At first glance, the group of common pain medications called NSAIDs (nonsteroidal anti-inflammatory drugs) would seem to be a runner’s dream come true. They mask minor aches and pains and reduce inflammation. Runners have plenty of both. It’s a match made in heaven. The most common NSAIDs include aspirin, ibuprofen (such as Advil and Motrin) and naproxen (Aleve).

However, this group of widely available pain pills deserves a second, closer look. Like all drugs, NSAIDs have side effects. Most runners don’t think about the side effects, because they never develop major problems. But a clear understanding of the risks is important for smart, healthy running.

NSAIDs can cause stomach upset and bleeding. They may interfere with kidney function. They have been shown to disrupt messenger proteins that contribute to the training effect (the reason you are running in the first place). And they are associated with increased risk of stroke and heart attack.

In fact, in 2015 the Food and Drug Administration toughened the language required on NSAID consumer information labels. The labels now warn that “the risk of heart attack or stroke can occur as early as the first weeks” of NSAID use, and can increase with continued use over longer periods. One NSAID researcher has summed up her view as follows: “Patients should use the smallest possible dose for the shortest possible time.”

That’s a wonderful guideline, which I follow myself. Yes, I use NSAIDS on occasion. However, only when I have a specific, acute ache or pain, and never for more than seven to ten days in a row. That’s what most experts recommend, and it seems the safe, smart approach.

Acetaminophen is a different story. It’s an effective pain reliever that carries less heart risk than the NSAIDs, but it’s not an anti-inflammatory. Hence it’s good for pain blocking but not injury healing. Use it accordingly. The National Institutes of Health recommend taking less than four thousand milligrams a day, and not for an extended period.

  

Don’t pop pills: According to some surveys, up to 70 percent of runners use NSAIDs at one time or another. If you’re one of these, limit your use to acute, short-term situations. Don’t get into the habit of tossing back a few pills before every workout or race. They’re not an appropriate insurance policy against aches and pains. In fact, they could backfire by masking a pain that needs more specialized attention. The result could be a minor injury that turns into a bigger, more long-term one.

The up-and-down motion of running produces a sloshy stomach. That’s why more runners than cyclists become nauseous while exercising, particularly if they hydrate a lot. The stomach sloshing also exacerbates an NSAID’s tendency to increase intestinal leakage and systemic inflammation. The only things you should introduce to your stomach while running are fluids and fuel—not pain pills.

  

Begin with RICE: The classic RICE approach is the best way to begin tissue rehab: rest, ice, compression, elevation. Every runner I know has a bag of peas in the freezer to apply to various parts of the leg. I put my peas inside a plastic sandwich baggie to give my skin a secondary layer of protection from the ice.

Recently some physical therapists have begun following the PRICE system. The P stands for protection in the form of a strap, belt, and/or functional compression sleeve that can be worn around the clock, including during your first cautious return to exercise. I have several of these with adjustable Velcro straps that I can adjust to my leg circumference.

  

Opt for nonpill relief: We runners have an ever-growing selection of alternative therapies for pain relief when dealing with muscle and tissue discomfort. As a general rule, these are far safer and smarter than NSAIDs. The therapies include ice, cold water, massage, acupressure, acupuncture, trigger-point therapy, and self-massage with a range of sticks, rollers, and similar devices.

Some are more effective for one type of injury than for another, but all are employed by large numbers of runners. I have a handful of self-massage pressure tools that I use when necessary. They sit idle much of the time, thank goodness, but I find them effective at relieving the discomfort of minor injuries.