NSAIDs Are Killing Your Gains

Training makes us sore and there’s no way around it. There’s a multitude of things we all try to alleviate this soreness and NSAIDs (and ice) are always on top of this list. We’ve got a ton of inflammation that causes tightness and soreness and NSAIDs are a cheap and easy way to mitigate some of these unwanted side effects of training. Today we’re going to talk about why you’re better off putting that Aleve down and going for a walk instead!

What Are NSAIDs?

NSAID stands for non-steroidal anti-inflammatory. It’s a classification of drugs that help to decrease inflammation in the body. During the process of mitigating inflammation in our bodies, they also act as a pain reliever. Got a headache? Take some ibuprofen. Have an acute injury that’s causing pain? Take some naproxen. Sore from your training session? Well, a lot of us reach for that anti-inflammatory so we can move around throughout the day with less pain because life doesn’t stop just because we’re sore and tight from the day before. These NSAIDs help reduce pain associated with inflammation in our bodies, and they do a really good job of that. Perhaps too good when it’s all said and done.

NSAIDs work by blocking a specific enzyme called cyclooxygenase, or COX for short. COX-1 and COX-2 specifically are effected by these NSAIDs. This enzyme is responsible for making prostaglandins in the body and in blocking this enzyme from creating prostaglandins, NSAIDs reduce inflammation not just locally but systemically. Sounds great right? Well, not so fast. In order to understand the recovery process, we must first understand the inflammatory process and we’re going to go over that now.

The Trigger for Growth

Training is merely the trigger for growth. We don’t actually get any bigger or stronger while we’re training, that happens throughout the recovery process. What’s step one in the recovery process? Believe it or not it’s the inflammatory response. When we train we create a ton of localized damage. You’re actually creating small tears in the protein structures of the muscle cell when you’re training, specifically in the eccentric or negative phase of movements. The eccentric portion can best be described as the portion of the movement where the muscle is under tension and being lengthened. There’s three types of contractions we go through when lifting:

1. Concentric - shortening of the muscle under tension. This could be standing up during the squat or the curl part of a bicep curl. Your muscle is firing and getting shorter in an attempt to move a load. We are the “weakest” in this phase of movement.

2. Isometric - no length changes in the muscle under tension. This would be like holding the top portion of a pull up or pausing a squat in the hole. You’re not moving anywhere but your muscles are still firing. We’re second strongest in this phase of movement. You can hold more than you can lift.

3. Eccentric - lengthening of the muscle under tension. This would be like the downward portion of the squat. You don’t just fall down in the squat, your muscles are firing allowing you to control the weight while descending. We are strongest in this phase of movement. You can control negatively more weight than we can hold or move.

If you’ve ever been on an eccentric based program like German Volume Training then you completely understand how different eccentric movement is when compared to regular training. It’ll leave you feeling broken, and this is due to both the damage caused by the training and also from the over abundance of inflammation in response to the trauma caused by your training. Just getting out of bed can be an absolute chore when this happens and you’ll more than likely reach for ANYTHING that can take this pain away. In the next section we’re going to talk about the inflammatory and recovery process and how important it is to allow your body to get through it.

Signs of Inflammation

The inflammatory response is one of those things you’d probably choose not to have to go through if you didn’t have to. It can be debilitating with both acute injuries and training. You’re sore, tight and it’s tough to even move around. But there’s a purpose to all of this! Inflammation is step one in the recovery process, without this step there is no bigger/faster/stronger and your efforts in the gym and on the field would be exercises in futility.

When we train we create damage just like when you sprain your ankle. Have you ever sprained your ankle? It swells up and locks down so your body can begin to take care of the damage and rebuild so you can get back at it. There are five things typically associated with the inflammatory response:

1. Heat

   1. The area gets a little bit hotter than normal and this is due to histamine and bradykinin. These two cause the blood vessels to dilate to allow for more blood flow to the area and cause the affected area to become warmer than normal. Blood brings nutrients and oxygen but it’s also how our bodies transfer heat throughout our body.

2. Redness

   1. Same as above, more blood equals more heat and redness.

3. Swelling

   1. More blood flow equals more swelling. There is more blood brought in to the area without an increased lymphatic flow to pull everything out. More on this later.

4. Pain

   1. The body releases growth factors and cytokines due to the localized trauma. Some of these substances activate peripheral nociceptors which alert us to potentially damaging stimuli. They detect extremes in temperature and pressure (both increased due to the inflammatory response) and can cause intermittent pain signals to be sent to the brain.

5. Loss of Function

   1. Swelling and pain cause lack of function. There’s also some evidence to suggest that the body will “guard” in an attempt to minimize movement to mitigate further damage to the area.

Now the above response definitely sounds like something we don’t want. I mean who wants to not be able to walk around due to soreness/stiffness following training. Nobody’s got time for any of that! But this step is IMPORTANT, it’s the beginning of the cascade of events that facilitate recovery. We can actually mitigate a lot of this without the use of NSAIDs and ice, and we’ll discuss that later in this article.

So we know the five things that are associated with inflammation, but what’s actually happening throughout this process? We’ll talk about that now.

What Happens After We Train?

For the purposes of this article we’re going to talk about the body’s acute inflammatory response. Chronic inflammation is outside the scope of this article and the process is a little bit different. Chronic inflammation is not a good thing, and is caused by a serious underlying condition that you need to speak to your doctor about.

We know training causes positive adaptations in the long run, but how does this occur? Inflammation is step two for growth and it’s incredibly necessary (step one is your training, the trigger). Slowing down this process actually slows down your recovery and will delay your ability to train at the highest levels a little bit longer. Your body is going to go through this process one way or another, so you’re better off letting your body do its job while mitigating the pain in productive ways.

Step one is training, step two is the inflammatory response to localized trauma. Your body recognizes the damage that has occurred and will begin to try to remove the damaged tissue and rebuild in an effort to be better prepared the next time your body gets put under the same stimulus. The whole process looks like this:

1. Phase One - The inflammatory Response

   • This is an acute vascular response. This helps to increase blood flow to mobilize and transport cells to initiate healing. Damaged protein structures are removed and the body begins to lay down collagen/proteins to rebuild what was damaged. Depending on how much damage was done during your training, this can last up to a few days in length.

2. Phase Two - Repair and Regeneration

   • The body lays down collagen/proteins in a relatively disorganized manner. This is essentially scar tissue which is why your body kind of “guards” (you feel stiff and not really able to move through a range of motion pain free) in an effort to keep this new tissue together. This process begins during the initial inflammatory response, and it can last roughly as long.

3. Phase Three - Remodeling and Maturation

   • During this process the body strengthens the bonds of the newly laid collagen/proteins. Movement is actually incredibly important during this phase as it will help to cement the bonds within these newly laid proteins as well as allow for the proteins to orient along the lines of stress the body will typically face.

There’s a lot more to it, but the above steps are the gist of it. The inflammatory response to training is necessary and lays the ground work for the rest of repair. Without this stage we don’t get to repair and regeneration or remodeling and maturation. The inflammatory response is incredibly important to realizing those gains you work so hard for in the gym, and to slow that process down leads to a longer recovery time and the loss of the ability to train at the highest levels sooner.

NSAIDs and Recovery

Non-steroidal anti-inflammatory drugs put a serious damper on your recovery process. They delay the inflammatory response by prohibiting it from occurring. You may feel better in the moment and have less pain, but you’ve essentially stopped your recovery process, at least for the moment. Here’s the thing though, your body is going to go through this process one way or another, you can’t stop it from occurring you can only slow it down. Once you pop one of those pills it starts a whole cascade of events that halt the inflammatory response, hell it’s in the name “anti-inflammatory drug”. They inhibit the release of prostaglandins that signal the brain to begin the inflammatory process and also inhibit pain signals from reaching the brain. These things are GREAT for pain management and may even have you believing that you’re “recovered” because you have less pain, but your markers for muscle damage (Creatine kinase, lactate dehydrogenase, aldolase, myoglobin, troponin, aspartate aminotransferase, and carbonic anhydrase CAIII) will still be high, you’re not recovered.

In stopping the inflammatory response you’ve essentially stopped your recovery, or at minimum delayed it. Can we recover while taking NSAIDs? Yes, but the process will be delayed and inefficient, and if you’re planning on training more than one day per week you’re going to struggle to be as efficient as possible during your next training session. It’ll cost you those gains! If your body is devoting energy to recovery, you’ve got less energy to devote to your training and you’ll be sorer, longer.

What’s a Better Alternative?

So if we’re unable to use anti inflammatory meds for our recovery what helps alleviate our delayed onset muscle soreness and the soreness/stiffness that comes from the inflammatory response? Active recovery measures!

We went over the inflammatory response process, but one thing we didn’t talk about is the process of shuttling everything out. We get all this blood shuttling in the good stuff during the inflammatory response, but we’ve also gotta shuttle all that bad stuff out through our lymphatic system. This system is similar to our circulatory system with one BIG difference: our lymphatic system doesn’t have a heart to pump everything through it and it relies on pressure changes to move everything out of the area. These pressure changes come from muscle contractions. Muscles contract and relax changing the pressure placed on these vessels in the lymphatic system which allows them to “pump” all the bad stuff out of the effected area.

Remember the different kinds of muscle contractions we talked about earlier in this article? Well concentric muscle action is key in creating these pressure changes without creating more damage that we would have to recover from. Mobility work, pushing and pulling a sled, going for a walk, doing an active dynamic warm up, body weight movements (no load), etc are GREAT ways to achieve both blood flow to bring in the good stuff and the pressure changes necessary to shuttle the bad stuff out. In addition to that these movements increase what’s called “general physical preparation”. It’s almost like conditioning because it has positive effects of our heart and circulatory system, but as an added benefit it’s a good way to increase our overall workload. So you can increase your work capacity/conditioning AND recover faster? Sign me up!

Have you ever been really stiff from training and noticed that the more you sat around the worse it got? Or perhaps you’ve realized that when you get up and move around that you feel better and less stiff? This happens because we’re moving around creating both blood and lymphatic flow via muscle contractions and pressure changes. Moving around and active recovery measures work better than ice and NSAIDs, and even most passive recovery measures like normatec boots and game ready machines. Cal Dietz and his staff up at the University of Minnesota did an in house “study” where they had their athletes train and then followed this training with either time in ice baths, normatec boots, etc or a 20 minute walk. Guess who had lower muscle damage markers and lowered rates of perceived exertion the next day? Thats right the active recovery 20 minute walk group! Now this study isn’t really a study in the sense that there wasn’t a control group, and the sample size was pretty small, however it’s absolutely still worth mentioning and definitely worth further exploration in the future.

When you’re sore from training try not to reach for those NSAIDs and instead get out of the bed and off the desk and go for a walk. You’ll feel better, you won’t be increasing the likelihood of ulcers (something we didn’t really touch on here but it’s absolutely worth mentioning), you’ll be increasing your physical preparedness, AND you’ll do positive things for your heart health. Win/win/win/win!