Are anti-inflammatory drugs useful after tendon, ligament and muscle injuries?
A summation of the article written by: Dr. Bahram Jam (APTEI: July 14th, 2014 on www.aptei.com)
Background History on Anti-Inflammatory Drugs
Non-steroidal anti-inflammatory drugs (NSAID’s) are one of the most commonly used medications worldwide and it is estimated that over 30 million people take them on a daily basis. They can be of benefit for people with various conditions. However, it is well documented that all NSAIDs have potential side-effects on the kidneys, liver, cardiovascular system and gastrointestinal (GI) systems (causing bleeding stomach ulcers). “Conservatively it is estimated that 107,000 patients are hospitalized annually for NSAID-related GI complications and at least 16,500 NSAID-related deaths occur each year in the USA.
What is the effect of excessive and prolonged use of NSAIDs for the treatment of tendon, ligament and muscle injuries and how do they affect reoccurrence rates due to inadequate repair of tendon, ligament and muscles?
The answer to the question is answered in multiple animal studies. Researchers would intentionally injury and cut tendons, ligaments and muscles on rats and rabbits. After the forced injury, half of the animals were given NSAIDs while the other half are left alone to heal naturally (limping along). After 3days, 1week, 4weeks and 2months the animals were euthanized and their tissues analyzed. Most studies found that, compared to the animals not given the drugs, those who were given NSAIDs had poorer healing and weaker tissues – concluding that the tendons and ligaments were easier to tear when pulled apart.
Various research articles stated the following:
“Anti-inflammatory drugs with the exception of ibuprofen, had a detrimental effect on healing strength at the bone-tendon junction” but “Acetaminophen (Tylenol®) had no effect on healing strength” (Ferry et al 2007)
“...NSAIDs significantly inhibited tendon-to-bone healing...” (Cohen et al 2006)
To quote the Journal of the American Academy of Orthopaedic Surgeons, “When fracture healing or spine fusion is desired, NSAIDs should be avoided” (Dahners et al 2004)
A review paper published in the Annals of Physical and Rehabilitation Medicine written by sports medicine physicians states, “We do not recommend the use (NSAIDs) for muscle injuries” (Ziltener et al 2010)
On a more positive note, there is mounting evidence (on real humans) that EXERCISE and PHYSICAL ACTIVITY have anti-inflammatory benefits.
Therefore instead of only relying on medication, correct movements(s) in the right direction(s) performed at optimum intensity and frequency may be potentially more effective in both short and long-term in those with soft-tissue injuries.
A physiotherapist is the ideal health care provider with the ability to effectively evaluate and prescribe the optimum daily exercise/movement program following all acute and recurrent musculoskeletal injuries.
The correct exercise prescription has no side effects, can help strengthen the healing tissue and may help prevent recurrences.