It was as casual as pulling out a driver. As Tiger Woods stood in the 10th tee box on the first day of the Masters, he removed a white bottle from his bag, poured two white pills into his hand and swallowed them.
“It’s called ibuprofen,” Woods explained afterward. “My surgeon says to take it all day.”
The mid-round medication has become a form of preventive maintenance for Woods, who has said he is feeling better lately than he has in several years. And for him, after four back surgeries, it appears to be working. His comeback continues in this week’s Players Championship.
But for weekend duffers with back pain, this is one of the rare things Woods does on the golf course that some experts would advise not to try to copy.
Ibuprofen, the anti-inflammatory drug found in over-the-counter pills such as Advil and Motrin, has long been popular among athletes not merely to treat pain but to ward it off. But several studies in recent years have highlighted potential side effects including an increased risk of heart attack or stroke, kidney and gastrointestinal problems and even lower male fertility.
Some doctors and academics argue that the widespread, casual use of ibuprofen to pre-empt pain is a problem to which most athletes are blind.
“Please don’t emulate this,” said Robert Klapper, chief of orthopedic surgery at Cedars-Sinai hospital in Los Angeles and host of “The Weekend Warrior” on ESPN Radio. “You need to respect the pain, because what it’s telling you is to stop.”
Woods, 42, is hardly the only golfer to have taken ibuprofen or related anti-inflammatory drugs such as aspirin while on the course.
Fred Couples, the 1992 Masters champion, has long played through back pain. Now 58 years old, he did so at this year’s Masters, where he finished tied for 38th place. Couples said he has taken “all kinds” of pain relievers for his back during rounds of golf over the years, without elaborating, but has since soured on them.
“I lived on that stuff for a long time, so I try not to take any of it,” Couples said. “Just bear it out—I won’t say ‘tough it out,’ because it’s not really being tough, it’s just trying to swing—but I don’t want to keep taking that stuff. I don’t think it’s that good for you.”
The body of research supporting that general idea has grown. The U.S. Food and Drug Administration in 2015 strengthened an existing warning about heart attack and stroke risks from the use of nonsteroidal anti-inflammatory drugs, including ibuprofen. There have also been studies specific to athletes.
David Nieman, a health and exercise science professor at Appalachian State University, conducted a 2006 study of ibuprofen use among ultramarathoners, who compete in races longer than standard 26.2-mile marathons. It found that runners who pre-emptively took ibuprofen not only had mild kidney impairment—they also reported no less soreness afterward than non-users.
In a new study this year, looking at cyclists, Nieman found that eating bananas may be an equally effective and safer alternative. The study found that banana metabolites perform comparably to ibuprofen in reducing inflammation and supporting the immune system during intense exercise.
“I don’t see any performance advantage in ibuprofen,” he said. “There’s just too many things wrong with it to just be casually recommending people to take it. I think we need to step away from that approach.”
There isn’t universal agreement on this subject. Some well-regarded back surgeons and pain specialists continue to recommend ibuprofen as a preventive measure for people who either have had surgery or suffer from chronic back pain.
Alfred Ogden, a neurosurgeon at the Spine Center at Columbia University Medical Center, said anti-inflammatories are especially useful in golf, which puts significant stress on the spine.
When asked about the potential side effects, Ogden said, “None of these things are surprising. Like any medicine, they have ill effects. Having said that, most people tolerate them pretty well. They’re effective. And those risks can be mitigated by not taking them continuously.”
Thomas Buchheit, chief of pain medicine at Duke University Medical Center, said he prefers that patients do not take anti-inflammatories “all day,” as Woods said he was told to do. But for a golfer who knows that he or she is likely to have a flare-up by the time they’re on the back nine, he said taking one before or during a round is reasonable.
“It’s probably safer than being on an opioid,” Buchheit said.
Woods would know. After his DUI arrest last year, he was found to have two opioid painkillers in his system, among three other drugs. He later checked himself into rehab for issues related to his use of prescription medications.
The potential risk-reward calculation is also different for him than it is for just about everyone else. The average recreational golfer isn’t taking ibuprofen to extend one of the greatest careers in the history of sports. Many people coming off back surgery aren’t even trying to play two days in a row, let alone two weeks in a row, as Woods is set to do this week.
“It’s blasphemous to say this,” said Klapper, the Los Angeles surgeon, “but do we treat in America an elite athlete differently than a weekend warrior? I’d love to say that we don’t, but we do.”