NSAIDs and Athletic Performance: Are Pain Relievers Holding Athletes Back?

In this episode of the ICA Sports and Fitness Science Council podcast, Dr. Brant Hulsebus of Rockford, Illinois, welcomes Dr. Kyle Hoeft of Fishers, Indiana, for a discussion on NSAID use and athletic performance.

The episode reviews the research paper:

“Is Physical Performance Affected by Non-steroidal Anti-inflammatory Drugs Use? A Systematic Review and Meta-analysis”
The Physician & Sportsmedicine
June 2024; Vol. 52; No. 3; pp. 207–216.

NSAIDs are commonly used by athletes before and after games, training, and competition. But do they actually improve performance? According to the discussion in this episode, the research does not support NSAIDs as a performance enhancer. Dr. Hulsebus and Dr. Hoeft discuss how regular NSAID use may fail to improve strength or physical performance and may raise concerns for athletes trying to recover, adapt, and improve.

The conversation also explains how sports chiropractors look at the cause of an athlete’s pain instead of only covering symptoms. Dr. Hoeft discusses how ankle and foot mechanics can contribute to knee pain, while Dr. Hulsebus explains how spinal and extremity function, biomechanics, and nervous system communication all matter when caring for athletes.

This episode is for chiropractors, students, athletes, coaches, trainers, and anyone interested in sports chiropractic and performance-based care.

Topics include:

• NSAID use in sports
• Athletic performance and pain relief
• Strength and muscle recovery
• Sports chiropractic care
• Extremity adjusting
• Ankle, knee, and spine biomechanics
• Helping athletes stay mobile and perform naturally
• The role of the ICA Sports and Fitness Science Council

Hosted by Dr. Brant Hulsebus, Rockford, Illinois
Guest: Dr. Kyle Hoeft, Fishers, Indiana

To learn more about the ICA Sports and Fitness Science Council, visit the International Chiropractors Association at:
https://www.chiropractic.org/

Transcript

0:08

Hi, everybody, and welcome to another ICA Sports and Fitness Science Council podcast part of the ICA ChiroCast podcast platform. If you haven't seen one of these podcasts before, my name's Dr. Brant Hulsebus. on the board of the ICA Sports and Fitness Science Council, and I'm a chiropractor in Rockford, Illinois, and I am joined today by my good friend, Dr. Kyle Hoeft I always want to say Fishers, but I know it's Carmel, Indiana, right? No, it used to be Carmel, but yes, now I'm back in Fishers, Okay Indiana, just north of Indianapolis. So yep And Dr. Hoeft is also on the board with us as the, ICA Sports and Fitness Science Council. And podcast, we pulled up a research paper about ACLs, predicting ACL tears and injuries, and we had a lot of positive feedback from that podcast. So if you haven't listened to that one, go back and check it out. It's a really neat article about how chiropractic adjustments to the pelvis area and lower back could actually prevents, especially in young females, having a non-contact ACL tear. What a cool way to integrate chiropractic in the sports world. And, and, you know, in chiropractic, we're always prevention, prevention, prevention. Here's a cool way we could prevent things. Absolutely So we went searching and we found some more articles 'cause that… to get a g- good reviews on that. Today we wanna talk about another research paper, A Physical Performance Affected by Non-Steroidal Anti-Inflammatory Drug Use. It's a systemic review in meta-analysis from the Physician and Sports Medicine of June of 2020- 2024, 52, number 3, pages 207 to 216. And what this article does, it's, it's, it's, for those of us who aren't full research nerds, which I know Dr. Hoeft and I were not in college, but we do a lot more today, , it's, it's, it- they're taking a whole bunch of stuff, a whole bunch of research, a whole bunch of literature, and putting it all together and trying to come up with a, an opinion based on everything they did. And this to me is interesting because, know, I take care of the local hockey team, the Rockford IceHogs. I've taken care of basketball teams, baseball teams, soccer teams, MMA fighters, and even the local college I work with. And I've noticed something about the athletic trainers, 'cause I kinda hang out in the corner of the trainer's room. I don't get too involved with their world, I just kinda hang out in there. And the one thing that I see gets popped like crazy are these non-steroidal anti-inflammatory drugs. The short word for that is NSAIDs, non-steroidal anti-inflammatory drugs. I watch these players take them, they're just, they- they're just popping them like candy. Dr. Hoeft, have you, have you seen a lot of that yourself? I, I see that a lot as well, and I imagine you see quite a bit more than I do, being right there with a lot of, sports teams, the, the, the professional sports teams. Which, which is the most popular brand are you seeing that, is over the counter? Are you seeing like Tylenol, Tylenol, Advil? That's what I typically see, a lot of Advil. You know, a lot of, lot of the generic stuff too, but it's, like you said, it's like they, they find that stuff, it's like candy, , and they don't really even watch how many that they're taking The trainer for the hockey team manages little packs all ready to go. They just come in, they grab a packet. It probably has an Advil in there, an aspirin in there. they know that that's not my thing, so they don't really share too much of it with me, but I find that these players, they know they have a chronic lower back, they know they have a chronic knee, they know they have a chronic shoulder problem, they're popping them before the game as prevention to try to prevent that pain. Then after the game, they're going in there for even more. And even the orthopedic doctors and stuff, I know that's the… know, I, I researched up these nonsteroidal anti-inflammatory drugs, these NSAIDs a lot, and I know that's the first thing when you, even, i- not even for athlete. If you have lower back pain or neck pain or headaches and you go to your walk-in clinic, your primary, the first step is they give you a nonsteroidal anti-inflammatory drug, an NSAID. And just even outside of this research, as I do read a lot of research papers, as a side note, chronic use of NSAIDs lead to chronic lower back pain and headaches. So I think it's ironic the pills that you're taking actually create the cause could become the cause of what you're trying to prevent. But let's, let's jump back to athletes, because and athletes always worried about their performance and how they're gonna compete today. You wanna review a little bit of what we found out when we were looking at this article together about the use of NSAIDs and how it affects your athletic performance? You know, it's, it's, it may not be surprising to some people, but for us you know, th- this is very important to bring to the average you know, to the average person, the average athlete, family. So these NSAIDs that you know, that we t- just talked about that are being prescribed every day, both before, during, and after competition, number one, they did not improve physical performance. So some people may think that, "Oh, if I take this beforehand maybe this'll give me a little extra boost or a little extra, you know, a little extra speed, a little extra bounce." No proof. Nothing to show that. Number two decreased muscle resistance performance. So that's another one there. You know, if you're lifting weights and you're trying to build up muscle anabolically you know, those NSAIDs are not gonna help you do that. Did not improve strength levels. Again, a lot of people in the weight room, a lot of people working with trainers and so forth trying to optimize their strength levels and performance, NSAIDs aren't gonna help you do that. What the… The bottom line is this, it's not going to help with your performance, and muscle strength gains actually decrease with regular re- use of NSAIDs. So, you know, that's our tie-in with why chiropractic is so so perfectly the best alternative to help get you those results you're looking for. Because we're gonna work with the joints, we're gonna work with that alignment, and we're gonna get the pain reduced naturally and that mobility back to its normal level.

Yeah, you know, I get up at to 5: 6:18

00 every morning and go to the gym, and I, I see some of the people there with me popping these NSAIDs. And, you know, after reading this and I see that it actually is not good for you, it actually hinders your growth and your repair and everything, you know, it's just totally the wrong approach that you wanna do. Especially, like I said, I take care of a lot of minor league athletes, and they're just trying to get to the next level. So that's kind of where we come in, right?'Cause people are like, "I still have my ankle pain." That's great."So I don't take this," right?"I'm not gonna take this, but I still have my ankle pain. I still have this lower back issue. I still have this knee issue. If you don't want me to take these, what am I supposed to do?" And that's kind of where the ICA Sports and Fitness Science Council steps in. So, so talk a little bit about in your office. So I'm an athlete, I told you I've been popping NSAIDs every day. I've had this lower back pain. What happens if I walk into your, your clinic there in Fishers, Indiana? What, what, what should I expect? You know, so if I'm gonna, if I'm gonna have you come into my office and let's say, you know, back pain, we deal with that every day. Let's talk about more detail, like let's say I got an athlete. Let's say I got a, a knee pain a left knee pain on the inside of the knee of an athlete that's a soccer player, for instance. Right away we know that with that soccer player kicking a ball, the foot and, and in particular the bone called the talus that is like the keystone bone of the foot, and that bone very commonly can get jammed up, and it does get very commonly jammed up playing soccer. So one of the first things I'm gonna look for is to free up the mobility of that bone because that r- releasing the n- the normal mobility of that bone can also release the mobility of the knee because now the ankle can dorsiflex or it can extend much easier. And that way that, that patient is getting the benefit of proper alignment, not just covering it up with, you know, a pain pill or in this case incense. That, I can't tell you how many patients I have helped resolve a knee pain just by adjusting their ankle and not even having to look at the knee. Just depends on the sport and their presentation. So that's just one example, Brant. Yeah, you can even take that, ask why is that one ankle going on, not the other ankle, and trace all the way back up to the L2, 3, and 4 area and get that adjusted. So when you come to my clinic, you're gonna get, you get X-rays of your spine. We're gonna examine your extremities, and we're gonna see what motion isn't working right. So the bottom line is what we're trying to say in many, many words instead of a few words is we're gonna find the cause. gonna find out what's causing this issue, eliminate the issue, correct your biomechanics, and therefore the correct biomechanics, being that we, as calls chiropractors subluxation free, no nerve resistance, no nerve interference, then the body's gonna perform the way it's supposed to. actually, if… when we study with our colleague, our other board member, Dr. McDougle, they're actually lifting more. They're actually breaking PRs after getting their adjustments, which the science shows you can't do on an NSAID. Actually, it would just be the opposite. Absolutely and that, that's part of seeing a sports chiropractor, correct? Is we have different… Like, I take care of athletes different than I take care of a grandmother, provided the grandma's not an athlete, right? Let's not Yeah short. But provided that we have a different approach. You want to talk a little bit about how we look at an athlete versus looking at an everyday person? Yeah. So with an athlete you're, you're gonna see they can- they're probably going to be a lot more resilient. Their, their tissues are gonna be stronger. Their bone g- density in general is gonna be stronger as well'cause they're usually younger. So they can handle a, a, a, a, a few different techniques because of those generalities. Now let's take an older patient, maybe somebody that's around the retirement age we'll say around 60, 65. Those patients are tend- gonna tend to have… They're gonna be less mobile, more sedentary, so you tend, you're gonna tend to see more osteoporosis, osteopenia type, type patients. And that alone alters the kind of technique that you wanna use for those people. And their tissues aren't gonna be as elastic because they're not as mobile. So the kind of adjusting and kind of treatment that you give them, you would modify it accordingly and but that's a really good, a good point I remember when you and I were at Palmer College, to get adjusted by Dr. Burns in his clinic, and he built a track around his clinic. So after you got adjusted, you had to do two or three laps around his clinic to help hold what he just did. I think we can say that, as you were just mentioning, the person with osteoporosis you used to live in Wisconsin. We, around here we call it the Milwaukee goiter, the big big belly. Yes that person, the odds of them getting up and going for a walk after an adjustment are a lot slimmer than your athlete. Your athlete just Right"What more can I do? Send me on my way." So the patient compliance with the ideal chiropractic adjustment is so much higher with an athlete. So I, Absolutely article really neat, and I can't wait to share it with some of the strength coaches and athletic trainers I know. It, you know, just kinda get the word out. I probably even will print it off, I'll leave it on my, my front lobby there where patients are waiting to come back to a room so they can read that. Any other suggestions you would do with this article, who you would share it with or expose it to? You know, I just think the, the drive home point here is that n- NSAIDs are not going to help your performance. You might get some temporary pain relief and maybe that helps you sleep at night occasionally or helps you get through your day, but it's definitely not something that you wanna rely on regularly to treat any kind of exercise or sports-driven injury. Your local chiropractor they are the experts and they are gonna be the most efficient provider to resolve those issues much better than, than you know, the over-the-counter NSAIDs Or two that whatever, as Dr. Kyle was talking earlier, that the ankle's misaligned, there's problems in the foot, it's giving you the knee pain. That's a lot of stress to those ligaments in that foot. And if you just keep taking the NSAIDs and not feel it, your foot's not getting stronger, it's not getting better. So you have a choice. You can either go to the orthopedic doctor, get immobilized either with a brace or surgery or something else, and go to a chiropractor and get mobilized and get back in the game. And that's kind of what we're here to teach other chiropractors Absolutely. Yep. That's exactly my thoughts on that as well Well, everyone, I want to say thanks for tuning in. Dr. Haith and I are gonna keep going through some of these articles. And if you have a you'd like to share with us, just go ahead and share it wherever you're watching or listening to this. And maybe you can even join us sometime and talk about a cool article you found on chiropractic. We have about another half dozen that we've got, you know, on deck, this… to use a baseball analogy. So Dr. Haith, I want to say thanks for joining us Thanks for having me, Brant, and enjoy sharing the information that we learn, and this is stuff that's you know, extremely relevant to today's athlete, especially multi-sport athletes that you know, they get started early and earlier, younger and younger. So good stuff You wanna learn more about the council, I got a couple opportunities for you. One, just go to the ICA webpage, chiropractic.org. You'll find a link to us right there. You can reach out to us, meet us. If you're in Fishers, Indiana, or anywhere near Indianapolis, you can go out and meet Dr. Hoeft. If you're anywhere near Rockford, Illinois, free to stop by and meet me, and see our other board members wherever you are. We have them in Utah, we have them in Florida, we got them in Pennsylvania, Kentucky. So I'd love to meet you guys. Opportunity to actually meet us, we got coming up here in the end of July this year, we're gonna be at the Pro Hockey Chiropractic Society in Minneapolis. So go on the Pro Hockey Chiropractic Society, see their website. That seminar is not just for hockey chiropractors. It's anybody that would like to work with athletes. In fact, if you go, they put you in a database, and then when a team's looking for a team chiropractor, you're in the database and they set you up. So if you wanna do more of that, that's a great place to go. And I'll be there, along with Dr. Curry from the ICA. Then the… Coming up in Atlanta, or Marietta, Life University this fall at their their big thing that they'll do during September 18th weekend, if you're a chiropractor, you should know the significance of September 18th. Dr-… Myself and then Dr. Kevin Jackson will be out there. We're gonna have the stage on Saturday for a couple hours. Dr. Jackson's gonna talk about subconcussive injuries. We got many articles about that, so make sure you find us there. And then we're hoping really quick here, you know, keep your calendars open, July of 2027, the last weekend of July, we're gonna have a huge announcement here about a symposium where you can come and meet all of us, and learn from all of us, and basically become a really confident sports chiropractor, and we look forward to meeting you. So in the meantime, like, subscribe, follow us, and feel free to shoot us any questions. So again, Dr. Kyle Hoeft, thank you for joining us, and Thanks again, Brant Yeah, we'll see you guys next time around. See you later