Docs: Learn us up on inflamation, anti-inflamatories, and ice/compression!

Coach Rich

'Sup, Docs!

I'm pretty sure that all of us have been around the block enough times to have experienced all flavors of injuries to everything. Can you guys please explain to us:

• What's going on when something is inflamed?
• Why ice?
• Ibuprofen or tylenol? Why?
• Why compression?
• Why elevation?

Basically, I know that ice, compression, and elevation works but I have seen conflicting advice on anti-inflamatories (vitamin I) vs painkillers and I'd just generally like to know what's going on, the mechanisms involved, etc.

Thanks!

mgraffeo

I'd like to add one other request to Rich's, which is to discuss the use of Ibuprofen during endurance events? I've seen some pretty stern warnings, but then heard a lot of folks (here and elsewhere) who swear by it's use.

Thanks, looking forward to learning!

jamison.gaddy

Motrin can cause constriction of vessels that supply blood to your kidneys. The group of vessels called your afferent arterioles bring blood to your nephrons. A nephron is the smallest functional unit of your kidneys. In other words your kidneys are made of many nephrons. These are important because they help regulate water and sodium by filtering blood. Motrin has been found to constrict (make smaller) afferent arterioles. This could reduce the blood to your kidneys and cause kidney failure or dangerous imbalancse of sodium.  It could negatively increase your blood pressure  and potentially increase your risk of stroke. These events are not very common but certainly worth discussing.



Do not take motrin if you are dehydrated. I personally have during HIM events but will not use during IM distance events. I recommend to others not to use it at all. Certainly not toward the end or immediately after finishing any long workout or race.



Hope that helps, I’ll try to discuss the other bullets after dinner.

 

Kevin Walter

There is a rapidly expanding body of literature linking even relatively mild NSAID (Ibuprofen) use to cardiac problems, including atrial fibrillation and more lethal arrythmias. This is the issue that resulted in Vioxx being recalled from the market, but further studies (which aren't getting as much press as they should in my opinion) clearly show that the link is just as strong with other NSAIDS like ibuprofen, celecoxib (celebrex), and diclofenac (voltaren). The only one that seemed to be in the clear was naproxen (Aleve) though I would still be skeptical on that one too. Bottom line is that I don't take ibuprofen any more. Tylenol (acetiminophen) is generally safer as long as you don't exceed the recommended dose. Liver toxicity and failure kicks in at doses not much higher than what is indicated for over the counter use.

Kevin Walter

Quick follow-up: Tylenol is not an NSAID and does not have any anti-inflammatory properties per se. It is a pure pain reliever. Its biochemical mechanism of action is different from NSAIDS.

rtagher

I do not think there is a risk to using OTC antiinflammatories (i.e., ibuprofen) in short bursts for pain - say regular use for 7-14 days or so and then go off for a few weeks. For acute injury it can work wonders. However, I do not recommend regular use and personally do not use for endurance events. Even though I am a physician I gravitate towards natural products if they have been proven to work and are essentially risk free. For long term regular use I recommend Zyflamend (a mixture of natural antiinflammatories like ginger, turmeric and others). I also use arnica for a day or two after long runs/rides for muscle soreness (usually after those longer weekend efforts). If I am having more severe pain that needs acute, but short term, treatment I take old fashioned aspirin here and there but usually limit this to a few times per week.

mgraffeo

Wow, Kevin, that's a pretty compelling indictment of NSAID's overall. Any good summary resources you'd point someone towards who wanted to learn more?

Kevin Walter

@ Mike: This is a pretty good summary

http://general-medicine.jwatch.org/cgi/content/full/2011/1229/8

@ Rob: That would have been my general take until recently when studies like this started to come out.

Kevin Walter

Shoot, link doesn't work. I am inside our university so I probably have access through the university that is blocked otherwise. I will get a hard copy and post it.

Coach Rich

Docs, thanks for the learnin' about what pills to pop, not pop, etc. Now...

What's the dealio with inflamation? What's going on, is it/why is it bad and why do y'all want us to make it go away with ice, compression, elevation, etc.

morpheus

the body protects itself, goes back to when we dragged them knuckles.

Inflammation is a 'Men at Work' zone. lots going on, busy intersection stuff. Gotta get the badness out and the goodness in. Byproducts of trauma gotta get cleared, by bloodflow basically. Gotta get the fresh good blood to provide the 'Men' to do the 'at Work' stuff. Meaning, an increase in bloodflow. Damaged area swells cuz it 'recieves' all of the extra attention, not to mention that a damaged area may kick off this whole acidotic environment cuz it's releasing breakdown stuff. Any changes in pH in an area may have a role in swelling. Combine that with the increased 'incoming' trying to fix the prob and you got alot of commotion in a tight little area.

Swelling and tightness and pain -- body saying 'HEY, chill, I'm healing here, don't do X right now'.

ice -- cooling the hot area slows down the outgoing 'messages'. Why? 1) bottom line is that it tightens the vessels and capillaries, reducing the blood 'rush' to the scene. 2)may also play a role with nerve conduction. BUT you need good blood flow to get the good 'stuff' to the injured areas, SO, it's a mix...cool it to reduce the inflow, but don't overdo it so that we can heal it with good bloodflow.

elevation -- natural gravity effect. lots of 'leaking' with damaged cells. elevating the injured area helps with the passive circulation that will 'drain' the injured area back to the central circulation.

compression -- same

all the meds -- lock and key system of receptors where we're trying to trick the brain.


My apologies to the super experts if I'm off or oversimplified this very, very intricate balance.


also, I'm not a doc. I'm an anesthetist with more than enough years of Level 1 Trauma care. Just my 2cents worth, keep the change.

[Deleted User]

Hmm, interesting. I've always known that there was some controversy over stuff like Motrin, etc., but never realized the risks of such things...

That being said, I'm guessing it's important to heed the warning on the labels and not pop pills for more than a week, right? I'm guessing the risk increases as the dosage period gets longer.