Ibuprofen Can Worsen Recovery — A New Study Points to How
Self-medication with NSAIDs before and/or after exercise is exceedingly common, especially in older athletes. There are aches and pains and ibuprofen can take them away, making it a tempting solution before an event or hard exercise session. Unfortunately there’s no free lunch here, as a new study shows how ibuprofen can worsen exercise recovery. The answers, as always, are in the cytokines.
Exercise, Inflammation, and Anti-Inflammation
Exercise stimulates hundreds of chemical releases and changes in your body, but the focus today is on how it affects inflammation, and boy does it. It has this effect through the production of cytokines, tiny immune signaling molecules that can turn inflammation up or down depending on exactly which one has come calling. These cytokines are released by immune cells and focus on many areas of the body, trying to help them respond effectively to exercise. They’re very useful, but they have to be balanced. Since there’s a mix of pro and anti-inflammatory cytokines, they all work together to develop the right amount of inflammation to be effective during and after exercise.
Inflammation is Actually a Good Thing. Usually.
Right now, I know what you’re thinking, “Inflammation is bad, why would I want any pro-inflammatory cytokines.” And you’re right, to a degree. Inflammation is bad, but only some types of inflammation. Chronic and out of control inflammation are bad, but controlled, acute inflammation in response to exercise or injury is actually a good thing. Just yesterday, I tweaked my knee while climbing (technically it was a kneecap subluxation, but so minor compared to my other injuries that I stick with “tweak”) and it has swelled up, but not massively, and that’s a good thing. I used ice to keep the inflammation under control so I now have just enough to allow cells to heal the damage but not so much that the joint’s range of motion is affected. If inflammation weren’t good in some way, it wouldn’t happen at all. It’s a developed characteristic that helps us recover from illness, cuts, and injuries. As long as it’s kept under control.
Right now, in my knee, the minor inflammation is allowing the healing process to take place. From the onset of injury, an inflammatory cascade begins. It’s a rapid process that causes blood vessels to become more porous, allowing water and immune cells through their walls and into the interstitial spaces between cells. Once there, these immune cells can start working on the underlying problem and stimulating the healing process. In the case of my knee, the cells will begin to break down the areas that were damaged in the subluxation and stimulate the healthy cells in the area to grow new tissue and recover. As the recovery process continues, the immune cells in the area will generate anti-inflammatory cytokines. This slowly causes the inflammation to reverse itself as the area returns to normal and the tissue recovers fully.
All of that is the normal, healthy healing process. Unfortunately, things can sometimes take a turn for the worse in a lot of ways. For the case we’re talking about, the concern is the last step, when anti-inflammatory cytokines are expressed. Without those anti-inflammatory cytokines, the area will keep introducing new immune cells and begin to degrade itself. In the tissue healing process, immune cells have one job, and they’re great at it. They cause tissue to remodel itself and stimulate its growth. This is a great thing if kept under control, but leads to scar tissue build up and stiffness if not properly turned off. If the anti-inflammatory cytokines aren’t released and the tissue stays chronically inflamed, it will remodel itself too far, stay swollen, and result in a loss of function. We don’t want any of that.
Inflammation in Exercise
The knee example was good for an overall take on inflammation in general, but what about in exercise? That’s a little different, but the broad principles are the same. Part of the reason that exercise works to strengthen your body is its deleterious effect. Ever feel beat up the Monday after a particularly hard weekend? That’s this effect at work. Exercise causes micro-trauma and tears in muscle, ligaments, tendons, and more, causing these tissues to release inflammatory agents as they ask for help to heal. Their tissue remodeling process needs to be carefully monitored, just like the process currently happening in my knee. During and after exercise, pro and anti-inflammatory cytokines have to stay balanced. Otherwise inflammation won’t happen (resulting in limited gains from exercise) or it will run away out of control (resulting in limited recovery from exercise). This is a tightly balanced system that must be set up to fit just right.
And that brings us to the study at hand. A group of researchers from Texas, Connecticut, and Arkansas wanted to learn more about ibuprofen’s effects on inflammatory cytokines in response to ultra-endurance exercise. Being in North Texas, they had a perfect candidate event to use, the Hotter Than Hell Hundred. This 100 mile bike rally across North Texas attracts cyclists from all across the Plains States to ride for 5–7 hours in 90–100 degree heat. I’ve done it myself. Once. And I shan’t repeat the experience.
The researchers gave 15 athletes ibuprofen within 2 hours of the ride’s start and gave 16 others a placebo pill. They took blood samples before and after the ride and checked both for anti-inflammatory cytokine levels. The research itself was pretty simple and produced some clear results. Taking ibuprofen prior to the ride led to significantly lower IL-10 expression, an anti-inflammatory cytokine essential to immune system control in humans.
What Does This Mean For Me?
IL-10 is a complex molecule, incredibly important in the balance of pro and anti-inflammatory cytokines. It has roles in tumor suppression, immune system control, allergies, and many other elements of normal human life. Neither the authors of this article nor I are saying that taking ibuprofen makes it more likely that you’ll get tumors or have allergies due to the anti-IL-10 action in exercise. That’s not what you should take away from this. IL-10 is such a complex signaling molecule that it also plays a significant role in exercise recovery, and that’s what we care about today. This cytokine limits the inflammatory response to muscle damage, causing just the right amount of repair to take place after a workout and turning off the inflammatory response so you’re prepared to ride again. Taking ibuprofen can limit those effects.
We still don’t have all the information we need about cytokines and the exercise recovery process to know the full effects of losing IL-10, but we do know that this isn’t good in the long run. That doesn’t mean you should stop taking ibuprofen altogether, but consider stopping prophylactic use and instead use that powerful NSAID for taking care of nagging aches and pains, as it was meant to be used.
