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I Said, NSAIDs!

Ibuprofen, acetaminophen (Tylenol), and aspirin are among the most commonly used non-steroidal anti-inflammatory drugs (NSAIDs). Some ultrarunners take so much ibuprofen that they joking call it “Vitamin I.” General prophylactic use of NSAIDs before workouts lessens the benefits of those workouts by limiting the body’s natural healing response to inflammation. That healing response is what leads to stronger muscles, tendons, and bone. Properly dosed NSAIDs can be part of the effective treatment of an acute injury; however, be careful not to mask pain to the point where you are able to run in a manner that worsens the injury.

Excessive use of any NSAID—in particular, ibuprofen—can be dangerous. Much has been written warning about combining strenuous running (more than your daily run) and ibuprofen. It has been implicated in severe kidney problems among a few ultrarunners who took ibuprofen while dehydrated during a race.

I like to think I take a commonsense approach to NSAIDs in races. I don’t take more than the recommended dosage at any time, I don’t take more than two doses during a race, and I don’t take NSAIDs if I am severely dehydrated. While I will take ibuprofen if it’s the only option, I prefer to take Excedrin, which combines acetaminophen, aspirin, and caffeine. I hold off on using NSAIDs until the second half of a race. If there’s a particularly nasty descent late in the race, I’ll often take a dose 30 to 60 minutes before I begin it. Please note, I am not a medical professional and this is not medical advice. I am merely sharing my own choice. Make your own calculated, educated choices regarding NSAIDs and ultras.

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[Author’s Note: “The Lean” described below is a non-serious, non-permanent listing of a runner toward one side from the waist. The lean becomes more common as the length of an ultra increases and is most commonly seen in older men.]

The Lean

Scotty Mills

For those who have been around some of the longer ultras over the years, a not-so-common but very apparent race day condition known affectionately as “The Lean” can adversely affect ultra runners especially in the later stages of an event. There has-n’t been a great deal written about this ailment, and it doesn’t seem to be a chronic condition among most ultra runners. However, it can take a huge toll on a runner’s body with regards to form, posture, and ability to continue moving to the finish line. The following observations and recommendations are simply from my personal perspective, as I have occasionally heard aid station volunteers and crew helpers say, “We have a leaner coming in!” Unfortunately, that leaner has been me on two separate occasions, at Western States and at the Wasatch 100.

I have done limited research and failed to identify this condition in any sports medical literature or scientific articles. I can only surmise that not much is written about runners’ leaning because it occurs so infrequently and usually only at the very end of a long and grueling endurance event. Most would think that a weak back or unconditioned back muscles might be the root cause of this loss of control, but I am not convinced this is the case. Rather, my assertion is that the body is reacting to total exhaustion from the result of too many miles and hours of running on very challenging terrain and in hot daytime conditions.

This exhaustion may cause the body of the runner to lose some muscle control and balance.

My assumption in this regard is the fact that I work very diligently throughout my training to strengthen my core and back muscles. I have never had a back injury, and following a leaning episode I have no back or side pain the following day. I do know that the leaning episodes have occurred late in the event and at a time when I felt totally devoid of energy near or akin to “bonking,” yet instead of feeling totally out of energy, the body seems to lose balance. So what to do to try to avoid The Lean?

As with bonking, I feel the most important thing an ultra athlete