#427 Should I take ibuprofen for a plantar plate sprain? - DOC

#427 Should I take ibuprofen for a plantar plate sprain?

Today on the Doc On The Run podcast, we’re talking about, should I take ibuprofen when I have a plantar plate injury?


Well, that depends. Ibuprofen or Motrin, Aleve, all these anti-inflammatories that you can take, that you can get over the counter at the pharmacy, non-steroidal anti-inflammatories, they do a great job at decreasing musculoskeletal healing, but there is a little bit of a problem.

Now there’s some research, some of it is kind of crossover research, like some studies done in rats and some other things, that actually show that some anti-inflammatories, particularly non-steroidal anti-inflammatories, can slow down healing of tendon to bone junctions. And so the collagen that’s in a tendon, where it attaches to the bone, is very similar to that which is in ligaments.

The plantar plate ligament connects two bones and helps hold those two bones together, and reinforces and stabilize the toe against the ground by connecting them together. Hence the term ligament, it comes from ligate, or to hold together.

In general, unless you’re really having a lot of discomfort, I do not recommend anti-inflammatories as a form of treatment. And a lot of people will say, “Well, when you get a plantar plate injury, one component of it is capsulitis.” And that’s because the plantar plate ligament is attached to the joint capsule.

When you have inflammation within and around the joint capsule, we call it capsulitis. So itis just means inflammation. If you have tonsillitis, you have inflammation of your tonsils. And if you have a gastritis, you have inflammation within your stomach.

The idea is that since it is an anti-inflammatory, that the non-steroidal anti-inflammatory like ibuprofen might actually decrease the inflammation in the joint capsule, and make it feel better or heal faster. Well, yes and no. So if the anti-inflammatory is targeting just the inflammation and you’re trying to make it feel better, so that you can compete in a race or something like that, yes, it can achieve that.

The issue though, is that it also works as a pain reliever. So if you’re taking an anti-inflammatory like ibuprofen and it’s kind of masking your pain a little bit when you run, and you’re kind of beating it up a little bit more, and it helps to facilitate your athletic activity, but it actually inhibits your ability to keep accurate pain records, then it makes it harder for you to assess whether or not each of these given athletic activities, like a long run, or a trail run, or something like that, whether or not that thing’s really safe for you.

As you know, in the planter plates sprain course, one of the mainstays of the idea is that you need to track your pain, you need to print out the pain journal, you need to get your numbers, you need to figure out what your real baseline is, at the outset. Then as you heal, and as you recover you’re testing activities very systematically and carefully, to ramp up the intensity and the duration just a little bit and then you see if your pain numbers change.

If you’re not having bruising and you’re not having swelling, and the only thing you have to go on is pain, you really need to be able to feel it. That’s sort of the second reason that I don’t really like to recommend ibuprofen for people who have a plantar plate injury, and they’re trying to get back to running as quickly as possible. But that is a great question.