Nonsteroidal Anti-inflammatory Drug
Use in Collegiate Football Players

Holmes N, Cronholm
PF, Duffy AJ, Webner D. Clin J Sport
Med. 2013.
Epub ahead of print

Take Home Message: NSAIDs are a common
treatment method for musculoskeletal injuries; however, over-the-counter availability,
overuse, self-medication, and trends of initial use in high school may
interfere with appropriate consumption among college athletes.

anti-inflammatory drugs (NSAIDs), a common treatment for athletic injuries, are
generally safe medications when used short-term but can become problematic when
used long-term and without oversight from a medical professional. There is a discrepancy
between the amount of NSAIDs used in athletics and the number of studies that
address their safety in athletics. In this cross-sectional study, Holmes et al.
surveyed 211 collegiate football players at two institutions on two occasions (beginning
of 2006 and 2009 seasons) regarding their NSAID use during the respective
seasons. The authors categorized athletes as “high users” (NSAID use daily or
weekly) and “low users” (NSAID use monthly or rarely). The authors then compared
off-season use and in-season use of NSAIDs between high- and low-use groups. Half
of all athletes reported high use of NSAIDs in-season compared to only 15%
during the off-season. During the season, 33% of high users consumed NSAIDs
after games, 11% before games, and < 1% during games. For the same group, after-practice
use of NSAIDs was the highest (20%), followed by before-practice use (5%), and
during-practice use (< 1%). Close to half of all athletes first utilized
NSAIDs in high school (49%), followed by junior high (46%), and only 6%
reported first use of NSAIDs in college; which they received from a variety of
sources: themselves, parents, athletic trainers, and physicians. NSAIDs were
largely obtained over the counter (81%); in comparison, only 27% obtained from
physicians and 30% from athletic trainers. Approximately, 57% of athletes with
a higher body mass index (> 28.2 kg/m2) utilize NSAIDs in-season
compared with 40% of athletes with lower body mass index (< 26.6 kg/m2).
Finally, only 3% of athletes reported adverse reactions to NSAIDs.

This study
demonstrates overuse and potential for misuse of NSAIDs in a college football
population. More research is needed to generalize these results, but they raise
concern for athletes’ health. This study also touched on health concerns by
reporting adverse reactions; but the number of adverse reactions could have
been higher since they can often be asymptomatic and require lab work to fully
evaluate them. This issue is further complicated by athletes self-medicating
with NSAIDs, which leaves the medical staff unaware of frequency and dosages. Medication
management for college athletes is difficult because of the various sources and
the ease with which NSAIDs can be obtained. Athlete education focused on
adverse reactions and their warning signs may help to solve over-medicating. In
addition, it might help to cut down on confusion in self administration of
medications, as previously reported by Wolf et al. Furthermore, improved supervision of
over-the-counter medications should be addressed to aid the medical staff in
managing athlete consumption.

How can
the sports medicine community work together to improve medication safety for
athletes? What interventions could help to decrease the first time use of NSAIDs
in high school athletes?

Written by:
Christian Glaser, DO
by: Laura McDonald


Holmes N, Cronholm PF, Duffy AJ 3rd, & Webner D (2013). Nonsteroidal Anti-Inflammatory Drug Use in Collegiate Football Players. Clinical Journal of Sport Medicine PMID: 23528841