Fewer Gains, Possible Injury from Four Popular Meds
Are you an athlete? Do you train athletes? Then pay attention to this little article on popular medications (one even OTC, not prescribed) and the potential for either muscle damage, tendon damage, or even rupture. One may also have a negative effect on your body's ability to synthesize protein for muscle growth. What you don’t know, might hurt you. But armed with this little bit of information, you may be able to prevent injury, or at least avoid shorting your gains. And these are things that all performance-oriented minds want to know.
The NSAID: Non-steroidal anti-inflammatory drugs, like ibuprophen, naproxen, and the like, are taken with regularity and frequency in athletic circles. In fact, many times this drug is taken before competition in contact sports as a prophylactic aid to combat pain. However, prolonged use could inhibit training-induced strengthening of myotendinous junctions and increase vulnerability to injury. Furthermore, using NSAIDs can slow tissue repair phases where inflammation is used to release cytokines, chemoattractors and other factors involved in tissue regeneration and repair. This process is not just for injury, either. The same holds true for the catabolic to anabolic state muscles go through during hypertrophic resistance training cycles. NSAID use is shown to inhibit post exercise muscle protein synthesis – which will lessen your gains in the gym.
- Fluoroquinolone Antibiotics
There’s a family of antibiotics, originally designed to fight anthrax and other drug-resistant bacteria, that is being prescribed widely for a variety of “normal” infectious pathologies like bladder, urinary tract, sinus, and upper respiratory infections. Unfortunately, Fluoroquinolones have been implicated in tendinopathy and subsequent rupture, mostly in the Achilles, but newer research has found similar issues in gluteal and hamstring tendons. Going by the names Cipro, Levaquin, Noroxin, and more, these drugs are still being prescribed as of the publishing of this article, yet the damage to tendons is real. The drug seems to inhibit the actions of tenocytes, the main cellular component of tendons that promotes its own proliferation, as well as the formation and synthesis of collagen. Unless you have allergies to the more common antibiotics, if it’s absolutely necessary to take one, then ask your doctor for the more basic ones, like those in the penicillin family.
Less common but still found is tendon damage from statin use. Statins are used to lower cholesterol, and have already been implicated in muscle weakness and peripheral neuropathy. However, a certain percentage of statin users also develop tendinopathy, and changing brands does not seem to help once it’s developed. While younger athletes aren’t likely candidates for statin prescription, your masters athletes may be, so caution should be taken when training, especially for those ultra-endurance masters competitors. The risk from repetitive microtrauma under training loads common to ultra-endurance athletes/triathletes, combined with use of statins, could create career-ending damage.
What about corticosteroids? Aren’t they used to treat damaged joints? Steroid injections have been shown to cause tendon rupture in several areas, including the great toe, Achilles, and even quadriceps tendons. And the quad tendon rupture was a case report of a bilateral tear after repeated inhaled (nasal) steroid use for a different condition, far away from the leg muscles! Many athletes receive cortisone injections to break up scar tissue after an injury, but the deleterious effect may not be localized to the scar tissue, but infiltrate adjacent, healthy tissues, as well. Best to be careful with this one, too.
While this may not be exhaustive, it’s a start in creating awareness of very common medications present in the sport and athletic world. Now you can make an informed decision as to whether or not taking that pill, or getting that injection, is the best for your overall performance and greatness!
Blanco, I., Krähenbühl, S., & Schlienger, R. G. (2005). Corticosteroid-associated tendinopathies: An analysis of the published literature and spontaneous pharmacovigilance data. Drug Safety, 28(7), 633-643.
Chen, M., & Dragoo, J. (2013). The effect of nonsteroidal anti-inflammatory drugs on tissue healing. Knee Surgery, Sports Traumatology, Arthroscopy, 21(3), 540-549.
Sharma, P. & Maffulli N. (2005). Tendon injury and tendinopathy: Healing and repair. Journal of Bone and Joint Surgery, 87-A(1), 187- 202.
Goya, Dennehey, Barker, & Singla (2015). Achilles is not alone! Ciprofloxican induced tendinopathy in gluteal tendons. QJM: An International Journal of Medicine, 0(0), 1-2.
Mackey, A.L., Mikkelsen, U.R., Magnusson, S.P., & Kjaer, M. (2012). Rehabilitation of muscle after injury – the role of anti-inflammatory drugs. Scandanavian Journal of Medicine & Science in Sports, 22(4), e8-e14. Doi: 10.1111/j.1600-0838.2012.01463.x.
Omar, M., Haas, P., Ettinger, M., Krettek, C., & Petri, M. (2013). Simultaneous bilateral quadriceps tendon rupture following long-term low-dose nasal corticosteroid application. Case Reports in Orthopedics, 1-5. doi:10.1155/2013/657845
Schoenfeld, B.J. (2012). Does exercise-induced muscle damage play a role in skeletal muscle hypertrophy? Journal of Strength & Conditioning Research, 26(5), 1441-1453.
Warden, S.J. (2010). Prophylactic use of NSAIDs by athletes: A risk/benefit assessment. The Physician and Sports Medicine, 38(1), 1-7.