Anti inflammatory advice

Hi all,
What are your thoughts on pills to take to reduce knee swelling/puffiness around the fornt of the knee. I had a cruciate ligament reconstruction 5 years ago and but did not have a good rehab after.

As a result I dont get full bend nor full straighten on the joint. The knee is permanently bigger and have just got used to that, however if i run on the fells and decend to quick I do get a bit more swelling. I dont need pain relief but would like to take something post race that will help calm it down and help me recover quicker.

Any suggestions? What have you used?

Thanks

Work on the RICE Principal try and avoid Anti inflamitory drugs, & see if you can find a good Clinical Sports & remedial therapist to perform some Soft tissue release manipulation, or a good sports physio

And Placebo Pills.

when you get home ice it (ice pack/bag of frozen peas/whatever)

wearing a doubled over tubigrip bandage during running/and after might minimize swelling

a second tubigrip or double over part of main tubigrip is grate for holding ice pack in place

put your leg up on the sofa (with a cushion under your knee if your knee is locking out)


- don't ice it before running
- don't wear tubigrip overnight
(i am not a doctor or physio - i have used ibuprofen gel for acute intial treatment of injuries, but you've got a chronic long term injury - one theory is that the some of the prostaglandin production that NSAIs (non steroidal anti inflammatories lke ibuprofen, aspirin, deflonac) inhibit are actually required for healing.

If you want to trial anti-inflammatories - take with food, take the recommended dose etc

- the inhibition of prostaglandins(PG) by NSAIs is indiscriminate - so as well as the PG that causes swelling etc, they also stop the production of PG in your stomach that should prevent excess acid production (in some people this PG inhibition can also affect enzymes in the lungs so exacerbating asthmatic conditions).

Did quite a bit of research into NSAI's and endurance sport for a short article I wrote for 220 Triathlon mag..... pasted in below but general gist is be careful and don't just pop them willy nilly........

Bike and run kit set-up in transition, wetsuit and goggles on, a final few sips of water and pop a couple of ibuprofen. Sounds familiar? Habitual use of ibuprofen appears to be endemic amongst triathletes and other endurance athletes. But, is it effective? Can it deaden the pain of a long event and what are the risks?

In a 2008 study on the use of non-steroidal anti-inflammatory drugs (NSAID’s) by competitors in the Brazilian Ironman, out of 327 athletes questioned, 59.9% had used NSAID’s in the three months prior to the race and 47.4% consumed them during the race as part of their fuelling strategy. The overwhelming reason for doing this was not the treatment or pain management for an acute or chronic injury but simply as a pre-emptive measure in an attempt to ease the pain of the event. However recent research, both in the field and in the lab, seems to question not only the effectiveness of this practice but also indicate it might be detrimental to our health, recovery and performance.

The Western States 100 is one of the most gruelling foot races on the planet. Covering 100 miles on the rocky trails of the Sierra Nevada, climbing over 18000ft and with temperatures ranging from well below freezing to a stifling 40C, it makes an Ironman look like a walk in the park. David Nieman, of the Human Performance Laboratory at North Carolina Research Campus, set out to study the physiological stress markers found in the blood of competitors. 70% of racers took ibuprofen before, during and after the event and, when the users blood results were compared with the non-users, as well as signs of kidney impairment and endotoxemia (bacteria leaking from the colon into the bloodstream), they also showed higher levels of tissue inflammation. He then went on the question the racers at aid stations throughout the race, and at intervals after the race, about their pain and soreness levels. He found that there was no difference in perceived pain, both during and after the race, between the users and the non-users. So, not only were the pills totally ineffective in easing the racers suffering but were also causing significant physiological stresses of their own. Lab based studies on animal tissue have indicated that NSAID’s may actually slow the healing process of injured muscles, tendons, ligaments and bones. Use of NSAID’s inhibits the production of prostaglandins that are involved in pain and the creation of collagen. Collagen is the building block of many tissues so, fewer prostaglandins means less collagen, slower healing and weaker tissues. This process is also instrumental in the breakdown and re-building of tissue that is responsible for the positive effect of tough training sessions so, if you’re popping pills to get through those sessions or to prevent soreness after, you might well be significantly reducing their effectiveness.

Dr Mike Bundy of Pure Sports Medicine www.puresportsmed.com has worked as UK Athletics Team Doctor and with England Rugby agrees: “Pain or discomfort is an inevitable part of endurance events and competitors will naturally seek relief from it but it’s important to look at the side effects profile. Just because something is available over the counter it doesn’t mean it’s 100% safe. The inherent stress of an endurance event can tip your body over the edge and heighten any negative side effects. The profile of ibuprofen isn’t great and includes gastro-intestinal bleeding, disturbance to the lower digestive tract and lowering kidney function. We’re using ibuprofen less and less.”

Mr Sanjiv Jari www.thekneedoc.co.uk is a consultant lower limb and orthopaedic sports medicine surgeon flags an additional concern: “Joint and muscular pain is there for a reason and that is to stop you from doing something that is potentially causing damage. If you mask that pain then you could be setting yourself up for degenerative joint problems such as arthritis in the future. Anti-inflammatory and painkiller use was rife in American Football and many ex-players are crippled as a result today.”

Bob Brown has run across America and Australia has completed a Deca-Ironman and is planning to run across Russia so is no stranger to pain and has fallen foul of misusing painkillers: “I never take any pharmaceutical aids, not since overdosing on painkillers during the Deca-Ironman in Mexico. I had just 100 miles to go, but a severe Achilles injury meant I couldn't even walk. I remembered back to the British 24 hours running Championships which I had won the previous year. I was given painkillers for the first time and the effect was almost instanteous. Feeling quite desperate, I just kept chugging down Red Bull and loads of Ibuprofen in an attempt to get me running. Although I set a British record of 8 days 6 hours, I was nearly dead by the finish. I was hallucinating wildly and could barely breathe. It took over 2 years to recover, the painkillers having burnt my stomach lining.”

If you’re planning on going long, a certain amount of pain and discomfort is part and parcel of the experience and, if popping pills isn’t an effective measure for coping with it, what can you do?

Train Hard: Stating the obvious but, it’s amazing how many people turn up for races under-prepared. Invest in a coach and make sure, at the very least, you’ve covered the distances required. Planet-X sponsored Hywel Davies is one of the UK’s top “endurance hard men” having won the 2008 Double Ironman UK subscribes to this: “You have to do is experience the hardest possible scenario. When I did the Ultrafit X Training events, I had to run at 14kmh on a 10% treadmill for 800m. That was very tough, but in training for it, I would find a run 10 times longer and ensure that I ran every step of it without walking. Come the race, you know that you have endured much harder.”

Cut out avoidable pain: Lower back pain from a poor bike-fit, chaffing from your wetsuit or blistering from your running shoes are all examples of pains that are totally avoidable. Make sure you iron out all of these problems on in training so they don’t affect you on race day.

Get mentally tough: Endurance sports do involve a certain level of discomfort and over-coming this is all part of the game. Bob Brown again: “What I do is try and embrace the pain. The pain is there because you are trying to do something very special. That way, pain becomes your friend. In a long stage race like running across the USA, I just think of one day at a time. The maximum I will be in pain for is ten hours, and then I will have 14 hours of relaxation. I never think of the long term goal, often months away. By breaking down a goal into small manageable chunks, it helps cope with the sometime immense pain I am suffering.”

Kim Ingleby is a triathlon coach and NLP practitioner www.energisedperfromance.com and believes strongly in the power of the mind over suffering: “If you find yourself focusing on the negative aspect of a long training session such as tiredness or discomfort breath in the qualities you need, such as strength and breathe out the*limiting factors*you no longer want, such as pain, tiredness etc. If you suffer from physical pain such as muscle cramps, aches, stomach problems etc but there is no long term damage, just a short term problem which affects performance ask, What is the benefit of having this limiting problem and what can I do right now to resolve this?* Then create a step-by-step action plan to remove the limiting problem, and focus on feeling the best possible. There are also specific NLP techniques which can be used to numb the area to allow an athlete to race pain free in that moment, through hypnotherapy and anchoring techniques but this is a very individual thing and would require a personal consultation.”

4) Recover Right: DOMS (delayed on-set muscle soreness) can be an inevitable result of a tough training session or race but by taking a number of steps it’s affects can be reduced. Hywel Davies: “I did my final year dissertation on this. DOMS comes from doing training or racing that you are not used to. It’s easy to avoid by doing specific training and building up to the event progressively.*If you can’t do that and you do get muscle soreness, then I normally use compression tights afterwards and try to do as much exercise as I can tolerate, such as cycling or rowing.* For me Linebreak tights seem to work much better than the others though. You seem to recover much more if you don’t just stop and rest but maintain a light programme.* Prevention is better than a cure but massage is helpful at about 4 days afterwards.”

In the 15 years i have been in clinical practice as a Clinical Sports & remedial therapist, I have seen Anti inflammatory Drugs used to mutch.

I work closely with clients to work on isolating the area that has the most acute inflamation. If the tissue is alowed to settle down without drugs i feel this is the better method.

Wouldn't anchoring techniques slow you down though?


Sorry.

Hi, thanks for the posts. I did wonder about Ibuprofen to be used on the odd occasion, like after a race. I dont get any issues when cycling or swimming but just impact elements of downhill running. I also dont really get much pain, more some swelling which makes the knee a bit stiff. I do ice it, raise it and I am getting some compression tights to try.
the mother in law is suggesting Emu oil - how about that for one to debate!

So can a gel form of ibruprofen be safer maybe than a pill?

Always go for a Natural Anti inflamitory gel.

Pineapple is a natural anti inflamitory, so is Ginger.

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Originally Posted by nuts250

So can a gel form of ibruprofen be safer maybe than a pill?

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I think it might be a bit safer but can still have a systematic effect (ie affect the rest of your body). So in theory (though the effect is likely to be less than taking a pill) putting gel on your kneee can affect acid production in your stomach (cazy eh).

If you use gel you need to follow the dose, not take other ibuprofen/aspirin type drugs as well (though you could take paracetemol for pain) - and remember to wash our hands.

Thanks all for the contributions. As ever have gained knowledge. Onwards to clay bank east this week! Enjoy your weekends.

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Originally Posted by ratfink

I think it might be a bit safer but can still have a systematic effect (ie affect the rest of your body). So in theory (though the effect is likely to be less than taking a pill) putting gel on your kneee can affect acid production in your stomach (cazy eh).

If you use gel you need to follow the dose, not take other ibuprofen/aspirin type drugs as well (though you could take paracetemol for pain) - and remember to wash our hands.

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Ibuprofen-type gel really can upset your stomach if it is susceptible. At one time I took lots and lots of aspirin and strong NSAIDs for migraines and injuries. Probably as a result, I now have lots of stomach problems, so never take any. My GP thought Ibuprofen gel would be OK, but when I tried it my stomach quickly got sore. This is not so surprising - after all you can kill someone by putting poison on their skin, it has been done.

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Originally Posted by nikalas

Did quite a bit of research into NSAI's and endurance sport for a short article I wrote for 220 Triathlon mag...

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Some good info there nik.

I wonder how a 'non-anti-inflams' competitor would feel about being beaten by someone dosed-up on anti-inflams? It's a form of drug abuse isn't it?

Personal opinion Try not to take them, take natural anti inflammitory .google natures aid Anti Inflammitory

My personal opinion, too, avoid taking pills. It's inflamed for a reason. Use RICE and gentle massage.

Ice is the best option

Placebo ice.

Ice............on the rocks.

maybe I'm misguided but I take anti-inflamms quite regularly (Ibup / Diclofenac) - often just after or before a race to stave off sciatic pain, and they also seem to help reduce muscle soreness as a side-effect.

Get to the root of the pain, you will regret in later lfe if you carry on taking pain killers

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Originally Posted by injury advice

Get to the root of the pain, you will regret in later lfe if you carry on taking pain killers

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An MRI revealed a prolapsed disc (I forget which one right now), which is the probable cause. So there's not much you can really do about this is there? - pilates / Alexander technique are said to help, but in the end running over rough terrain is still going to aggravate it isn't it.

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Originally Posted by injury advice

Get to the root of the pain, you will regret in later lfe if you carry on taking pain killers

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As we age our kidneys gradually work less and less well, until it is "normal" for a 75 year old to have half the renal function of a 20 year old, and 1 in 2 people over 75 actually have chronic kidney disease. This is not often mentioned, presumably for fear of alarming the elderly. Once I found this out, I did not want to do anything to compromise my renal function any more than it is already, at 67, so taking anti-inflammatories is out for me, especially during long distance events where I always end up dehydrated. Another way I do not intend to risk my kidneys is by eating a high protein, low carb diet. I used to work on a renal dialysis unit and, believe me, kidney failure is not a happy prospect.

I didn't know that about Pineapple and Ginger -that's interesting. I will try eating those and see if I feel any better. My massage therapist nj tells me to stay away from the anti inflammatory medications too but she hasn't actually told me why they're a problem. I'm happy to know that there are foods that have natural anti inflammatory properties that may be of benefit -good to know.

PS. Isn't the Isle of Man cold?

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Originally Posted by skennaugh

Pineapple is a natural anti inflamitory, so is Ginger.

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Olive oil is an natural anti inflammatory. You can drink it and rub it on your skin.