**4. NSAIDs**

Experimental animal models of muscle injury have been used to examine the effect of NSAIDs on healing. These models have mostly demonstrated no effect on muscle healing, no reduction in muscle strength and no altered cytoarchitecture after injury (Jarvinen et al, 1992).

Studies conducted on humans subjects examining the effect of short courses of NSAIDs on acute muscle injury are contradictory [12,13,14,15,16].

While some investigations have not found any effect of NSAID administration on muscle recovery, there are several reports supporting a protective effect of NSAID medication, typically characterized by a lesser degree of muscle damage and functional deficit in the early period after injury.

One research study showed that Diclofenac taken priorto a strenuous exercise program produced lower levels of histological muscle damage in athletes compared with athletes who received placebo medication [17]. In addition, Naproxene has been demonstrated to decrease muscle pain post strenuous exercise [18], while ibuprofen proved to be less ef‐ fective [19].

However, generally, in patients with acute hamstring muscle injury who were undergoing physiotherapy, the administration of NSAIDs had little effect on pain assessment or muscle performance.

It can be concluded that the short-term use of NSAIDs in muscle injury reduces pain and the time to return to full activity. Conversely, the few studies that have followed the repair process over a longer period of time suggest that any apparent benefit of NSAID treatment in the short term is not maintained in the long term and may result in a higher incidence of GI and CV adverse effects (ref).

An alternative to NSAIDs for analgesia is acetaminophen, which can be considered as effective as NSAIDs for pain reduction after musculoskeletal injury [20].

The prophylactic use of NSAIDs to prevent inflammation and pain that may accompany normal training and activity currently lacks scientific evidence and its use may create harmful collateral effects.

However, it is also worth considering that from a purely clinical viewpoint, the use of NSAIDs' for muscle lesions may possibly predispose to injury recurrence as a result of pain masking.

Finally on a biological level, a number of basic science studies showed that NSAIDs may inhibit muscle regeneration in the first stages of healing, which relies on the inflammatory process.
