A Guide to Using Drug Store Pain Medicine for Runners

How to use over-the-counter pain meds to treat running-related injuries

a runner's guide to over the counter pain medicine
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You finish a hard workout, head to the shower, and peer in the medicine cabinet to consider your options: Advil? Motrin? Aleve? Maybe you reflexively grab a bottle and down two pills in a single gulp without a second thought.

“Unfortunately, many long-distance runners are chronic users of ibuprofen. Mainly, they think it’s going to reduce pain associated with exercise,” David Nieman, Ph.D, FACSM, director of the NCRC Human Performance Lab at Appalachian State University tells Runner’s World.

But in fact, the opposite is true. Researchers have proven the persistent use of pain medicine for runners can have negative health impacts. According to a study conducted by Nieman, the chronic use of ibuprofen in long distance runners stimulated mild endotoxemia—bacteria leaking out of the colon into the blood stream due to ibuprofen intake—and increased inflammation.

In another study, Nieman and his colleagues found taking ibuprofen during intense exercise amplified oxidative stress—an excess of free radicals (molecules that can damage your cells and cause disease) in your body. Too much oxidative stress can overwhelm your muscle tissues and possibly lead to injuries.

“Ibuprofen—especially [in] those who are chronically using it before the race, training, and during the race—tends to disrupt the lining cells of the gastrointestinal track,” Nieman says. Researchers discovered long-distance runners who took ibuprofen a week after completing a 100-mile race didn’t experience reduced inflammation or muscle soreness. Instead, Nieman says, it made things worse. “Their kidney function was altered in a negative way,” he says.

And, recent studies back Nieman’s findings. In a 2016 study, researchers found ultramarathon runners who took ibuprofen experienced acute kidney injury—a sudden decrease in kidney function—at higher levels than those who received a placebo.

You don’t have to be an ultra super-stud to want to numb a creaky knee. Bill McOarberg, M.D., founder of the Ohronic Pain Management Program at Kaiser Permanente in San Diego, California, says the use of over-the-counter pain medicine trickles down from competitive athletes to recreational runner. “People assume they are safe because they are sold over the counter, but pain relievers, particularly NSAIDs, can be risky,” he says.

To cut back on the risk, maintaining a rainbow diet—eating lots of colorful fruits packed with polyphenols—can help athletes naturally reduce inflammation and aid recovery, says Nieman.

But of course, runners rely on over-the counter medicines to treat more than just running related aches and pains. So, here’s how to safely take drugstore meds to treat your aches and woes.

Ibuprofen (Advil, Motrin)

a runner's guide to over the counter pain medicine
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The Pain: You twisted your ankle on a run, or you ran a hard half marathon and 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. (NSAIDs inhibit blood flow to the kidneys. Kidney circulation can also be suppressed by dehydration. So a dehydrated, NSAID- using athlete’s kidneys could struggle to maintain a proper fluid and electrolyte balance.) Can cause GI distress, more so if taken pre or midrun.

The Rx: Take 1 pill (200 mg) 2-3 hours postrun (once you’re rehydrated) for an acute injury or severe soreness. Don’t take for more than four days.

Naproxen Sodium (Aleve)

a runner's guide to over the counter pain medicine
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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-lasting relief than ibuprofen. NSAID associated with lower heart attack risk.

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

The Rx: Take 1 pill (220 mg) 2-3 hours postrun (once you’re rehydrated) to relieve an acute injury or severe soreness. Don’t take for more than four days. (Taking NSAIDs could increase muscle soreness if taken before or too soon after exercise. Ibuprofen can allow endotoxins to slip into your blood stream, which can cause cell oxidation and result in muscle soreness.)

Acetaminophen (Tylenol)

a runners guide to over the counter pain medicine
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The Pain: You woke up with a killer headache and have a killer workout on tap. Or your foot hurts but you're set on racing anyway.

The Good: Acts as an analgesic but is not an anti-inflammatory, meaning it relieves aches without impacting the stomach or kidneys.

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

The Rx: Take 1 regular-strength pill (325 mg) before or after a run. Skip the booze. Alcohol increases the med’s liver toxicity. Don’t take for more than four days.

Aspirin (Bayer, Excedrin)

a runners guide to over the counter pain medicine
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The Pain: You are on a daily low-dose aspirin regimen prescribed by your doctor.

The Good: Anti-inflammatory that inhibits blood-clotting to protect against heart disease and stroke. Analgesic that lessens aches and pains.

The Bad: Can cause GI distress if you're not accustomed to it. Even a low 81 mg dose can impair your blood's ability to clot. (NSAIDs block an enzyme that produces a layer of mucus that protects your stomach. Without it, you’re prone to nausea, diarrhea, and stomach cramps.)

The Rx: Safe before a run, if you are on a regimen. Trail (or clutzy) runners may want to skip due to risk of bleeding. Can also worsen swelling and bruising.

Quercetin & Polyphenol

a runners guide to over the counter pain medicine
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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, berries) and polyphenols (found in grapes, plums, coffee) reduce inflammation in athletes.

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

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

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