True story: When I was in St. Louis, there was an enormous jar by the door leading out of the Cardinals’ training room. It was filled by anti-inflammatory pills. It was huge, like those jars filled with M&M’s where kids try to guess the number in the jar. It must have had thousands of pills when full. Players would grab entire handfuls on the way out of the training room. Interestingly enough, there was a jar of antacids right next to the tub of anti-inflammatory medications. This behavior probably shouldn’t be imitated, but it is probably not uncommon in sports. Hopefully this post will help people use these medicines more appropriately.

Tip #1: Stick to recommended doses of anti-inflammatory medications.

Yes, anti-inflammatory medications (NSAIDs), such as ibuprofen and naproxen, are sold over the counter. This does not mean that these medicines are completely safe. Especially at doses that exceed recommended total daily doses, these medications can have side effects. By exceeding the total daily allowance, especially for extended periods of time, it is possible to cause gastrointestinal side effects, such as heartburn. It is possible for patients to develop stomach ulcers as well. Large amounts of these medicines are probably acceptable for short periods of time, but not for months on end.

Tip #2: Base the dose given to children on their body weight.

Unlike adults, in whom the recommended dose is fixed, the amount given to children at one time is based on body weight. Make sure when giving these medicines to children that you take their body weight into account in order not to exceed recommended daily doses.

Also read:
Take anti-inflammatory medications safely
Use of nonprescription pain medications by athletes

Tip #3: Pay attention to possible side effects.

As I said above, these drugs are not completely without risk for all patients. If you experience any continued heartburn, you should probably stop taking them, or at least reduce the dose you are taking, to prevent developing an ulcer. Also, check with your physician if you have any underlying medical problems that these drugs can worsen. While uncommon, they can be associated with high blood pressure, kidney issues, and rare cardiovascular events.

Tip #4: Use anti-inflammatories after acute injuries in conjunction with other treatments.

Acute sports injuries, such as ankle sprains, are often appropriate times to use NSAIDs. But there are other treatments that are just as important, if not more so, than anti-inflammatories. After an acute sports injury, you have to remember RICE. This is an acronym that stands for Rest (avoiding continued activity stressing the injured body part), Ice (cold therapy to decrease swelling), Compression (bandages or other efforts to decrease swelling of an extremity), and Elevation (lifting the extremity above the level of the heart to return fluid to the rest of the body and decrease swelling.

Tip #5: Take these medications for no more than 10 days after an acute injury.

While there would be some controversy about this tip for all patients, I do not believe that anti-inflammatory medications are designed to be taken for months on end. I think that they are best used for short periods of time after an acute injury. 7-10 days to me seems to be an appropriate length of time to use these medicines to decrease pain and swelling after a sports injury.

Tip #6: Consult a physician if symptoms persist.

As in the previous tip, I think that if pain and swelling persist, especially after 7-10 days, it might be appropriate to see a sports medicine surgeon. At that point, proper diagnosis of the injury and other forms of treatment, such as physical therapy, might be employed to better rehabilitate the patient. Failure to make significant improvements by this point might suggest that more serious structural damage might have occurred that could require surgical treatment.