Even before Advil sponsored runfluencers, runners have reached for non-steroidal anti-inflammatory drugs before training and races. Many runners believe that NSAIDs will reduce soreness in training or will blunt pain so they can run faster on race day. These misconceptions are outdated and potentially dangerous. NSAIDs do not improve running performance or recovery. When you misuse Advil before running, you do increase your risk of bone stress injuries, kidney injury, and more.
Of course, any dialogue around over-the-counter medication requires nuance. Yes, NSAIDs are habitually used to treat menstrual cramps, headaches, and other ailments. Yes, your physician may guide you to use NSAIDs in particular scenarios. And yes – there are risks to using (and misusing) these medications.
Advil Before Running Doesn’t Prevent Soreness
Runners often rely on Advil before running (or after) to relieve soreness. However, this practice may not be the most efficacious for soreness – or for training adaptations.
A 2024 study randomized controlled trial found that an 800-mg dose of ibuprofen had no significant impact on muscle soreness at 4-hours and 24-hours after exercise. Nor did the painkiller improve next day performance – meaning that NSAIDs did not improve recovery.
If you are so sore all the time in training that you need painkillers, you may need to reassess your training approach. A properly programmed running program should not render you sore all the time.
If you are chronically sore in training, you may need to assess your:
- Sleep duration and quality
- Nutritional intake, especially protein and carbs
- Frequency of rest days
- Time at intensity and intensity on hard workout days
- How easy you are going on easy runs
- Strength training programming
Frequent NSAID Use May Impair Adaptation
Additionally, you do not want to take ibuprofen for soreness, as doing so may impair training adaptations. Inflammation is not the malignant bane that some present it as. Both running and common supplemental training (lifting, plyometrics, etc.) trigger acute inflammation; your body’s response to this inflammation leads to training adaptation.
If the inflammation is repeatedly blunted (such as via chronic NSAID use), your body will not repair the stressed tissue – and therefore, you will not adapt to your training well. A 2024 systematic review in Sports suggests that NSAID use before, during, and after train could impair training adaptations.
While chronic NSAID use for soreness will impair adaptation, do not fret if you only occasionally use the medication for period cramps or headaches. One 2024 randomized controlled trial found that a single dose of ibuprofen did not inhibit muscle signalling after exercise (in healthy adults).
Advil Before Running Won’t Improve Performance
Many runners reach for Advil before a marathon, thinking the pain relief will help them push harder through the tough moments of the race. However, painkillers won’t improve your performance – they may even harm it.
No conclusive data exists on any performance-boosting impact from NSAID use. One 2024 study found that NSAID use did not correspond with any performance improvements or reductions in muscle damage for trail marathoners. Likewise, the above-cited 2024 systematic review found no performance benefits from oral, topical, or intravenous use of NSAIDs.
Popping Advil before a race does not quicken your post-race recovery, either. Ironically, a 2013 non-interventional cohort study found that runners who took Advil before a marathon were significantly more likely to experience muscle and joint pain after the race.
What can improve running performance? Carbs, caffeine, and research-backed supplements such as sodium bicarbonate offer proven performance boosts – without the risks of NSAIDs.
NSAID Use Could Worsen Your Runner’s Trots
Ibuprofen, naproxen, and similar medications all bear a warning about ulcers and gastrointestinal bleeding. NSAIDS reduce pain by suppressing prostaglandin levels. However, prostaglandins are also responsible for a healthy gut lining. When used chronically, NSAIDs may cause inflammation in the gut lining, which leads to a host of chronic and uncomfortable upper GI problems.
Acutely, NSAIDs reduce blood flow to the gut. Reduced blood flow contributes to lower GI symptoms, especially during intense exercise – aka your dreaded runner’s trots. In the above-cited 2013 cohort study, the painkiller-popping cohort was more likely to drop out of the race due to GI upset. If you are popping an Advil for performance, know that you may end up slowing down more for more bathroom breaks – or DNFing altogether.
For athletes who have inflammatory bowel disease (such as Crohn’s disease), Advil before running can worsen their symptoms. These athletes should consult their physicians before any NSAID use, even infrequent.
NSAIDs May Increase Risk of Bone Stress Injuries
Chronic NSAID use poses multiple risks. The labels themselves even state not to take long-term unless instructed by a doctor! In addition to the risk of gut inflammation, regularly popping an Advil may increase your risk of a bone stress injury (BSI).
A 2021 study demonstrated inhibited bone formation in physically active populations who regularly used NSAIDs. A 2024 study broadened these findings, demonstrating that NSAID use increases fracture risk in all populations.
Runners already have a higher risk of stress fractures due to training load, low energy availability, and other variables. While the occasional Advil for menstrual pain or a headache won’t give you a stress fracture, frequently using NSAIDs in training does increase your bone injury risk.
Do NSAIDs Increase Risk of Kidney Injury?
The above-cited 2013 cohort study observed that marathoners who took Advil before the race had a five-fold higher incidence of adverse medical events – including hospital admittance for temporary kidney failure.
The longer the race, the more apparent the risks may be. A 2024 review in BMJ found that NSAID use during ultra-marathons is associated with electrolyte imbalance and acute kidney injury.
Due to the risk of acute kidney injury, ultra-marathon giant UTMB has banned any form of NSAID in the 24 hours prior to and during competition. While UTMB’s ban does not impact road races, it does demonstrate real risks around athlete use.
Masking Pain While Running is Risky
If you are experiencing pain so severe that you cannot run without ibuprofen, you should not be running. NSAIDs reduce inflammation enough to reduce pain perception – they won’t magically and suddenly heal your muscle strain or tendinopathy.
If you mask the pain, you do not fix in the actual problem – you simply blunt your body’s signals. You risk worsening the injury if you load it before the tissues are healed enough to tolerate loading. (Don’t think Tylenol before running is any better in this situation – masking pain with any medication bears risks.)
Rather than popping painkillers, you should rest – and seek guidance from a physical therapist – when you experience running-related pain that does not resolve with 3-5 days of rest.
If a doctor or physical therapist prescribes NSAID use for a running injury, defer to their expertise. They understand the nature of injury healing, including when inflammation is beneficial for the recovery process – and when excessive inflammation needs to be treated.
Concluding Thoughts on Advil Before Running
The data demonstrates clear risks around frequent NSAID use. If you are popping an Advil before every workout and long run, you increase your risk of stress fractures and gut inflammation, while also blunting your training adaptations. No evidence demonstrates performance enhancements from taking NSAIDs before a race, but there are potential risks, including kidney injury, electrolyte imbalance, and runner’s trots.
If you are using the periodic ibuprofen or naproxen to manage menstrual pain, a headache, backache, or similar scenarios, you are not at high risk. But if you are reaching for these due to constant pain from training, you should reassess your training approach and recovery habits.
If in doubt, consult your doctor before using any medications, over-the-counter or not.
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