Muscle soreness and injuries are common among runners – and many reach for pain killers such as ibuprofen without much thought. But did you know that ultra-distance running events have banned the use of ibuprofen because of the health dangers? We ask the experts why you shouldn't take ibuprofen when running.
What is ibuprofen?
Ibuprofen is a commonly used nonsteroidal anti-inflammatory drug (NSAID). Carolina Goncalves, the superintendent pharmacist at Pharmica, reveals the science of the over-the-counter treatment. She says: “Ibuprofen exerts its effects by inhibiting the cyclooxygenase (COX) enzymes, which play a key role in the synthesis of prostaglandins – the compounds involved in inflammation and pain signalling.
“Therefore, taking ibuprofen before, or while, running can blunt pain perception.”
Ibuprofen and runners
Research shows that many endurance runners regularly use NSAIDs. Indeed, one study before the 2016 London Marathon found that 46% of runners said they would take an NSAID during the race.
Other research revealed that up to 75% of runners take NSAIDS in longer distance running events.
Health dangers of ibuprofen for runners
There are a number of key reasons why taking ibuprofen before, or while, running can have a negative outcome for a runner’s health.
Masking the pain
Firstly, Carolina points out that the very fact that the ibuprofen is numbing the pain can lead to further injury.
She says: “Pain serves as an important signal to prevent overexertion and injury. By masking this pain, ibuprofen can lead individuals to inadvertently push their bodies beyond safe limits, potentially resulting in musculoskeletal injuries or exacerbating existing conditions.”
Renal issues
Carolina explains what happens to the kidneys when runners take ibuprofen. She says: “Exercise, especially running, triggers the redistribution of blood away from organs, such as the kidneys and towards skeletal muscles. This reduction in renal perfusion, combined with the dehydration often associated with prolonged physical activity, can exacerbate the damaging effects of NSAIDs.
“Ibuprofen further reduces prostaglandin synthesis, which normally helps maintain adequate blood flow to the kidneys under stress. As a result, there is an increased risk of renal ischaemia (restricted bloodflow) and acute kidney injury, particularly in the context of exercise-induced dehydration.”
Running ultramarathons can have more potential risks for acute kidney injury (AKI). Research shows there are increased rates of AKI in those who took ibuprofen.
Stomach problems
Another risk associated with taking ibuprofen before, or when, running is gastrointestinal irritation. Caroline explains: “The inhibition of COX-1 by ibuprofen reduces the production of protective gastric prostaglandins, which compromise the integrity of the gastric mucosa – stomach lining – and increase susceptibility to gastric irritation, ulcers and bleeding.
“This effect can be particularly concerning during running because the jostling motion and reduced blood flow to organs can further aggravate gastrointestinal tissues, heightening the risk of abdominal pain.”
Body temperature
Thermoregulation describes the body's ability to maintain its core temperature . This can also be affected by ibuprofen. Carolina says: “Prostaglandins play a role in the body's response to heat stress, including sweating and blood vessel dilation to dissipate heat.
“By inhibiting prostaglandin production, ibuprofen can impair these thermoregulatory responses, making it more difficult for the body to cool itself during prolonged or intense exercise.
“This can increase the risk of heat-related illnesses, such as heat exhaustion or heat stroke, which are already concerns during running, particularly in hot or humid conditions.”
Sweat and illness
Abbas Kanani, the superintendent pharmacist at Chemist Click, points to issues with ibuprofen and sodium levels. He says: “Running can cause excessive sweating and water consumption and because ibuprofen can affect kidney function and sodium balance, this can increase the risk of low blood sodium levels, a life-threatening condition known as hyponatremia."
What's the evidence: ibuprofen issues for runners?
As we have seen already, there are a number of studies on athletes and how ibuprofen affects them. There is also a body of research focused on runners.
Dr Luke Powles, associate clinical director with Bupa Health Clinics, points to two studies. He says: “A study of marathon runners has shown that taking analgesics, like ibuprofen, before and after engaging in sports can increase the risk of cardiovascular, gastrointestinal and kidney damage. The more ibuprofen taken, the greater the risk of damage to these parts of your body.
“Other research concluded that a third of those surveyed through a parkrun study had an adverse reaction to NSAID, including gastrointestinal discomfort, heart burn, nausea and vomiting, diarrhoea and gastrointestinal bleeding.”
Another study by researchers at the Stanford University School of Medicine (and several other institutions) found that people who take ibuprofen while running very long distances double their risk of acute kidney injury.
What to do about pain from running?
Dr Powles makes it clear that if you have pain from running you should speak to a health professional before reaching for analgesics like ibuprofen, especially if you have kidney disease.
He says: “Other non-medicinal treatments may help to manage your pain, like applying ice or heat to areas where it hurts, using supportive braces or bandages, sports massage therapy or complementary therapies like acupuncture or dry needling."
Taking a break from running so that you body can heal is also very important.
Ibuprofen can be a useful remedy for managing some injuries and supporting recovery but you should check with a health professional that ibuprofen is suitable for you. Dr Powles adds: "It’s important to read the medication’s instructions before taking ibuprofen. It’s advisable to take it with water, milk, juice or a meal and not on an empty stomach. Never exceed the daily maximum dosage and stop taking it if you continue experiencing pain, you start to feel unwell, or your symptoms last for longer than three days.”
