No I’m not having a heart attack.  Not even a stroke.  But I am religiously using nitroglycerin patches for some of my sports injuries.  If you find yourself with connective tissue pain from running and cycling (who doesn’t?), you may want to ask your doctor about this simple but very effective solution.

Disclaimer:  I am not a doctor and this is not medical advice.  I can’t tell you about medications that may work for you or that may be harmful to you.  Each of us is unique.  I can only tell you about my experience and what has worked for me.  So before you try this strategy, make sure to talk it over with your doctor– which you will likely have to do anyways given that nitroglycerin patches require a prescription.

Background on Nitroglycerin

Nitroglycerin isn’t just for blowing things up.  It’s also a really powerful vasodilator.  I remember reading somewhere that Alfred Nobel first noticed this effect in some of his factory workers who were regularly exposed to nitroglycerin.  I’m not a physician or biochemical engineer, but from what I understand, nitroglycerin is absorbed pretty easily into the body where it gets converted to nitric oxide, which has a pretty strong vasodilator effect.  Nitric oxide is one of the darlings of the body building community– it has something to do with “pump” or some other nonsense that this scrawny runner wouldn’t know much about.

Nitroglycerin patches deliver a very tiny, sustained, time-released dose of nitroglycerin into the body.  They are great for people with angina (insufficient blood flow to the heart muscles) and probably 98% of nitroglycerin patches get used in this way.  But a quick Google search reveals that they are also used by elite runners suffering from achilles tendinitis.  Yes, that’s right, unless you are in the top 1% or bottom 1% on the American health scale, you probably won’t ever get prescribed nitroglycerin patches!  If you’re interested in spending a little time online researching nitroglycerin patches, here’s a great article to get you started that summarizes the research to date.  Also, because most of the folks getting them from the pharmacy are on the unhealthy side of the spectrum, don’t be surprised when the pharmacist gives you an odd look, probably thinking to herself that you look way too healthy to be prescribed nitroglycerin patches.

So why do they work?  Connective tissue, like tendons and ligaments, heals slowly in adults.  This is mostly due to the fact that, once we pass our teenage years, blood flow to these areas virtually stops.  It doesn’t stop entirely, of course, but it’s so slow that there is virtually no cellular turnover in our ligaments and tendons.  Consequently, when we get injured in these areas, healing takes forever and often gets done in a haphazard, incomplete kind of way.  This is the reason that procedures like PRP and autologous blood injections are so helpful.  Increasing nitric oxide in these areas works by increasing blood flow, but nitric oxide also has some kind of injury signaling effect for wound injury that I’ll never understand.  It somehow kickstarts the healing process in ligaments and tendons while increasing blood flow.  It’s also known to have an analgesic effect.  So it kills pain and promotes healing– exactly what I need when I get injured.

What Have I Used Them For

Two years after getting a very successful PRP injection in my achilles tendon, I started noticing the pain coming back when I increased my mileage late last season.  My doctor prescribed nitroglycerin patches and they worked like magic– pain was reduced within a week and I was running pain-free in two weeks.  In fact, I didn’t miss a single day of training because of the injury.  Since then, I used them on an upper hamstring tendon and a really bad case of plantar fasciitis, which I’ll talk about in an upcoming post.

Best for Newer Injuries and in Higher Doses

I was a bit skeptical when the doctor prescribed the patches.  I told her that I had been prescribed them before by a different doctor and I found them pretty useless.  She asked me how I used them and I told her that I cut the patch into quarters and put a quarter on the painful areas.  She explained that a quarter patch (1.25 mg per 24 hours) wasn’t enough– I really needed a half patch (2.5 mg) or even a full patch (5 mg) to really get a good measure of its effectiveness (note: the picture at the beginning of the post is a box of 5mg patches– they deliver nitroglycerin at a rate of about 0.2 mg per hour).  Sure enough, when I increased the dose to a full patch on my achilles tendon, the difference was night and day– all of a sudden, the patches just worked.

Also, my doctor explained that nitroglycerin patches work best for newer injuries– before a case of tendinitis had progressed into tendinosis.  It’s not that they aren’t useful for older cases– it just takes a lot longer to really get good, long-lasting results because now there is scar tissue to deal with.

These tips, plus my success with using full 5mg patches, earned nitroglycerin patches a permanent place in my first aid kit.  Now, if I feel a case of tendinitis coming on, I’ll just immediately put on a patch without waiting a week to see the doctor.

I Have to Drink Lots of Water to Avoid Headaches

When my doctor was increasing my dose, I told her that I got horrible headaches from even a quarter of a nitroglycerin patch– so how could possibly I take four times that dose?  She then asked me if I remembered to increase my water intake.  I responded sarcastically that I might have remembered to increase my water intake if someone had told me to do that in the first place!

All of this makes sense.  Nitroglycerin gives headaches because it is a strong vasodilator, which brings on the headaches.  Having more water onboard counteracts the headache effect.

I’ve also found that it’s not a smart idea to jump immediately into a full 5mg patch after not using them for awhile.  Now I start with a half patch for the first day, making sure to increase my water intake a lot.  Then I bump it up to 5mg on the second day, as long as the headaches (which always seem worse on waking) aren’t too bad.

How I Use Nitroglycerin Patches

Using the patches is ridiculously simple.  I just find the tendon or connective tissue that hurts, identify the most painful spot on it, and stick the patch directly on that spot.  The patches have a really strong adhesive and so they adhere very well.  But just to be sure that they stay in place, I cut a piece of Leukotape, round the corners (deters catching on clothing and sheets), and tape down the patch.  Also, the Leukotape hides the lettering on the nitroglycerin patch, so I don’t have to explain to quite as many people that I’m not about to have a heart attack.  If you don’t already have a few rolls of it around, here’s the link to Leukotape on Amazon.  It’s like duct tape to physical therapists– they use it for everything.  Ultra marathoners use it to prevent blisters.  I use it to keep band-aids in place.  It’s like a super-strong athletic tape that really sticks.  Trust me, if you do endurance sports, you’ll find a use for it.  While you’re at it, pick up a pair of super-cheap fluoride coated scissors on Amazon— they make cutting any kind of adhesive tape (particularly Leukotape, which has a thick strong adhesive) much easier and far less messy.

My sports medicine doctor knows that I’m a nutty runner and cyclist and so I’m frequently getting minor connective tissue overuse pains.  As much as we like seeing each other, she’d rather enable me to fix myself, so she can focus on other cases.  So, she lets me refill my prescriptions pretty freely.

If you’re reading this blog, there’s a strong possibility that you also get minor connective tissue pain on a pretty regular basis.  If so, you may be interested in asking your doctor if it’s a good idea for you to try the nitroglycerin patches.  While it isn’t a perfect solution, it has kept me out of the doctor’s office for some time now.

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