Management of Muscle Strain or Cramp Due to Endurance Exercise

Treatment Options

The American College of Cardiology is not mentioned, however, a guideline recommends considering acetaminophen (paracetamol) up to 4g daily for mild pain 1
For localized pain, try topical NSAIDs like diclofenac gel, as suggested by the European League Against Rheumatism 2, 3
For systemic pain, use aceclofenac (100mg twice daily), which has a better gastrointestinal safety profile than diclofenac 1
If aceclofenac is unavailable, consider ibuprofen at lower doses (1.2g daily) due to its lower gastrointestinal risk, as recommended by the American Heart Association and other organizations 1, 4

Both medications should be used at the lowest effective dose for the shortest duration possible to minimize adverse effects, according to the American Geriatrics Society 1, 4
Diclofenac has been associated with an increased risk of thrombotic events compared to some other NSAIDs, as reported by the American Heart Association 5
For patients with cardiovascular risk factors, neither aceclofenac nor diclofenac would be first-choice medications; naproxen might be preferred in these cases, as suggested by the American College of Cardiology and other organizations 5
In elderly patients or those with gastrointestinal risk factors, consider adding gastroprotective agents if NSAIDs must be used, as recommended by the American Geriatrics Society and other organizations 1, 6

Avoid using NSAIDs as first-line treatment before trying acetaminophen, especially for mild pain, as recommended by the American Academy of Family Physicians and other organizations 1, 4
Do not combine multiple NSAIDs as this increases risk without providing additional benefit, according to the American College of Rheumatology and other organizations 4
Be aware that NSAIDs may delay natural healing processes as inflammation is a necessary component of tissue recovery, as reported by the National Institutes of Health and other organizations 4
Monitor for cardiovascular, renal, and gastrointestinal adverse effects, especially with prolonged use, as recommended by the American Heart Association and other organizations 1, 6

The American Gastroenterological Association notes that diclofenac carries a moderate risk for serious upper gastrointestinal events, particularly during the first 6 months of treatment 7
The European League Against Rheumatism suggests that for patients with gastrointestinal risk factors, aceclofenac remains preferable to diclofenac, but add proton pump inhibitor co-therapy regardless of which NSAID is selected 8
Patients with prior ulcer complications represent a special high-risk group where even COX-2 selective agents may not provide adequate protection, with recurrent bleeding rates of 9.8-12.8 per 100 patient-years despite selective therapy 7