• Before I start, I want to make it clear that I’m not a pharmacist or a GP and I’m not making recommendations but making sure YOU are fully informed of how non-steroid anti-inflammatories (NSAIDS) can reduce healing and cause other adverse effects.

    As a physiotherapist, I see people taking Anti-inflammatories such as Ibuprofen and neurofen on a daily basis for all sorts of pain and they seem to be the go-to for pain relief after injury, partly due to the fact that they are available to so easily, without prescription and most of the companies have huge marketing budgets.

    NSAIDs are now even used regularly by athletes that aren’t injured, just to preempt pain. In elite sports over 25% of athletes use them regularly.

    When are NSAIDs most helpful?

    In inflammatory pathologies such as inflammatory arthritis, tenosynovistis, soft tissue impingement and other similar issues where the main issue is an inflammatory pathology, rather than injury.

    When can NSAIDs have negative effects?

    In bone injuries and ligament sprains. There is evidence from numerous studies that NSAIDs delay the healing of ligaments and bone. There is some suggestion that NSAIDs could be used in the sub-acute stage after the initial inflammation had settled, however there is concern that NSAIDs could have adverse effects on healing. A suggestion has emerged from the research that NSAIDs should not be used at all in the first 48 hours after a soft tissue injury, due to their effects on healing. Like anything in the health and medical world, this is not set in stone and there may be some situations where NSAIDs in this time frame may be helpful.

    NSAIDs are also not very helpful in Tendinopathies as research has also found that these are more of a degenerative process of fibre disorientation rather than inflammatory process.

    The reason Anti-inflammatories delay healing and can cause reduced healing response is through limiting the healing process. Non-steroidal inflammatories inhibit the activity of cycloxygenaxe (COX), which is important in the formation of prostaglandins. These play an important role in tissue repair, particularly in bone and ligaments. Inflammation is part of the first stage of healing, if you reduce the initial healing phase, you reduce and prolong the subsequent healing phases – a bit like limiting a scab being laid down internally.

    Marketing from numerous companies over the years has turned inflammation into the bad guy, but it isn’t, it is crucial to healing – why mess with that unless you need to?

    Anti-inflammatories may ease pain and improve function, but is it worth using them and having a negative effect on the healing process? Particularly when there is other ways to ease pain and there are certainly other ways to improve function. It also needs to be taken into account that daily use of NSAIDs can negatively effect your stomach, cardiovascular system, kidneys and more.

    Many guidelines now recommend not to use them in the first 3 days of an injury and then if needed in the sub-acute phase after that they can be. At times when there is too much inflammation and standard pain killers aren’t helping, your doctor may advise anti-inflammatory use because the benefits outweigh the negatives. If in doubt, consult your GP.