 Poster: A snowHead
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In general I now take 2 x Nurofen 256mg caplets after skiing or any other activity that gives my knee slight pain to stop/reduce swelling. (No special reason for Nurofen they were just
what caught my eye first when I went to the chemist). I was just wondering :
1)Is there a time limit after which one should not take them anymore ? ) or should they be taken until all swelling has gone even if it takes 6 weeks?
( when I only have slight swelling and no ,or only slight, pain I don't take them )
2) Is an anti-inflammatory gel (e.g. Nurofen Ibuprofen Gel) applied to the knee any better than taking anti inflammatory pills ?
3) Any general advice on which anti-inflammatories ?
Thanks
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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I always get the cheapest generic tablets (and gel) I can find but like brnttptr would be interested to know if there is a more enlightened way of choosing!
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Just as a heads up, some studies have shown that excessive use of Ibuprofen can increase fracture risk.
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You need to Login to know who's really who.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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brnttptr, given your other post on the state of your knee, I can't believe you haven't got any more powerful NSAIDS on prescription. Surely you should be taking Diclofenac or one of the more modern selective COX 2 inhibitors like Arcoxia (not sure that's the UK brand name) that are designed for arthritis BEFORE activity?
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You'll need to Register first of course.
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One of the best anti-inflammatories is Naproxen. By comparison, taking ibuprofen/neurofen is like taking water for the pain (i.e. doesn't work).
People call Naproxen "The Ten Years Younger Pill" for good reason.
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Until recently these "anti-inflamatories" were considered pretty innocuous.
No longer.
Raceplate, most hospitals have removed Diclofenac from their shelves. I presume GPs are taking similar steps.
See MHRA article
boardiac is a bit unfair in denegrating Ibuprofen to efficacy of water. It is effective for many people.
Certainly works for me.
However you are right in advocating the use of Naproxen.
It does seem to have the best safety profile.
(though not sure i would go along with "The Ten Years Younger Pill" label)
More info from Lancet study here.
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Jonpim,
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| most hospitals have removed Diclofenac from their shelves. I presume GPs are taking similar steps. |
Not in my experience. My Mum was prescribed Diclofenac a few weeks ago. But I am well aware of the controversy around it which is why I suggested Arcoxia.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Raceplate, the selective COX 2 inhibitors were initially greeted with enthusiasm because of their reduced risk of gastro-intestinal bleeding.
But then the spectre of cardiovascular risk appeared. Vioxx (Rofecoxib) was the first to go.
Then slowly it appeared that all the Cox 2s had similar problems
Even eterocoxib (arcoxia). See BMJ paper from 2011.
(Sorry, can't find link to original article)
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I used to take diclofenac for skiing but as my osteoarthritis deteriorated it became insufficient to prevent inflammation, which made my knees stiff and skiing difficult. I now get cortisone injections in my knees at the beginning of each season for the inflammation, plus no more than three standard (200mg) ibuprofen a day for residual pain. Ice packs help too.
Strong drugs should only be taken on medical advice, of course.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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brnttptr,
Anti- inflammatories
No one is more powerful than another
For some they cause side effects( ESP elderly, those on blood pressure meds,diabetic) and should totally avoided in any one with kidney disease or a history of stomach ulcer and possibly diabetics. There are people who have taken them for years with minimal trouble. The longer acting ( you take them once a day ) drugs seem to have higher risk of side effects,, especially liver problems. Some of these drugs are thought to increase risk of cardiac problems , especially in someone with a history of heart disease.
Some will respond well to Drug A, another responds just aswell to Drug B whilst finding Drug A useless. In other words individuals respond differently to these drugs. Find the one that works for you and stick to it.
All treatments carry some risk. If you tolerate the drug, it works and the pain without is awful the decision is easy. It is less easy if drug not well tolerated, it only works a bit or the pain moderate.
Discuss it with the doctor prescribing it or if using OTC drugs like ibuprofen for prolonged period.
I buy the cheapest version as long as it is made in UK as there are problems with counterfeit drugs in some parts if the world .
Tactical use of these drugs whilst skiing can get you through the week of skiing but don't forget ice and compression aswell.
Jonathan Bell
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Thank you all very much for the great feedback , advice and links which were all very useful .
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You know it makes sense.
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I'm 59, started skiing 12 years ago. I do get some knee pain but I find that wearing the blue neoprene knee supports from Boots ( with the round opening) helps a lot. I don't take Ibuprofen orally because it causes stomach pain ( so does aspirin) but I do take 2 paracetamol at breakfast and again at lunch. I sometimes apply Diclofenac gel to my knees but try not to since I feel that this causes stomach upset by absorption ( maybe imaginary.) I am a big chap but keep very fit by strenuous hill walking every week, I keep the neoprene around my calves for the ascent and pull them up over the knees for the descent. I used to suffer from horrendous thigh burn until, during a private lesson at Cham, the excellent Shona Tate told me that I was in the " toilet position" (aka back seat) - ever since then I keep my weight further forward and my thighs are much better. Hope this is of interest.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Poster: A snowHead
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pam w,
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I put some of the ice on me knees and the rest in the gin.
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what waste ice on the knees? 
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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pam w, oh Pam, fornicate not defecate was my understanding 
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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| Quote: |
| I used to suffer from horrendous thigh burn until, during a private lesson at Cham, the excellent Shona Tate told me that I was in the " toilet position" (aka back seat) - ever since then I keep my weight further forward and my thighs are much better. Hope this is of interest |
This has been my problem this last few days, I knew I was doing it but found it difficult not too. Back to ski school for me 
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You need to Login to know who's really who.
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brnttptr, pam w, Look to eating more anti-inflammatory foods too inc. onions, broccoli, asparagus . . . the list goes on. Include as a REGULAR part of your diet will reduce the amount of OTC stuff you need to use
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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Masque, I only use OTR anti-inflammatories occasionally - usually whilst skiing, but only before/after a hard day. And these days I have few of them. Today I did one long chair lift with a blue run down, then a short drag lift and a green run down, with a beginner. No drugs today. But am enjoying a glass of sparkling red wine (Freisa d'Asti) local to the part of Italy where my son lives. Only 11% and went well with the confit of duck. It's reducing my swellings a treat. and I do eat quite a lot of onions, broccoli and asparagus. 
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You'll need to Register first of course.
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brnttptr,I don't know if you're still following this thread but here goes anyway: first I believe Jonathan Bell is a medic so clearly his advice is sound, particularly wrt R.I.C.E: rest, ice, compression, elevation.
When I get back to my room after a days skiing I slap a cold pack on each knee and put tubigrip on them sitting on the bed with a beer - ie about 10 mins.
I spent 25years in the pharmaceutical industry so can tell you that, as far as I am aware, there has never been any evidence of 'tolerance' (not working after a time) developing to NSAIDs. With those available over the counter, as JB said, there isn't one any stronger than the other, but individuals do get more relief from one rather than another - as their mode of action is the same, no one really knows why, it's just put down to differing responses to the chemical compounds in question. As far as gels are concerned, they can be of great help if, as is often the case, it is the localised swelling that is causing the pain - topical application is pretty much useless if you've got a hip problem, but knuckles, knees and ankles fair quite well. Because there is little fat covering these areas drug absorption's not bad: my preferences are diclofenac and ketoprofen, but whatever is cheap and works for you is the one to get.
On the subject of long term oral dosing, I would really seek your doc's advice because there are a number of what are called systemic side effects that are very much in the 'not nice' catagory.
Hope this helps 
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Start taking Glucosamine. Loads of people I know use it including myself. Keeps the knees healthy, certainly know the difference if I dont take it for a few days.
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mozwold Thanks for the info . So far the Nurofen have not made a big difference so I will have to see the Doctor and maybe try a more powerful prescription painkiller. As both you Jonathan mentioned its trial and error
to find the right one. At the moment I am just skiing for short periods to avoid swelling so use pain as the guide when to stop.
If will be interesting to see , if I find a stronger painkiller that suits me, if the reduction in pain leads to longer skiing hours with no swelling or if it just masks the pain which is the trigger to stop and avoid swelling ?
snowrider Thanks
I have been taking 150mg Glucosamine and 120mg of Chondroitin daily for 4 weeks now and to be honest have not noticed any difference yet.
Thanks to everyone else for their comments. All helpful as this is a very steep learning curve for me.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| Quote: |
snowrider Thanks
I have been taking 150mg Glucosamine and 120mg of Chondroitin daily for 4 weeks now and to be honest have not noticed any difference yet.
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I took them for a year - The stuff of Witch Doctors if you want my opinion.
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Frosty the Snowman, + 1
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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I have to agree with Mozwold. Having suffered for years with various knee injuries (2.5 years ago I was told to stop playing sports) I have completely removed the painkiller/anti-inflammatory medicine element. For me it's just a way of covering up a problem, rather than fighting the source. There are also lots of documented cases of long term use of ibuprofen and similar causing various stomach (and other) problems. If either of my knees are swollen then I am in trouble, as all my loose cartilage starts to float about... So prevention is much better than trying to cure it at this point.
Diet and exercise is key (isn't it always  ). So, as already mentioned, anti-inflammatory foods such as blueberries (a favourite of mine), almonds/almond butter, kale, oily fish etc etc (the list is extensive). Follow this up with low impact exercises. Ease in to it initially, see a specialist if need be. But there are a range of exercises you can do at home (no need for expensive gym memberships). Good technique when it comes to squats, lunges etc is key and riding a bike helps keep your knees mobile. As long as the knees are kept in-line through all of these, then there should be no problems. The idea is to build your muscles up so that the knees don't have to deal with the brunt of everything you throw at them. Finally I supplement with glucosamine and chondroitin, cod liver oil, vitamin D & calcium and magnesium. If you shake me I rattle and this may all be a placebo, but following all of the above I have never felt so good.
After a heavy day's skiing I R.I.C.E., take on some non-alcoholic fluids and make sure I am ready to go for the next day. Beers/wine/alcohol can follow once I am a little more hydrated (do not underestimate the effect de-hydration has on your joints).
Before I ski the next day I make sure my muscles are warm and I am good to go before I clip in. There is nothing worse for your knees that to take the brunt of your muscles not working properly.
Hope that helps!
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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Frosty the Snowman, + 2
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MSM Glucosamine is a wonder drug in my opinion, a real miracle cure, but the knees still swell and hurt after a days skiing.
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You know it makes sense.
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I believe Jonathan Bell is a medic
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not any old medic - a knee specialist. We are lucky to have him popping in here.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Poster: A snowHead
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I'd go with JB's advice but personally I go with 1 naproxen before I start skiing for the day. I used to occasionally top up with a second in the afternoon but found recently it's not been necessary (don't know why, not measurably fitter/lighter weight/knees miraculously better etc). Only take occasional ibuprofen when not skiing though.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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don't know why, not measurably fitter/lighter weight/knees miraculously better etc
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fatbob, you probably ski better - my knees bother me much less at 66 than they did at 46. But looking at this thread reminds me that after my very poor effort at an unpisted black run this morning (I got down it without falling over, and that's about as much as could be said for it) and coming back for a substantial late lunch, I might take some ibuprofen!
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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| boardiac wrote: |
One of the best anti-inflammatories is Naproxen. By comparison, taking ibuprofen/neurofen is like taking water for the pain (i.e. doesn't work).
People call Naproxen "The Ten Years Younger Pill" for good reason. |
This , or get Arcoxia if your Doctor is helpful.
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You need to Login to know who's really who.
You need to Login to know who's really who.
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brnttptr, Forgive me being pedantic, it's just there's a difference between painkillers (analgesics) like paracetomol and codeine, and NSAIDS like naproxen, ibuprofen etc. Only the latter have any anti-inflammatory effect. Just be aware of the difference when talking to your doc: he may prescribe one of each.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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mozwold . Thanks ,yes your right, should have said anit-inflammatories or NSAIDS but it was a slip up as the pain was still fresh !
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You'll need to Register first of course.
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Glucosamine and Chondroitin.
Now, of course, if you feel it works for you, then that is fine. Trials are not about individuals but populations.
But the data on Glucosamine and Chontroitin is pretty fuzzy.
Glucosamine studies seem to be significantly influenced by industry involvement - see ARTHRITIS & RHEUMATISM Vol. 56, No. 7, July 2007, 2267–2277
(for more on this general problem read by Bad Pharma by Ben Goldacre)
A recent BMJ review on Effects of glucosamine, chondroitin, or placebo in patients with osteoarthritis of hip or knee: network meta-analysis concluded "Compared with placebo, glucosamine, chondroitin, and their combination do not reduce joint pain or have an impact on narrowing of joint space."
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Jonpim, would agree totally on the fuzzy evidence and don't recommend it at all to our patients/customers , but on the advice of our vet, we've been giving it to our arthritic dog recently, and there's been a big improvement in her mobility.
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I am reading this with interest.
My Dad was advised to take it by his doctor due to help his arthritis. Obviously we can't know would he be suffering MORE if he hadn't been taking it? He is off skiing as we speak.
The reason I Am interested is I have had 3 operations over both my knees (twice on one of them). I have been told to expect to develop arthritus quite early on due to the extent of the damage and surgeries I have had. I have been considering taking these supplements in the hope of delaying the onset of it..... Is it worth it? I realise this question is up there with will we have lots of snow when we go skiing in April
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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Jonpim
That makes an interesting read. Basically, any test with no involvement from the drug company seems inconclusive accept maybe the glucosamine sulphate variety. I'll still keep taking it though as it seems to work for me.
What I will try is ibuprofen and cold compresses too.
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Nicky J I was diagnosed with arthritis in one of my knees in late Nov and was advised to take G&C for it . I have been taking it daily for 6 weeks now and don't notice any difference . I was told to take it for three months
and if, by then , it was not helping to stop taking it.
I know some people who swear by it and others that said it had no effect on them. I got mine from Healthspan on the internet (ChondroMax ) you might want to look at the reviews from people who use it which are very positive .
http://www.healthspan.co.uk/products/chondromax
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FAQ
