I tend to mash down on my teeth when I strain during heavy deadlifts. The discomfort from this movement is temporary, and by the time I finish stretching after the WOD, the pain is gone. But what if you have recurring and persistent pain from seemingly innocuous exercises like running? That may be a sign of potentially serious dental issues, and really whole body issues, that you need to address.
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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.
by Geoff Rand
When I was in the Army, we pretty much ran on Motrin. Before a long run, after a long run, after a long ruck march, after a vigorous Physical Fitness Test, before bed, after waking up, we took it all day long. We called it Ranger Candy or Vitamin M. The medics handed it out like M&Ms. I’ve since found out that this was a horrible practice and suppressing the body’s natural pain response is extremely counter productive to the healing process.
Inflammation is a response from the immune system after experiencing tissue damage. Tissue damage can be in the form of micro tears that are normal occurrences when building muscle by lifting weights or stressing our joints when running or jumping. It can also be more serious damage like a strain, sprain, or tear.
Whatever the cause or degree of injury, the body’s response is the same. The inflammatory process happens in three phases. In the first phase, blood saturates the site of the injury, which causes heat, swelling and associated pain, and stiffness. Think of this phase as the fire department being called to put water on a fire. Then, specialized white blood cells come in and soak up the damaged cell debris. They are like the trash trucks hauling away the garbage. In the third phase, cells called macrophages move in and start to rebuild the damage. They are the construction crew.
Inflammation is a necessary process for the body to heal and become stronger. The swelling and pain produced is a signal to discontinue the activity that caused the injury while the body recovers and rebuilds. Studies have shown that the more you stress your body, the more resistant it is to experiencing the pain from inflammation. In other words, the harder you work your muscles and joints, the more stress they are able to take before they start to signal you to slow down. Think of how you feel on your first day back at CrossFit after returning from vacation. You need to rebuild your tolerance to the stresses your body was able to withstand before you left.
If you train too hard for too long without adequate recovery time, the body will become overwhelmed trying to put out all the fires, and things will start to break down. Muscles and joints become chronically inflamed or degenerate to the point of a serious injury occurring.
Recovery time is essential, but your regimen should not include popping a pill for pain. Studies have shown that taking certain pain medications after a workout can nearly totally negate any gains you may have made during that session.
In the medical community and society as a whole, there has been a trend to treat pain as an illness by taking medication to suppress pain. In certain cases taking pain meds is appropriate, like with a broken bone or after surgery, but for every bump and bruise and general soreness after a workout, it is not. Suppressing the natural healing process might make the pain go away, but it will also delay and increase the recovery time. And, taking some common pain reducing medications can cause other undesirable effects throughout the body.
In Part 2 of this article, we’ll look at what NSAIDs are and how they affect the body when taken as well as some alternatives to taking them.