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First published on November 23, 2004, doi:10.1177/0363546504266069
This version was published on December 1, 2004
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The American Journal of Sports Medicine 32:1856-1859 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

Nonsteroidal Anti-inflammatory Drugs and Acetaminophen in the Treatment of an Acute Muscle Injury

Frank T. G. Rahusen, MD*, Paul S. Weinhold, PhD{dagger} and Louis C. Almekinders, MD§,{ddagger}

From * St Maartenskliniek, Nijmegen, the Netherlands, the {dagger} Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, and the § North Carolina Orthopaedic Clinic, Duke University Health System, Durham, North Carolina

{ddagger} Address correspondence to Louis C. Almekinders, MD, North Carolina Orthopaedic Clinic, Duke University Health System, 4309 Medical Park Drive, Suite 100B, Durham, NC 27704 (almek002{at}mc.duke.edu).

Background: Nonsteroidal anti-inflammatory drugs are frequently used to treat muscle injuries in athletes. It is not known whether the anti-inflammatory effects of these drugs are important or whether their effectiveness is a result of their central analgesic effect.

Hypothesis: The effects of nonsteroidal anti-inflammatory drugs are no different than the effects of an analgesic (acetaminophen) without anti-inflammatory action in an experimental, acute muscle contusion model.

Study Design: Controlled animal study.

Methods: A standardized, unilateral, nonpenetrating injury was created to the tibialis anterior muscle of 96 adult male mice. Four treatment groups were used: group 1, placebo treatment; group 2, treatment with rofecoxib, a nonsteroidal anti-inflammatory drug with cyclooxygenase-2 selectivity, and treatment after the injury; group 3, rofecoxib treatment starting 24 hours before the injury; and group 4, acetaminophen treatment after the injury. The muscle and the contralateral normal muscle were evaluated at 2, 5, and 7 days after injury by grading of gait, wet weight as a measure of edema, and histologic evaluation.

Results: Group 1 had significantly more gait disturbances at day 2 than all other groups (P < .05). No differences were found at days 5 and 7. Wet weights showed an increase at day 2 in group 1 (P < .01). Again, no differences were found at days 5 and 7. Histology revealed similar inflammatory changes at day 2 in all groups, with regeneration of muscle fibers at days 5 and 7.

Conclusions: The results indicate that rofecoxib as a nonsteroidal anti-inflammatory drug and acetaminophen as a non–nonsteroidal anti-inflammatory drug analgesic have similar effects. The lack of differences in wet weights and histology suggests that the anti-inflammatory effects of rofecoxib are not an important feature of its action.

Clinical Relevance: The routine use of nonsteroidal anti-inflammatory drugs in muscle injuries may need to be critically evaluated because low-cost and low-risk analgesics may be just as effective.

Key Words: muscle injury • nonsteroidal anti-inflammatory drug (NSAID) • acetaminophen • soft tissue • contusion




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