by Geoff Rand
In Part 1 of this article we learned about the body's response to tissue damage and how inflammation is a natural response that is the start of the repair and healing process. In Part 2 we'll look at NSAIDs and their effects and some alternative treatments.
NSAIDs are Non-Steroidal Anti-Inflammatory Drugs. They include the common-named medicines like Ibruprofen, Motrin, Advil, Aleve, Tylenol, and Nuprin. NSAIDs work by inhibiting the activity of cyclooxygenase (COX), an enzyme that is part of the cell repair process. While COX works to repair cell damage, a byproduct of this action is increased sensitivity to pain. NSAIDs block the production of the COX enzymes, and thus the pain from the inflammation isn’t felt. Good, right? Not really. Here’s why.
While some enzymes of the COX family do cause an increase in pain sensitivity, others in that family control production of platelets that protect the stomach lining. This can cause bleeding and ulcers when they aren’t allowed to function normally. Other functions of COX enzymes are protein metabolism and stimulation of satellite cell proliferation, which when suppressed, result in greatly reduced muscle growth. Long term use of NSAIDs can cause liver and kidney damage. When you limit COX production, you can also set yourself up for increased chance of heart attack or stroke.
It would be great if the pill you ingested knew where it was needed and only affected that area, but it doesn’t. Once the medicine is released, it affects the whole body, whether it is needed or not.
So when you take that pill, you are causing many vital body functions to be acted upon, not just your pain receptors. While an occasional NSAID use is not likely to completely derail your training regimen or muscle growth, continued use, like we practiced in the Army, can lead to greatly reduced benefits from exercise and, more serious health problems associated with suppression of important body functions.
So, if taking a pill is bad for me, then I’m back at being in pain and not wanting to workout or feeling unable to move, right? What are my alternatives?
Dr. Kelly Starett of Mobility WOD advocates MCE, Movement, Compression, and Elevation. In this treatment, you move safely what you can, when you can. Compress lymphatic and soft tissue, which helps carry waste material away from the injured area. Elevate to further help drain the affected area. Note that MCE has replaced RICE (Rest, Ice, Compression, Elevation) as the recommended treatment for soft tissue and joint injuries. Icing is especially detrimental to the healing process.
Along the lines of the MCE prescription are techniques to mobilize the inflamed areas like regular mobility sessions or yoga. While the benefits of mobility classes are pretty easy to see, yoga has been shown to reduce the production of stress hormones that promote inflammation, and reduces the number of pro-inflammatory molecules in the body. Plus the gentle movements help to increase blood flow and encourage movement of lymphatic fluid, aiding reduction in inflammation.
Curcumin, which is found in the spice Tumeric, is sometimes referred to as a natural NSAID. It doesn’t suppress all of the COX enzymes, and is considered a safer alternative to the synthetic NSAIDs. It also has other beneficial characteristics such as reduction of muscle atrophy, normalizing the effects of insulin, and reduction in estrogen levels (which could lead to increased testosterone levels). Note that unaltered Curcumin has low bioavailability. This means that in 1-2 hours, the level of Curcumin retained by the body is much less than when it was originally ingested. To assist with the duration of the Curcumin’s effects, choose a brand that pairs it with ingredients that increase its bioavailability.
You can also take a high quality Omega-3 fatty acid, like fish oil. Omega-3s help to increase blood flow, which aids in muscle recovery and growth and reduces inflammation. It has also been shown to have benefits to heart and immune system health.
There is always the option of foam rolling or light to moderate exercise. Both treatments will assist with keeping the affected areas mobile and help drain the lymphatic fluid from them. Electronic Muscle Stimulation therapy may also be helpful to optimize your recovery and get you back to normal faster.
Finally, inflammation can be caused by diet. This type of inflammation is undesirable and avoidable. Some smart changes to your diet like cutting out dairy, breads, processed foods, and sugar will greatly reduce your inflammation, as I’ve found during the Lurong Challenge. I don’t think it’s a coincidence that my shoulder issues have gone away since eating clean. Don’t forget to hydrate as well. Staying hydrated is a key element in ensuring the body is functioning properly and flushing out the toxins it needs to get rid of.
Inflammation can be a good thing, and you should be experiencing some degree of it if you are pushing yourself to be better, faster, and stronger. Welcome the feeling as proof that you are working hard toward your goals. Just don’t try to interrupt your body’s natural method of recovery by immediately reaching for a pill. Embrace the suck.