It is a scenario that no athlete wants to occur, yet it is also a situation that at one time or other every athlete will find him/herself confronting… being injured.
For many athletes, determined to return to play as quickly as possible, injury treatment is likely to include some form of analgesic pain relief or anti-inflammatory (reduces fluid and chemicals from the injury process) medicine.
When using such medication, you should be aware of the following points:
- They should be used with care and under proper medical supervision.
- The medication will affect both the injury site and your overall body systems.
- What happens when you sustain an injury and what the stage of healing is, impact upon whether it is or is not appropriate to take analgesic or anti-inflammatory medicines.
Anatomy of an injury
Acute (new) soft-tissue injuries are usually the result of an accident (like a fall on the court) or a result of an acute overload of the tissue (like a ligament or muscle), causing it to tear or break.
All injuries, regardless of severity, should be checked out by your doctor or health care provider, or with the Sports Medicine Therapist / Trainer (SMTT) on-site at a tournament. For acute injuries of any severity, the healing process occurs in stages over time:
Inflammatory Phase: 0-72 hours after the injury is sustained:
- Chemical stimulants are released from the injured cells that cause the tissues to bleed, swell and intensify the pain.
- Treatment should focus on decreasing the damage caused by the inflammatory response.
- Remember PRICE = Protection | Rest | Ice | Compression | Elevation.
Repair Phase: Continues from 72 hours to about 6 weeks after the injury:
- Special cells actively repair all the torn tissue structures. Scar tissue is formed at the site of the injury.
- For up to 6 weeks this scar is quite weak and vulnerable to re-injury (even when the initial injury is slight).
- Treatment aims to gradually and gently stretch and strengthen the repairing tissue, without overloading it.
- Exercises, supportive taping, modalities and manual therapies may all be applied.
- Add practical on-court drills that include balance, speed and endurance as the injury heals.
Remodelling Phase: Takes 6 weeks to several months:
- The scar tissue is remodelled (reinforced where it takes most load) and strengthed.
- Treatment aims to improve muscle strength in sport specific patterns, with continued work on flexibility to ensure the area can cope with the rigours of tennis.
What are Anti-Inflammatories and Analgesics?
Non-steroidal anti-inflammatory drugs (NSAIDs) are a common type of over-the-counter and prescription medication that relieves pain by decreasing inflammation associated with tissue damage from an injury.
They are also used for treatment of muscle aches and cramps associated with menstrual periods, joint pain and swelling associated with arthritis and other joint conditions such as gout.
Some NSAIDs are available to buy over the counter:
- Aspirin (also an analgesic), ibuprofen, ketoprofen and naproxen.
Others require a prescription:
- Votaren, Mobic, Relafen, Celebrex (Cox-2 inhibitor – subset of NSAIDs).
Analgesics are pure pain relievers, which have no effect on the inflammatory process. Examples include paracetamol and acetaminophen. They are also used to reduce fever associated with illnesses and to relieve headaches.
How do NSAIDs and Analgesics Help?
NSAIDs work by blocking the chemicals that stimulate the inflammatory response, which are released after injury, and the result is a decrease in pain and swelling. Most NSAIDs begin to have an effect 1-2 hours after taking them.
Analgesics (pain relievers) work by blocking the pain receptors in the brain from recognising the pain signals sent from the injury site and they will decrease the pain resulting from an injury. Most analgesics will take effect within 30 minutes after taking them.
In the early (inflammatory) stage of injury healing, these medicines may be appropriate and prescribed to assist in the healing response (NSAID) or to provide some relief from pain (analgesic).
- Gastrointestinal (stomach) upsets, including heartburn, nausea, ulcers and painful bleeding within the gastrointestinal tract. Cox-2 inhibitors were originally designed to reduce these risks but they have other risks.
- Cox-2 inhibitors, Vioxx and Bextra were removed by their respective pharmaceutical companies due to eveidence from scientific studies that indicated an increased risk of heart attack, strokes and blood clots associated with these medicines.
- Cardiovascular system affects, including heart attack, strokes and blood clots.
- All NSAIDs carry these potential risks but the risk is increased for older people and for those taking a Cox-2 inhibitor.
- High blood pressue – more likely in an older person at risk of high blood pressure.
- Kidney damage can result if NSAIDs are taken over a long period of time (> 3 months) and if taken above the recommended dose.
- Allergic reaction can occur especially in people who have asthma.
- Liver damage can result if taken in excessive amounts well above the recommended dose.
- Excessive bleeding or bruising when taking Aspirin as well as ulcers and gastrointestinal upset.
Many NSAIDs are not safe for pregnant women, especially in the last 3 months. If you suspect you are pregnant, check with your doctor before you take any NSAIDs, analgesics or any other medicines.
Taking NSIDs with alcohol increases the risk of gastrointestinal bleeding.
Children and teenagers (<18 years old) should not take Aspirin for fever or cold because of its association with a serious but rare disease called Reye’s syndrome.
Impact on injury healing
Research indicates that if NSAIDs are taken beyond the early healing phase of an injury (1-4 days) they can interfere with and delay the normal healing process. This effect has been demonstrated with healing of muscle, tendon, ligament and bone.
- Take NSAIDs at the lowest possible dose for the shortest possible time.
- If your doctor prescribes long-term NSAID use, periodic blood tests to monitor kidney and liver function are advised.
- Always stick to the prescribed dose. Taking the medicine in larger dose or for longer time can increase risk of dangerous side-effects.
- Take NSAIDs with food to decrease the risk of gastrointestinal upsets.
- Tell your doctor or SMTTs if you have a history of stomach upsets, before taking any NSAIDs.
- Do not use a non-prescription NSAID for longer than 7 days without discussing with your doctor
- NSAIDs are not recommended for chronic pain or muscle, tendon or ligament injury (beyond the first 4 days)
- Always seek advice from the ITF before taking any medicines to ensure compliance with the Tennis Anti-Doping Program.
The information provided above is for informational purposes only and should not be treated as medical, psychiatric, psychological, health care or health management advice. If you have any health or related questions or concerns, please contact your medical advisor.
Reproduced by kind permission from the WTA Tour.