2 VERY important reason not to use anti-inflammatory (NSAIDS) drugs when you have a tendon injury

OK, so in recent years it’s become apparent that tendons with ongoing tendinopathies don’t have inflammation in them. As a result researchers and clinicians have argued that None Steroidal Anti-Inflammatory Drugs or NSAIDS (like ibuprofen) are not useful as treatment for tendon pain. But what has not been highlighted enough is the detrimental effect that NSAIDS can have on acute tendon injury recovery as well as collagen formation in response to exercise.


I've also discussed it in this video:



NSAIDS interfere with the healing response of acute tendon injuries


While inflammation does not seem to play a role in ongoing tendinopathies, some of the more acute tendon injuries do have an inflammatory response. It’s important to understand that “acute” in this context does not refer to how painful the injury is, but rather to the nature of the injury. An example of an acute tendon injury is a strain or a tear that you’ve sustained in the last 3 to 5 days – it’s a very recent injury. Inflammation is a key part of the healing process during the first few days after sustaining an acute tendon injury.


Alarming fact about NSAIDS: What the research is showing is that, for acute tendon injuries, you can suppress your tendon’s ability to heal if you use these drugs within the first few days of the healing process when the inflammation is meant to do its job.



NSAIDS suppress the formation of new collagen fibres in response to exercise


Why am I bothered about this? Well, the research is clearly showing that the best treatment for ongoing tendon pain (like Achilles tendinopathy) is to follow a slow progressive rehab programme. The aim of this programme is to strengthen the tendon through heavy resistance training.


When we exercise all of our tissue, including tendons, sustain micro-trauma. This is absolutely normal and exactly what we want because the body then repairs this micro-trauma by producing new, stronger tendon fibres. Inflammation plays a very important role in this repair process.


Alarming fact about NSAIDS: When you take anti-inflammatory drugs, your body does not create new collagen fibres in response to exercise. This means that, by taking anti-inflammatory medication at the same time as following your rehab programme, you’re likely not going to see very good results from your rehab!


Let me know if you have any questions. Need more help with your Achilles injury? You’re welcome to consult us online via video call for an assessment of your injury and a tailored treatment plan.

Best wishes

Maryke


About the Author:

Maryke Louw is a chartered physiotherapist and holds an MSc in Sports Injury Management. You can follow her on LinkedIn, Facebook, Twitter or Instagram.



References:

  1. Christensen, B., et al. (2011). "Effect of anti-inflammatory medication on the running-induced rise in patella tendon collagen synthesis in humans." Journal of Applied Physiology 110(1): 137-141.

  2. Longo, U. G., et al. (2018). "Achilles Tendinopathy." Sports Medicine and Arthroscopy Review 26(1): 16-30.

  3. Magra, M. and N. Maffulli (2006). Nonsteroidal antiinflammatory drugs in tendinopathy: friend or foe, LWW.

  4. Virchenko O, Skoglund B, Aspenberg P. Parecoxib impairs early tendon repair but improves later remodeling. Am J Sports Med. 2004;32:1–5.

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