones DA, Newham DJ, Round JM, et al. Experimental human muscle damage: morphological changes in relation to other indices of damage. J Appl Physiol 1986; 375: 435–48
Evans GF, Haller RG, Wyrick PS, et al. Submaximal delayed-onset muscle soreness: correlations between MR imaging findings and clinical measures. Radiology 1998; 208(3): 815–20
Fleckenstein JL, Canby RC, Parkey RW, et al. Acute effects of exercise on MR imaging of skeletal muscle in normal volunteers. Am J Roentgenol 1988; 151(2): 231–7
Fleckenstein JL, Peshock RM, Lewis SL, et al. Magnetic resonance imaging of muscle injury and atrophy in glycolytic myopathies. Muscle Nerve 1989; 12: 849–55
Fleckenstein JL, Weatherall PT, Parkey RW, et al. Sports-related muscle injuries: evaluation with MR imaging. Radiology 1989; 172: 793–8
LeBlanc AD, Jaweed M, Evans H. Evaluation of muscle injury using magnetic resonance imaging. Clin J Sports Med 1993; 3: 26–30
Speer KP, Lohnes J, Garrett WE. Radiographic imaging of muscle strain injury. Am J Sports Med 1993; 21: 89–96
Shellock FG, Fukunaga T, Mink JH, et al. Acute effects of exercise on MR imaging of skeletal muscle: concentric vs eccentric actions. Am J Roentgenol 1991; 156(4): 765–8
Takahashi H, Kuno S, Miyamoto T, et al. Changes in magnetic resonance images in human skeletal muscle after eccentric exercise. Eur J Appl Physiol 1994; 69: 408–13
Palmer RM. Prostaglandins and the control of muscle protein synthesis and degradation. Prostaglandins Leukot Essent Fatty Acids 1990; 39: 95–104
Trappe TA, Fluckey JD, White F, et al. Skeletal muscle PGF2a and PGE2 in response to eccentric resistance exercise: influence of ibuprofen and acetaminophen. J Clin Endocrinol Metab 2001; 86(10): 5067–70
Trappe TA, White F, Lambert CP, et al. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab 2002; 282: E551–6
Thorsson O, Rantanen J, Hurme T, et al. Effects of nonsteroidal antiinflammatory medication on satellite cell proliferation during muscle regeneration. Am J Sports Med 1998; 26(2): 172–6
Acknowledgements
The author thanks Steve Lanier, Dr Erica Jackson, Dr Scott Stevenson, Richard Burke and Scott Kimberly for their assistance in the preparation of this manuscript. No sources of funding were used to assist in the preparation of this manuscript. The author has no conflicts of interest that are directly relevant to the content of this manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lanier, A.B. Use of Nonsteroidal Anti-Inflammatory Drugs Following Exercise-Induced Muscle Injury. Sports Med 33, 177–186 (2003). https://doi.org/10.2165/00007256-200333030-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00007256-200333030-00002