From the Guidelines
The preferred Non-Steroidal Anti-Inflammatory Drug (NSAID) prescription for musculoskeletal (MSK) injuries, such as meniscus tears and Anterior Cruciate Ligament (ACL) injuries, is topical NSAIDs with or without menthol gel as first-line therapy, or oral NSAIDs, as recommended by the American College of Physicians (ACP) and American Academy of Family Physicians (AAFP) 1, 2, 3, 4, 5, 6, 7, 8. The dosing and timing of NSAIDs for MSK injuries are as follows:
- Ibuprofen: 400-800mg three times daily
- Naproxen: 500mg twice daily
- Celecoxib: 200mg once or twice daily For acute injuries, NSAIDs should be started immediately after injury or surgery and continued for 7-14 days to manage pain and inflammation. Some key points to consider when prescribing NSAIDs for MSK injuries include:
- Starting NSAIDs immediately after injury or surgery to manage pain and inflammation
- Continuing NSAIDs for 7-14 days for acute injuries, or as needed for symptom flares in chronic conditions
- Using topical NSAIDs with or without menthol gel as first-line therapy, or oral NSAIDs as an alternative
- Being aware of potential contraindications, such as kidney disease, certain cardiovascular conditions, or use of blood thinners
- Recommending acetaminophen (1000mg three times daily) as an alternative for patients who cannot tolerate NSAIDs.
From the Research
NSAID Prescription for Musculoskeletal Injuries
- The use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for musculoskeletal (MSK) injuries, such as meniscus tears and Anterior Cruciate Ligament (ACL) injuries, is a topic of debate 9, 10.
- A systematic review and meta-analysis found that NSAID use can reduce strength loss, soreness, and blood creatine kinase level after an acute muscle injury, at least in the short term 9.
- However, another study suggests that NSAIDs can delay healing due to their effect on inflammation, and recommends paracetamol as a safer alternative for analgesia 10.
Dosing and Timing of NSAIDs for MSK Injuries
- There is limited evidence on the optimal dosing and timing of NSAIDs for specific MSK injuries, such as meniscus tears and ACL injuries 11, 12, 13.
- A study on non-operative management of acute knee injuries recommends a short period of knee bracing in extension with progression to weightbearing to tolerance after initial patellar dislocation, but does not provide specific guidance on NSAID dosing and timing 11.
- Another study found that the incidence of meniscal tear associated with ACL injury is higher in chronic cases, and recommends early ACL reconstruction to prevent secondary meniscal tear 12.
Differences in Dosing and Timing for Specific MSK Injuries
- The evidence suggests that the type and location of MSK injury may affect the optimal dosing and timing of NSAIDs 12, 13.
- For example, a study found that lateral meniscal tear was commonly associated with acute ACL injury, while medial meniscal tear was associated with chronic ACL injury 12.
- Another study found that meniscus injuries occurred 77% of the time when there was a persistent ACL injury, and that the incidence of medial meniscus injury associated with chronic ACL tear was higher than lateral meniscus injury 13.