It’s tough to imagine a world without the pain-relieving, fever-reducing and anti-inflammatory properties of common NSAIDs such as Ibuprofen.
As widespread as they are in their use, what role do they play in the weight lifting community?
What are NSAIDs and what are they not?
Although this article will mainly address NSAIDs and their effects on strength and hypertrophy, I want to take the opportunity to make a certain distinction between NSAIDs, steroids (corticosteroids) and anabolic steroids simply due to the confusion among people with these similar terms.
NSAIDs are nonsteroidal anti-inflammatory drugs, commonly sold as ibuprofen and aspirin among many others. Steroids (corticosteroids), on the other hand, serve as a more powerful anti-inflammatory drug that works similar to the hormone cortisol but with significantly higher side effects than NSAIDs and are primarily prescription-only.
The other steroid known to the bodybuilding community are anabolic steroids. These are the steroids that you may automatically picture someone injecting themselves with to increase muscle mass.
Anabolic steroids are synthetic substances intended to mimic the effects of the hormone testosterone. Simply known as “steroids” these performance-enhancing drugs can lead to increased muscle mass, reduced body fat along with other undesired secondary effects.
In short, steroids (corticosteroids) and NSAIDs serve a medicinal purpose and can often be confused with anabolic steroids which can also serve a medicinal purpose in individuals who face delayed puberty or low testosterone levels but are mainly used by athletes to gain a competitive advantage.
How are NSAIDs used at the gym?
NSAIDs are commonly used among athletes and everyday gym-goers to control pain and inflammation.
Whether you are a beginner experiencing DOMS (delayed onset muscle soreness) for the first time or an experienced lifter who’s experiencing joint pain you could benefit from the use of NSAIDs.
NSAIDs seem like the perfect aid for any bodybuilder who wants to continue their workout as originally intended without the roadblocks of pain and discomfort. As the saying goes, however, too much of a good thing can be bad — NSAIDs included.
Do NSAIDs impact muscle growth?
Like most OTC medications when used in excess will have a negative side effect, but did pharmaceutical companies leave out that NSAIDs such as Ibuprofen can actually hinder muscle growth?
Participants in a 2017 paper underwent an 8-week lower-body resistance training program in conjunction with a high daily dose (1,200mg) of ibuprofen compared to a low dose (75 mg/d) of aspirin. At the end of the study, participants (men & women ages 18-35) gained less strength and saw a smaller increase in muscle volume. [1]
Long-term and high-dose use of NSAIDs such as ibuprofen can in fact inhibit certain mechanisms responsible for skeletal muscular adaptations and can be counterproductive long-term.
The manner NSAIDs hinder muscle growth can be explained through the inhibition of satellite cell activation. But what are satellite cells?
Role of Satellite cells
Satellite cells (skeletal muscle stem cells) are known for muscle mass maintenance, regeneration and hypertrophy throughout your life.
These cells drive hypertrophy in response to exercise by binding and donating their nuclei to already existing muscle fibers. This is important because without new and additional nuclei, muscle fibers could no longer hypertrophy as each cell tends to reach a ceiling of growth based on the myonuclear domain theory.
The mechanism by which NSAIDs such as ibuprofen suppress inflammation also suppresses muscle damage-induced satellite cell activation.
Consequently, cyclooxygenase-2 (COX-2), an enzyme responsible for the synthesis of prostaglandins and known activator of satellite cells is also inhibited by NSAIDs such as Ibuprofen.
Concrete evidence demonstrates satellite cells decrease with age and muscle inactivity. On the contrary, increased muscle activity can actually simulate further satellite cell activation and proliferation. [2] Of course, satellite cell activity, like hypertrophy, is largely dictated by the intensity, duration and frequency of resistance and endurance exercise.
Why is there conflicting research on this topic?
There are two studies that may show conflicting results compared to the previously discussed study.
One such study in 2008 suggested long-term use of NSAIDs don’t actually inhibit muscle growth while another 2012 study performed in older adults shows there’s an actual benefit in hypertrophy for groups that used NSAIDS.
Okay great. Now there are three studies suggesting NSAIDs will either positively, negatively or simply not affect hypertrophy at all. What now?
Let’s break down these two additional studies to find out a reasonable explanation as to why they’re giving such conflicting results.
The 2nd study from 2008 showed no negative impact of NSAIDs on hypertrophy had younger participants use a low dose of 400mg of ibuprofen per day. With such a low dose of ibuprofen, it’s difficult to assess any negative or positive impacts on hypertrophy.[3] I would argue, however, that this is the most realistic dose people with mild muscle discomfort opt for either way.
The 3rd study from 2012 that reported a benefit to hypertrophy in older adults had participants use 1,200mg of ibuprofen a day.[4] It’s possible that elderly adults who often experience inflammation throughout their bodies could potentially have had high baseline levels of inflammation. With such a high inflammation baseline, skeletal muscle adaptation may have been negatively impacted. By reducing their baseline inflammation using high doses of ibuprofen, the study demonstrated an added benefit to hypertrophy.
What can we take away from these three studies?
Like many subjects of discussion in weightlifting, the use of NSAIDs is not necessarily a black or white matter. The effects on hypertrophy and whether it will actually have one largely depends on multiple factors such as:
- age
- baseline inflammation present
- training status
- frequency and dosing of NSAIDs
PHF on the subject
I know this can come off as a bit concerning for many lifters who are looking to maximize their growth potential and minimize losses.
For anyone who is considering using ibuprofen if they have joint or muscle pain following a heavy day of lifting, I want to remind you that these results point towards a long-term, high frequency, high dose usage of NSAIDs. Using ibuprofen acutely is not likely to disrupt any strength gains or muscle body adaptations.
This isn’t meant to give you the green light and resort to NSAIDs every time you experience a muscle or joint ache. Give rest to your body when it’s due to avoid injuries as chronic muscle and joint aches may be indicative of lack of rest or improper form among other possible underlying diseases.
Despite ibuprofen being the main NSAID of discussion, it is believed common NSAIDs will have a similar effect on strength and hypertrophy if used over a long period of time at high doses and high frequency.