Are you relying on over-the-counter painkillers to keep you running?

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You finish a hard workout, have a shower, then peer in the medicine cabinet to consider your options: Ibuprofen? Aspirin? Paracetemol? Maybe you just down two pills without a second thought.

It’s hard to pinpoint what percentage of runners regularly take non-steroidal anti-inflammatory drugs, or NSAIDs, the technical term for many types of over-the-counter painkillers (though Paracetemol is not considered to be one), but in 2006, David Nieman of the Human Performance Lab at Appalachian State University in the US, found 70 per cent of Western States 100-Mile Endurance Run participants took a painkiller before the event.

But you don’t have to be an ultra runner to want to numb a creaky knee. ‘The usage we see in competitive athletes trickles down to recreational athletes,’ says Dr Bill McCarberg, founder of the Chronic Pain Management Program at Kaiser Permanente in San Diego, California. ‘People assume they’re safe because they’re sold over the counter, but pain relievers, particularly NSAIDs, can be risky.’

Runners who pop NSAIDs before a distance event hoping to boost their pain tolerance are making a big mistake, says Nieman. In another study, he gave ibuprofen (600mg and 1,200mg the day before and during the race, respectively) to one group of athletes and compared their performances with a group that took no drugs. There was no statistical difference between the groups’ race times, muscle damage, perceived effort or reported soreness. But some members of the medicated group did have one big consequence. ‘The ibuprofen disrupted the integrity of the cells lining the colon; there was a leakage of bacteria into the bloodstream,’ he says. This can cause a condition called endotoxemia, which can lead to septic shock in extreme cases. The issue runners are more likely to experience is amplified inflammation and oxidative stress (the breakdown of cells), which can increase soreness and delay recovery. ‘Ibuprofen can make things worse,’ says Nieman.

There are varlous reasons to suck it up and skip the drugs altogether. First off, it can help you recover better: During exercise, small tears occur in your muscles, triggering white blood cells to rush in and start rebuilding. If you take an anti-inflammatory, you may interfere with that recovery process. Pain also tells you when it’s time to take a rest day - popping a couple of pills and going out for a run with a sore foot or knee is a good way to end up with a serious injury. Finally, a 2009 study found that anti-inflammatory drugs inhibited antibody production. Hard training can suppress immunity, so adding an NSAID to the mix may make you more likely to become ill.

But, taken sensibly, these meds do help runners manage aches and pains. See below for how to do that – safely.

Ibuprofen

The pain: You twisted your ankle on a run, or you ran a hard half marathon – even walking down stairs makes you wince.

The good: Relieves swelling and aches by blocking an enzyme that creates inflammation in the body.

The bad: Can impair kidney function, more so if taken before or during a run. Can cause GI distress, more so if taken pre- or mid-run.

The fix: Take a pill (200mg) two to three hours post-run (once you’re rehydrated) for acute injury or soreness. Don’t take for more than four days.

Naproxen

The pain: You twisted your ankle on a run or you ran a hard half marathon, and you have a family history of heart disease.

The good: Inhibits the body’s inflammatory response. Provides longer relief than ibuprofen. Associated with lower heart attack risk.

The bad: Can impair kidney function, especially if taken before or during a run. Can cause gut distress, especially if taken before a run.

The fix: Take a pill (250mg) two to three hours post-run (once you’re rehydrated) for acute injury or soreness. Don’t take for more than four days.

Paracetamol

The pain: You woke up with a killer headache and have a tough workout planned, or your foot hurts but you’re determined to race anyway.

The good: Acts as a pain reliever but is not an anti-inflammatory, meaning it reduces aches without affecting the stomach or kidneys.

The bad: Can have a detrimental effect on your liver if taken frequently or in large doses.

The fix: Take a regular-strength pill (500mg) before or after a run. Skip the booze. Alcohol increases the drug’s liver toxicity. Don’t take for more than four days.

Aspirin

The pain: You are on a daily low-dose aspirin regime prescribed by your doctor.

The good: Anti-inflammatory that inhibits blood-clotting to protect against heart disease and stroke. Lessens aches and pains.

The bad: Can cause GI distress if you’re not accustomed to it. Even a low (75mg) dose can impair your blood’s ability to clot.

The fix: Safe before a run – if you are on a regime. You may want to skip it if you bleed a lot when cut. Can also worsen swelling and bruising.

Quercetin and polyphenol foods and supplements

The pain: You’re after a big goal and want to reduce the general aches and soreness that come with a long, hard training period.

The good: Diets high in quercetin (found in onions, apples and berries) and polyphenols (found in grapes and coffee) reduce inflammation in athletes.

The bad: Supplements should be discussed with your doctor and not overdosed.

The fix: Eat foods rich in natural anti-inflammatories. During particularly hard training periods, you can take a supplement to enhance the benefits.

READ: Pre-run ibuprofen won’t improve performance if you’re already sore