NSAIDS and Hypertrophy by Jay McCombs

Handsome Fitness Male CaucasianYou’re vain and narcissistic, you have body-image dysmorphic disorder, or maybe you’re just trying to pick up chicks—whatever the reason, you want bigger muscles. You monitor your food intake down to the gram and take a quantity of pills that would seem obscene even to cancer patients, but a nonsteroidal anti-inflammatory drug (NSAIDs) is one pill that doesn’t cross your lips. No way! By now bodybuilders have heard about the study correlating NSAID use with a decreased level of post-exercise protein synthesis and consequentially purged their medicine cabinets of these vile analgesics [1].

It doesn’t take a PhD level physiologist to figure out that decreased protein synthesis could equate to decreased hypertrophy. However, there is a fundamental problem with bodybuilders. They tend to be a little too zealous and don’t always sit and ponder the finer points of the information they find on pubmed (if they even visit, and most never make it deeper than the abstract!). They are like frat boys who just chug beer for the buzz and miss the subtleties of the interplay between the hops, barley, and other ingredients. So, with that in mind, I would like to present a few thoughts on NSAID use and their relevance to bodybuilding.

First, I want to clear up a point of confusion. Many people believe that taking an NSAID precludes muscle growth. That is not what the research says. The research says it attenuates the post-exercise increase in protein synthesis; however, protein synthesis is still significantly increased over baseline levels. Therefore, despite taking an NSAID you can still grow big muscles. This makes sense. An NSAID works on prostaglandins which are just one of many mediators of inflammation [2]. These other mediators are still functioning correctly and proceed with tissue repair [3].

Second, I’d like to point out that if your level of soreness is affecting your daily life, you are going to have to make a compromise. Your hobby, bodybuilding, requires money—which your job provides. If you can’t function properly at work, you can’t make money. Do you see where I’m going with this? NSAID use possesses demonstrable effects on relieving delayed onset muscular soreness (DOMS) related to the damaging phase of eccentric training [4-6].

Now, there are studies that show no influence on subjective pain in NSAID users versus placebo [1]. The likely explanation is that the difference of 10 out of 10 pain versus 9 out of 10 pain is too subtle to be noticed by subjects. Also, keep in mind that subjects in this study took a high NSAID dose prior to exercising, not just after. This is significant because DOMS usually doesn’t rear its head until at least 24 hours post exercise, which is when most people would reach for the bottle of ibuprofen. This clears you through the time frame where protein synthesis would be most sensitive to inhibition. So, my second point: if you are in such pain that you have a decreased range of motion or other impairment to your daily life take an NSAID. You probably won’t get back in the gym any quicker, but the time between will be less painful [4].

Third, I’d like to address another group of NSAID users: those with chronic pain. This correlates with my previous point. If your arthritis or aching back are keeping you out of the gym or prevent you from inflicting adequate hypertrophy inducing damage on your muscles, you are increasing protein synthesis by zero. In this case, even sub-maximal protein synthesis would be more attractive than your alternative. Also, chances are you’re taking a selective COX-2 inhibitor versus a non-selective inhibitor like the ones used in the above study, which could have a different effect on protein synthesis rates.

Finally, I wanted to point out something I found while digging through the original article. The authors selected more than one NSAID for the trial. The first, ibuprofen, exerts its analgesic effect by inhibiting prostaglandin (PG) synthesis in the periphery and should consequently have an affect on protein synthesis. The second, acetaminophen, has previously been shown to exerts its analgesic effect through central pathways, not the periphery; therefore, the authors hypothesized it would have no effect on protein synthesis in the skeletal muscle—but their hypothesis was wrong. Acetaminophen had the same effect as ibuprofen and inhibited skeletal muscle PG synthesis. This raises the question of a possible, as of yet, unidentified COX enzyme unique to the skeletal muscle. If this is the case, it represents an exciting (maybe just for research nerds) and highly attractive target of therapies directed towards muscle pain and inflammation.

For all the readers who just skip to the end praying for a summary:

  • Post exercise protein synthesis still occurs, though to a lesser degree, even with chronic NSAID use. Hypertrophy should follow the same pattern.
  • NSAID use is a viable therapeutic option for relief of DOMS related pain and should be considered when soreness alters level of activity in daily tasks—don’t suffer needlessly for the benefit of your biceps.


1. Trappe TA, White F, Lambert CP, Cesar D, Hellerstein M, Evans WJ. Effect of ibuprofen and acetaminophen on postexercise muscle protein synthesis. Am J Physiol Endocrinol Metab. 2002 Mar;282 (3):E551-6.

2. Kumar V, Abbas AK, Fausto N: Robbins and Cotran Pathologic Basis of Disease 7th Edition. Elsevier, 2005.

3. Pizza FX, Cavender D, Stockard A, Baylies H, Beighle A. Anti-inflammatory doses of ibuprofen: effect on neutrophils and exercise-induced muscle injury. Int J Sports Med. 1999 Feb;20 (2):98-102.

4. Baldwin, Lanier A. Use of nonsteroidal anti-inflammatory drugs following exercise-induced muscle injury. Sports Med. 2003;33 (3):177-85.

5. Connolly DA, Sayers SP, McHugh MP. Treatment and prevention of delayed onset muscle soreness. J Strength Cond Res. 2003 Feb;17 (1):197-208.

6. Tokmakidis SP, Kokkinidis EA, Smilios I, Douda H. The effects of ibuprofen on delayed muscle soreness and muscular performance after eccentric exercise. J Strength Cond Res. 2003 Feb;17 (1):53-9.

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