Ibuprofen and Marathon Running: Safe? Or Not?
- Jordan Metcalf
- Sep 4
- 6 min read
Many runners have been told that they shouldn’t take Advil (ibuprofen) before a long run. But it’s so hard to figure out how serious medical advice is these days. For example, my generation was told that you need to wait 20 minutes after eating to go in the pool or you would basically perish, when really you might just get a little bellyache.
So is “don’t take ibuprofen before a run” in the same category?
Or are there more serious risks?
As a physical therapist who has worked with distance athletes for almost 10 years, I’m going to answer that question in this blog post by sharing what the research says, and sharing my professional experience.
Why shouldn’t you take ibuprofen while running long distance?
Let’s dive in!
How Ibuprofen Works
Learning how ibuprofen works can quickly turn into acronym soup, so let’s instead use an analogy to understand how this drug works.
Let’s imagine that the neighborhood where you live is a part of your body (think Osmosis Jones). Sometimes, the streets in your neighborhood get potholes (especially if you live in Boston). These potholes represent tissue damage in your body.
For that pothole to get fixed, there are four steps that need to happen:
A citizen needs to identify the pothole
That citizen needs to call 311 and tell the operator that there’s a pothole that needs to be fixed
The operator needs to send the pothole repair folks out to the job site.
Once the pothole repair folks arrive at the job site, they need to fix the pothole
You could simplify these steps into identification, notification, transportation, and repair.
In your body, the “operator” that sends the pothole repair folks out is an enzyme named COX-2. This enzyme signals the body to send materials that are important to the healing process to the area of tissue damage. When this happens in the body, it can look like swelling and redness, and isn’t particularly comfortable. However, it’s an important part of tissue repair.
Ibuprofen works by inhibiting COX-2. In our analogy, it’s as if ibuprofen is a thief that steals COX-2’s phone so that they can’t call the pothole repair folks about the pothole. Then, when COX-2 is finally operational again and sends the folks out to fix the pothole, it’s gotten bigger because without any signs that there was a pothole, people kept driving over it.
That’s how ibuprofen reduces inflammation and therefore pain, but why it can also prolong the tissue healing process.
Ibuprofen and Marathon Running
Now that you know how ibuprofen works, you can imagine why it’s not so great for distance running.
Running long distances causes some tissue damage just like any type of exercise. In normal conditions when completing an appropriate level of training, the body recovers from this tissue damage without significant injury. However, sometimes the level of training is too much and causes more tissue damage than the body can keep up with, which causes injuries.
The problem is, that’s often when people reach for the ibuprofen! They’ve been hoping that their injury will get better, but after a week of continued pain, they figure ibuprofen will be the solution.
But remember the pothole! Ibuprofen may alleviate the pain, but all that does is hide the pothole so that people keep driving over it, making it bigger and deeper. Ibuprofen restricts your body’s natural healing process, which means that, while your pain may be temporarily relieved, your tissue will remain unhealed.
Specifically, ibuprofen has been shown to limit bone and tendon growth and repair, which are the two most commonly injured tissues for distance runners. Especially those recovering from tendinopathy or a bone stress injury should NOT take ibuprofen, as it can prevent your injury from healing properly.
A Case Study
I had a patient who recently came to see me for some achilles tendinopathy while training for the New York City Marathon.
Based on my evaluation, I would describe his achilles tendon’s irritability as high. I use irritability to describe how much pain someone is experiencing AND how much activity it takes to make their pain worse. He was experiencing a moderate amount of pain, and it took very little activity to make it worse.
After speaking with him about his history, he revealed that he had been dealing with this pain for months, and had been taking ibuprofen to help manage his symptoms. RED FLAG!
With more chronic and severe cases of achilles tendinopathy, the tendon often changes shape by becoming bulbous at the site of injury.
This image is how this patient’s achilles tendon looked on examination.
Most cases of achilles tendinopathy get better with targeted exercises for the calf muscle, and can often start to improve relatively quickly. However, in chronic and irritable cases like this one, the capacity of the achilles tendon was so reduced after so much interruption to the normal healing process that it would take a long time to restore enough capacity for the patient to run a marathon pain free.
What If I Take Ibuprofen In Anticipation Of Pain?
This is another question that I get often.
“I’ve been dealing with some knee soreness but it’s been feeling better, and now it only bothers me when I’m 15 miles into a run. Should I take ibuprofen before my marathon to make sure I can get to the finish line?”
Let’s go back to our analogy.
Let’s now pretend that the operator (COX-2) is also responsible for sending out the street cleaning trucks, and running a marathon is like a thunderstorm. That thunderstorm causes all sorts of debris to land on the street that causes more damage the longer it stays out on the road.
When you take ibuprofen pre-emptively in anticipation of pain before a marathon, it once again “steals COX-2’s phone” and prevents them from sending out the street cleaning trucks for 24-36 hours. That means that all that debris lingers on the road, giving it more opportunity to create the dreaded potholes.
Not to mention, there is conflicting evidence to say that there may be an increased risk of acute kidney injury (AKI) with ibuprofen use during marathon or ultra-endurance sports.1,2 While the evidence on this topic is mixed, acute kidney injuries are serious and probably not worth the risk of taking ibuprofen before a race.
What About Tylenol (acetaminophen)?
Tylenol works differently than ibuprofen and is metabolized (dealt with) in the liver instead of the kidneys. It does not seem to have the same level of impact on the recovery of tissue damage after long bouts of endurance exercise.
However, both Tylenol and marathon running cause the liver to work harder than usual, and taking too much Tylenol can lead to acute liver failure. Generally, it appears safer to avoid taking it prior to or during a marathon.
Summary
Giving you specific medication advice is outside of my scope of practice as a physical therapist. However, I hope that the information that I’ve presented has given you some understanding as to why ibuprofen and marathon running don't mix well.
More importantly, if you’ve been wondering about taking pain relievers to help you get through your marathon, we should talk! Maybe it’s time to “get that street repaved” with the help of a physical therapist. Here at Alterra, we specialize in helping runners understand and address the root causes of their pain so that they can perform their best. If you’re a runner local to Boston’s Back Bay and have been dealing with an injury, book a free discovery call to speak to a therapist today!
Next on your reading list:
Disclaimer: The information in our blog posts is not a substitute for professional medical advice. Consult a healthcare provider before making decisions related to your health. Use our content at your own risk.
Sources
Lipman GS, Shea K, Christensen M, et alIbuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trialEmergency Medicine Journal 2017;34:637-642.
Pannone E, Abbott R. What is known about the health effects of non-steroidal anti-inflammatory drug (NSAID) use in marathon and ultraendurance running: a scoping review. BMJ Open Sport & Exercise Medicine. 2024;10:e001846. https://doi.org/10.1136/bmjsem-2023-001846
_edited.png)
