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Prophylactic misuse and recommended use of
non-steroidal anti-inflammatory drugs by athletes
Stuart J Warden Br. J. Sports Med.
2009;43;548-549; originally published online 9 Jan 2009; doi:10.1136/bjsm.2008.056697
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British Journal of Sports Medicine
selectively of the agent.8–10 As the adversegastrointestinal and cardiovascular effects
associated with NSAIDs become morepronounced with increased duration ofuse, athletes risk serious side effects by
using NSAIDs prophylactically for pro-longed periods. This is further com-
approximately 10% of those who useNSAIDs take up to five different com-pounds concomitantly.3 4 11
terms of blocking pain before it occurs.5
activities such as each player touching a
winning streak. These practices are rela-
athletes to inadvertently allow pathology
petition anxiety, but a concerning ritual
the prophylactic use of non-steroidal anti-
the synthesis of the extracellular matrix
isozymes and, in particular, the inhibition
the rate-limiting step in the formation of
synthesis immediately before or following
mechanical stimuli.13 14 Athletes who reg-
have reduced tissue adaptation to prevail-
ing loads potentially predisposing them to
is unsafe. In addition to participating in
lactic use of NSAIDs has the potential to
subsequent tissue repair following micro-
diovascular functions. As a result, NSAID
athletic endeavours, but more recent data
suggest athletes misuse their open accessto NSAIDs. Tscholl and colleagues4recently reported in this journal that23% of top-level male football playersused NSAIDs in two out of three matchesduring the 2002 and 2006 Fe´de´rationInternationale de Football AssociationWorld Cup tournaments and that morethan 10% of players took NSAIDs beforeevery match. These data suggest thatmany athletes use NSAIDs prophylacti-cally and presumably for prolonged peri-ods. This hypothesis is supported by thefinding that high-school level Americanfootball players who take NSAIDs daily
Correspondence to: Dr Stuart J Warden, Departmentof Physical Therapy, School of Health and RehabilitationSciences, Indiana University, 1140 W Michigan St, CF-
Decision tree for the prescription of non-steroidal anti-inflammatory drugs (NSAIDs) to
326, Indianapolis, IN 46202, USA; firstname.lastname@example.org
athletes with an acute or chronic musculoskeletal injury.
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risk athletes may be offered the option of
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phylactically.20 If an athlete wants to use
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