Painkillers for race day. Do they work and are they safe?

Recently here in Noosa we had the Ultraman Australia 3-day race where participants swam, biked and ran a total of 515kms. Invariably, the conversation surrounding these crazy athletes turns to injury management and how they plan to deal with niggles in order to back up performances day after day.

Which pain meds are people taking with them and what is better for sore spots leading in to the race? I often get asked which over the counter (OTC) medications are better for taking during races- whether it be for a sore knee during a marathon or a cover-all for any niggles that may pop up in an ironman.

Let me start by saying DO NOT try anything new on race day. Your coach has told you, your training buddies have told you and now you can hear it from me as well… Do. Not. Try. Anything. New. On. Race. Day.

Now that we have that out of the way- these are some (but not all) of the kind of things people keep up their sleeve or in their jersey pocket for racing. NB: also obviously before you take ANYTHING you must be aware that some things will be banned i.e pseudoephedrine + paracetamol combo/ steroids- and if you plan you take them then you’d better plan to look it up and make sure it’s legal.

 

Non-steroidal Anti-Inflammatory Drugs a.k.a NSAIDs (includes aspirin, neurofen, diclofenac, naproxen, advil)
Used to treat inflammation, fever and pain and are able to be bought at the supermarket. Mostly these are considered safe in normal healthy adults but when you are mid-marathon at the back end of an ironman that situation does not really apply! I don’t think anyone would argue that they feel healthy then…

The main side effects include kidney problems, which manifests as a difficulty maintaining salt and water balance. Aspirin in particular can decrease loss of sodium and water through the kidneys and cause your body to hang onto excess fluid- not ideal!

Stomach and digestive problems are common and include stomach pains, ulcers and bleeding. In a 2010 study published in the BMJ, they showed that adverse events (including gastrointestinal bleeding, blood in the urine, stomach cramps) happened up to ten times more often in athletes taking these painkillers. They also noticed that athletes tended to take waaay more than the recommended dose of NSAIDs pre-race because if a little bit works, then more is better…right? Nope! Check out the graph below and the linked article to read more if you fall into this category. Screen Shot 2017-05-23 at 6.14.06 PM
VERDICT: Not worth it! Avoid if possible. Pre or post race you can rub some voltaren gel onto your sore areas to relieve local inflammation without the nasty side effects.

 

Paracetamol a.k.a Panadol
Panadol is used to treat pain and fever, but doesn’t really have any effect on inflammation. In a race, this is typically where a lot of niggles come from. Usually paracetamol is safe and doesn’t have the side effects of those listed above. Liver damage can occur but is unlikely if you are just taking a small amount on a couple of days.
VERDICT: Can’t hurt too much unless you overdose, might provide some baseline analgesia but won’t alleviate serious pains.

 

Codeine (and other opioids)
Codeine is from the same family as morphine and is a potent painkiller. Opioids act on receptors in the brain but also in the gut. One of the main side effects of codeine is nausea and vomiting, which will definitely ruin your race. Another side effect is constipation, though this may not be so bad if you find yourself battling with diarrhoea!
But wait, the list goes on; it can make you feel dizzy, give you reflux and if you take enough of it might make you feel drowsy or not completely mentally clear.
VERDICT: steer clear unless you have had good results in training- but if you need codeine to get through training sets you need to get help!

 

Corticosteroid Injections
This one gets an honourable mention for the last resort of the injured athlete who is desperate to get a couple more pain free races from their crappy joint. Usually it’s a past injury that has come back to haunt them, and tends to flare up just after your final build into the race. The steroid works by making the capillaries in the joint less leaky, lowering the amount of inflammatory and destructive components coming from the blood into the joint. Steroid injections can work well to reduce inflammation and pain, but can take up to a week to take effect (so don’t get it done in race week!)

Results can go several ways- some people find that they work incredibly, and the effects can last for months to years. Others have only a mild amount of relief for a few weeks/days and some feel no difference at all. There is also always the risk of doing more damage while you can’t feel whats happening in the area. One of the main side effects is call the post- injection flare. It occurs in 1 in 100 patients and involves reactions similar to an infection, with warmth, pain and redness in the joint. Symptoms can last for 2-3 days, so plan your injection with this in mind so it doesn’t interfere with training or racing!
VERDICT: If you are thinking you need one, see your doctor months to weeks before the race to plan the shot. Lower the risks by avoiding getting it done in taper/race week.

Ultimately, training and racing should be pain free and you should work with a physio and massage therapist throughout the training block to prevent toeing the start line with an injury. Reality is usually not so peachy, so hopefully some of the above can be useful to those of you dealing with some pre-race niggles! 🙂

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