Why I Avoided NSAIDS During My Stress Fracture Recovery

When I first got injured I immediately started researching and quizzing my husband about what I should and shouldn’t be doing.  I wanted to make sure I wasn’t doing anything that would jeopardize the healing process.

One of the first thing I remember Wes telling me was to not take NSAIDS.  NSAIDS stands for Non-Steroidal Anti-Inflammatory Drugs. There is a whole bunch of them but the main ones you have heard of:

  • Ibuprofen
  • Aspirin
  • Diclofenac
  • Naproxen


How do NSAIDS work?

NSAIDS obviously are used for cases where pain and inflammation are present. You take them for headaches, body aches, and even to help reduce fevers.

NSAIDS work to reduce inflammation by blocking a key enzyme of the inflammation process called cyclooxygenase, which converts arachidonic acid to prostaglandins and leukotrienes.  Prostaglandins are what cause inflammation, so when NSAIDS work to block the process it in return reduces inflammation.

 

How does bone repair itself?

The bone healing process after a fracture typically works as such.

Stress Fracture Healing

(source)

As soon as the fracture begins it forms a hematoma around the site of the fracture.  At this point the inflammatory agents begin forming around the area to begin to initiate the healing process.

Inflammation helps to trigger cell division and growth of new blood vessels to help heal.  At this point the soft callus begins to form around the area.

Eventually as the process continues a hard callus begins to replace the soft around the broken area of the bone. As time continues, very strong bone replaces the weaker bone.  This is “remodeling” the bone and thus makes it the only tissue to heal without a scar.

 

So what’s the problem with NSAIDS and bone healing?

If you haven’t figured it out already, inflammation plays a key role in the healing and remodeling of bone.  If it weren’t for the inflammation process then the callus would not be as quick to form around the weak area.

NSAIDS as I stated above help to reduce inflammation by blocking the enzyme that begins the process.  If you are block the enzyme, not allowing the inflammation process to begin, then you are essentially slowing down the bone healing process. Inflammation is the key component to the bone healing process.
If you are one who enjoys reading studies here are a few:

Effects on Non-steroidal Anti-Inflammatory Drugs on Osseointegration: A Review.
The Detrimental Effects of Systemic Ibuprofen Delivery on Tendon Healing are Time-Dependent
Timing Matters: NSAIDS interfere with the late proliferation stage of repaired rotator cuff tendon healing in rats
Non-steroidal anti-inflammatory drugs’ impact on nonunion and infection rates in long-bone fractures.
NSAIDS and Fracture Healing
NSAIDS can have adverse effects on bone healing.
NSAIDS Prevent Proper Fracture Healing
Do Non-steroidal anti-inflammatory drugs affect bone healing? A critical analysis.

 

Other reasons I avoid NSAIDS

1. GI Issues – NSAIDS have been shown to cause a disruption of the stomach lining causing things such as: nausea/vomiting, dyspepsia, gastric ulceration, and diarrhea.  This has mainly been found in those who take NSAIDS very often. Not just for the occasional headache.

2. Delay of Muscle Healing – Along with NSAIDS interfering in the bone healing process, there has also been some research done showing that it can also delay muscle healing. This isn’t quite as discussed as the bone healing interference, but you can read more about it here.

 

Options for NSAID replacement

Of course, when I was dealing with my stress fracture I was in pain. It isn’t always easy to just sit there and “take” the pain.  If I have to take something I try to take a natural anti-inflammatory such as:

These are all three items that we have at home and that I took during my recovery process, and even though they still can delay the bone healing process since they are anti-inflammatories I prefer the natural forms over NSAIDS.

 

I know this is a little bit different of a post, but since I do on occasion get comments and emails from some of you who are either just getting diagnosed with a stress fracture or going through the healing process and want information on things you can do.  This is one of the biggest things that I made sure to eliminate when going through the healing process.

 

Have you ever tried a natural form of anti-inflammatories?

About Sara

Welcome to my blog! My name is Sara and this blog documents my journey as a wife and a runner. I train hard and put my heart and soul into my running. My life is a crazy journey full of ups and downs, and I am here to share it all with you!

18 comments

  1. Great information! Doesn’t cinnamon also have anti-inflammatory properties? It’s delicious and you can sprinkle it over anything that’s sweet! I bake with it a lot and add it to my oatmeal every morning.

  2. This is such an interesting topic Sara, and I could not agree more with you on this one. I am way of all NSAIDS after my most recent scare with them. Before my marathon I had a muscle strain, and I was so determined that i was still going to run sub 2:40 that I took well over the recommended amount for a week straight. The race was a complete disaster….well, I still ran a very respectable 2:49, but my body was in a bad place. My doctor said I was lucky I did not go into kidney failure, and I am positive the NSAIDS had a huge effect on my body going through what it did. I am definitely scared of them now, and do not plan to ever really use them again..

    Hope your stress fracture is healing up well, I know how much they suck, but you will come back stronger than ever :) I have not tried natural anti-inflammatories, but I do use primal sport mud, which I have information about on my blog. I find that really helps with muscle injuries.

    • Yes I am on the mend of my stress fracture! I am running again and getting back into it. This is a post I had on my “to do” list for a while so It though I would go ahead and share!

      Primal sport mud – I have never heard of that but I am going to have to check out your blog and that product! I love learning about new products.

  3. Yeah … I had a bit of an issue with advil last year. I have chronic TMJ pain and it flared up really bad when I started training for my first marathon. Combine 10-12 advil a day with 50 miles a week and GI distress became serious very quickly. One trip to the gastroenterologist who told me what could happen if I didn’t stop taking advil immediately and I quit cold turkey. I think I’ve had 2 since then!

    • Wow! Yes NSAIDS can cause serious GI issues! Thats amazing you were able to quit cold turkey. Do you take any natural anti-inflammatories or do you just deal with the pain and discomfort?

  4. Very interesting, thanks for covering this. I, too, have experienced GI issues when I was prescribed to take NSAIDS. I’ve resorted to several natural remedies.

  5. I see so many people with red flags of ‘abusing’ the advil/tylenol especially when training – they feel a pain and then need it to continue, and then shortly after their big race they have a raging injury. I totally understand on one hand you have this BIG goal and you want to accomplish it, but if you are seriously injured then you are out of the game way longer.

    • Yes you are so right Jade! I wish others would realize this – it’s not always good to mask you pain with advil/asprin or whatever pain reliever is chosen.

  6. This is great info. I think a lot of people can get confused because sometimes doctors recommend them. I ran in college and fractured my foot and the doctors and trainers gave me an anti-inflammatory immediately after they saw the x-ray. Luckily, I was in my third year of being a Kinesiology major so I had learned how they messed with the natural healing process. I’m just amazed at how many doctors over-prescribe them, especially early-on with an injury to the bone because it’s that much more crucial to not take them during that period. As for natural anti-inflammatories, I love arnica! I usually use a cream called Topricin that has arnica and a whole bunch of other anti-iflammatories in it whenever I’m dealing with some inflammation issues.

    • We have an arnica cream that I love to use for aches and pains! It’s great! Yes, it is confusing when doctors are recommending people to take them when they really shouldn’t. I think it is always important for us to educate ourselves as well!

  7. i love that you focused on good food and spices! love turmeric for healing powers

  8. Absolutely could not agree more. After 2 (probably more like 3) stress fractures within a 2 year period, I started doing my research, too, and found NSAIDS to be actually hindering my healing instead of helping, like many doctors say! It’s crazy! If you haven’t already, you should check out http://www.camilleherron.com . She’s an elite marathoner and anti-nsaids advocate, too. She did her masters thesis on bone-healing, and after reading it, I was pretty convinced.

    • I love Camille Herron! She was such a source of encouragement when I first got diagnosed with my stress fracture. I think I read over her entire blog about 5-10 times :)

  9. SUCH a great post, Sara!!! I used to pop Advil ALL the time for chronic headaches, and cut them almost cold turkey about 5 years ago (well, I’ve probably taken them 10 times since then). People don’t realize how they can interfere with our body’s healing mechanisms (and cause additional damage). Thanks for spreading the word!

  10. Thanks for sharing. I agree and all of the people who keep telling me to take them for pain just don’t understand. What I really want to know is what your take is on wearing a cast or boot. Wearing a boot now actually hurts a lot more than when I am not using it. . I am wearing a light-weight brace that straps around my ankle area. It’s been about 3 weeks since this happened and I don’t know where to go from here. Wearing my 5 fingers shoes and an ice pack feels best of all. It just doesn’t make sense to me. Did you wear a boot? Thanks so much for any feedback you can give!

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