In this article, Sarah Cormack, Senior Physiotherapist at Therapeutics, explores the use of NSAIDs among endurance athletes, highlighting the potential health risks, how these medications affect the body during long-distance events, and safer alternatives for pain management. 

Many long-distance runners take Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) — such as ibuprofen, naproxen, and aspirin — before or during races to manage pain. While they might provide temporary relief, it’s important to understand the significant health risks associated with their use during exercise.

How NSAIDs work

NSAIDs are anti-inflammatory drugs that reduce pain by decreasing inflammatory signals in the body. Many athletes use them to ‘take the edge off’ discomfort, but this can be risky, especially during endurance events.

Risks of NSAID use during exercise

Risk Area Effects Implications
Gut stress Irritation, ulcers, bleeding Exercise diverts blood from the gut; NSAIDs worsen stomach lining damage, increasing gastrointestinal issues and potential withdrawal from races
Kidney strain Reduced blood flow, potential injury Dehydration and heat stress compromise kidney function further when NSAIDs restrict blood flow, risking kidney failure
Cardiovascular load Fluid retention, increased blood pressure High core temperatures and dehydration, combined with NSAID effects, increase risks of edema and heart damage

Real-world data

A study involving approximately 4,000 marathon runners found that those taking NSAIDs before a race experienced more complications, including:

     

      • 3 cases of kidney failure

      • 4 gastrointestinal bleeding incidents

      • 2 heart attacks

    In large marathons, NSAID-related medical emergencies can amount to up to 80 cases, prompting some events to ban ibuprofen for safety reasons.

    Safer alternatives

       

        • Topical Agents: Gels like Voltarol have lower systemic risks.

        • Non-Drug Options: Applying ice, managing training loads, ensuring proper recovery, and consulting physiotherapists.

      Final Advice

      While NSAIDs can offer temporary pain relief, they pose serious health risks during endurance activities. Before your next race, consider whether you truly need them, how they might affect your performance, and explore safer options.

      Ask us if you have any questions.