title: Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis.
abstract: BACKGROUND
  There is debate as to whether the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is beneficial after acute skeletal muscle injury. Some studies have suggested that NSAID use may be detrimental to injured muscle.
  
  
  OBJECTIVE
  To determine whether NSAID use affects recovery from skeletal muscle injury as assessed by strength loss, soreness, and/or blood creatine kinase level.
  
  
  METHODS
  Systematic review and meta-analysis.
  
  
  METHODS
  An extensive systematic review was completed searching 16 databases (eg, PubMed, Cochrane Library, EMBASE). Inclusion criteria were (1) acute injury to skeletal muscle, (2) use of a control condition, (3) certainty of the NSAID dose administered, and (4) use of 1 or more of the 3 desired outcome measures. A total of 5343 study reports were screened, of which 41 studies were deemed suitable for inclusion. The standardized mean difference was used as the effect size (ES) and was calculated such that a positive ES indicated NSAID efficacy. Meta-analyses were run using a random-effects model.
  
  
  RESULTS
  For all studies, time points after injury, and injury markers combined, NSAID use was found to elicit a small to medium, significant decrease in the markers of injury (overall ES = +0.34; P = .0001). Because heterogeneity in study ES was apparent (ie, Q- df = 52.4, P = .000005; I2= 57%), subgroup meta-analyses and meta-regressions were run in an attempt to explain the heterogeneity. In human studies, study ESs were higher when lower body muscles were injured ( P = .045). In animal studies, study ESs were lower with longer NSAID administration durations ( P = .023) and at longer follow-up times after injury ( P = .010).
  
  
  CONCLUSIONS
  Overall, our analysis supports NSAID use for reducing strength loss, soreness, and blood creatine kinase level after an acute muscle injury, at least for humans and in the short term. Additional research is required to determine why NSAID use appears to be more effective when lower-body muscles in humans are injured. It would also be important to determine why NSAID use appears detrimental at later times after injury in animals but not humans.
authors.affiliation: Department of Physical Therapy, Georgia State University, Atlanta, Georgia, USA.
authors.forename: Kimberly M
authors.initials: KM
authors.lastname: Morelli
authors.affiliation: Department of Physical Therapy, Georgia State University, Atlanta, Georgia, USA.
authors.forename: Laura B
authors.initials: LB
authors.lastname: Brown
authors.affiliation: Department of Physical Therapy, Georgia State University, Atlanta, Georgia, USA.
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Warren
mesh_terms: D000818:Animals; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D006801:Humans; D018482:Muscle, Skeletal / Q000293:injuries*; D059408:Pain Management
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: creatine kinase; nonsteroidal anti-inflammatory drug; soreness; strength