Injury and drug therapy: basic principles for proper use

Did you injure your thigh while accelerating during your last training run? Has your knee been aching for some time after a quick change of direction at badminton? Your first instinct was probably to rest for a few days, put on ice or take a few Advil, Tylenol or Voltaren tablets. But do you really know what impact these drugs have on your recovery? Are there any real benefits to consuming them, or are they more detrimental to a healthy return to sport? This is what will be demystified here, to enable you to use these products wisely and better understand the different effects of analgesic and anti-inflammatory medication.

The healing process

First of all, to fully understand how these drugs work, it’s essential to talk about the healing process following an injury. This is divided into 3 phases. The first phase, known as the “inflammatory” or “acute” phase, lasts between 48 and 72 hours and is characterized by the arrival of inflammatory cells that help clean debris from the injury site, forming an initial temporary scar tissue. This is when symptoms such as redness, heat, pain and swelling appear. This is followed by the repair phase, which can last from 2 to 7 days, depending on the severity of the injury. It is at this stage that the cells manufacture collagen, helping to initiate more permanent tissue repair. Activities can be resumed gradually according to your healthcare professional’s recommendations. Finally, the remodeling phase is a crucial part of the healing process, as it is here that the scar is restructured to form new, functional tissue. To enable this process to take place, it is therefore important to apply stress to the structure, such as rehabilitation exercises and more intense resumption of previously practiced physical activities. This phase can be very long, extending up to 1 year after the initial trauma. However, it’s still possible to exercise at full intensity, even as your body finalizes tissue repair.

Advil, Naproxen, Voltaren, Tylenol… what’s the difference?

There are two main types of medication frequently used in the management of pain and inflammatory symptoms following traumatic injury: non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics.

The first, NSAIDs, are often better known as Advil, Ibuprofen, Motrin, Naproxen or Voltaren. The latter are applied topically, i.e. at the site of the wound, in the form of a cream, while the others are tablets taken orally. This type of medication prevents the production of prostaglandins, the substances that cause symptoms of heat, redness and swelling, and prostacyclin, which is responsible for pain, among other things.

The analgesic medication known as Tylenol or acetaminophen only inhibits the formation of prostacyclin, thereby mainly reducing pain sensations.

NSAIDs or painkillers: what’s the right choice?

Although NSAIDs may seem more effective at first glance, numerous studies have shown that long-term use of this type of medication can interfere with proper tissue repair. What’s more, since the effects of this medication may give you the impression that your injury seems to have healed, early resumption of your activities may have a significant long-term impact on the healing of the tissue, which will be of poorer quality.

In the light of this information, and in line with what is reported in the scientific literature, it would be advisable to limit the use of NSAIDs in the acute phase, unless your doctor or pharmacist advises otherwise. The period of use should be short and rapid, between 3 and 7 days maximum. It is therefore preferable to encourage the use of analgesic medication (e.g. acetaminophen) when pain becomes uncomfortable, and to limit the impact of other symptoms by using non-pharmacological means, such as compression bandaging, ice application and elevation of the injured limb.

If you have any doubts or questions, don’t hesitate to consult your pharmacist, who will be able to offer you valuable assistance in the judicious and prudent use of any medication, or to ask your healthcare professional (kinesiologist, physician, physiotherapist) to guide you back to safe play.

Jacinthe Bernier, stg Pht

Michael Morin, Pht, M.Sc., B.Sc., UASD, SPC, FCAMPT

References :

1. Frémont, Pierre. (Fall 2016). Theme 13: Introduction to the general principles of musculoskeletal injury treatment. Course notes. [PDF]. PHT-1000: Musculoskeletal system: from the laboratory to the clinic, Université Laval.
2. Ziltener, J.-L., Leal, S. & Fournier, P.-E. (2010). Non-steroidal anti-inflammatory drugs for athlete: An update. Annals of Physical and Rehabilitation Medicine, 53, 278-288.
3. Gladson, B. (2011). Pharmacology for Rehabilitation Professionals (^2nd edition), St.Louis, Mo: Elsevier Saunders.