There have been at least eight randomized, double-blind, placebo-controlled trials of ginger for pain.

There was one study in particular that freaked everyone out: A study of thousands of marathon runners found that those taking over-the-counter pain killers before the race had five times the incidence of organ damage. Nine were hospitalized—three with kidney failure after taking ibuprofen, four with gastrointestinal bleeding after taking aspirin, and two with heart attacks, also after aspirin ingestion. In contrast, none of the control group ended up in the hospital. No pain killers, no hospital. What’s more, the analgesics didn’t even work. “Analysis of the pain reported by respondents before and after racing showed no major identifiable advantages” to taking the drugs, so it appeared there were just downsides.

What about using ginger instead?  In that marathon study, the most common adverse effect of taking the drugs was gastrointestinal cramping. Ginger, in contrast to aspirin or ibuprofen-type drugs, may actually improve gastrointestinal function. For example, endurance athletes can suffer from nausea, and ginger is prized for its anti-nausea properties. Okay, but does it work for muscle pain?

There have been at least eight randomized, double-blind, placebo-controlled trials of ginger for pain—for everything from osteoarthritis to irritable bowel to painful periods. Overall, ginger extracts, like the powdered ginger spice you’d get at any grocery store, were found to be “clinically effective” pain-reducing agents with “a better safety profile than non-steroidal anti-inflammatory drugs.” The ginger worked better in some of the studies than in others, which is “likely to be at least partly due to the strong dose-effect relationship that [was] identified and the wide range of doses used among the studies under analysis (60-2000 mg of extract/day).

In terms of reduction of pain, the best results were achieved with one and a half or two grams a day, which is a full teaspoon of ground ginger.

The drugs work by suppressing an enzyme in the body called cyclooxygenase-2 (COX-2), which triggers inflammation. The problem is that they also suppress cyclooxygenase-1 (COX-1), which does good things like protect the lining of your stomach and intestines. “Since inhibition of COX-1 is associated with gastrointestinal irritation, selective inhibition of COX-2”—the inflammatory enzyme—“should help minimize this side effect” and offer the best of both worlds. And, that’s what ginger seems to do. Two ginger compounds had no effect against COX-1, the “good” enzyme, but could dramatically cut down on COX-2, the pro-inflammatory one.

Okay, but does ginger work for muscle pain? Not acutely, apparently. You can’t just take it like a drug. When folks were given a teaspoon of ginger before a bout of cycling, there was no difference in leg muscle pain over the 30 minutes. “However, ginger may attenuate the day-to-day progression of muscle pain.” Taking ginger five days in a row appears to “accelerate the recovery of maximal strength following a high-load…[weight-lifting] exercise protocol.” When you put all the studies together, it seems “a single dose of ginger has little-to-no discernable effects on muscle pain,” but if you take a teaspoon or two for a couple days or weeks, perhaps in a pumpkin smoothie or something, you may be able to reduce muscle pain and soreness, and “accelerate recovery of muscular strength…”

Is fresh ginger preferable to powdered? Maybe not. There are all sorts of compounds in ginger with creative names as gingerols, gingerdiols, and gingerdiones, but the most potent anti-inflammatory component may be compound called shogaols.

Interestingly, dried ginger contains more than fresh, which “justifies the uses of dry ginger in traditional systems of medicine for the treatment of various illnesses due to oxidative stress and inflammation.” In that case, why not just give the extracted shogaol component in a pill by itself? Each of the active ginger components individually reduce inflammation, some more than others, but the whole ginger is greater than the sum of its parts.

However, you can boost shogaol content of whole ginger by drying it, as they are the major gingerol dehydration products. Indeed, they’re created when ginger is dried. Heating ginger may increase shogaol concentration even more, so could heated ginger work better against pain than raw? You don’t know, until you put it to the test. A study examined the effects on muscle pain of 11 days of a teaspoon of raw ginger versus ginger that had been boiled for three hours. There was a significant reduction in muscle soreness a day after pumping iron in the cooked ginger group—and the same benefit was achieved with the raw ginger. Either way, “daily consumption of raw and heat-treated ginger resulted in moderate-to-large reductions in muscle pain following exercise-induced muscle injury.”