Dr. Brian Coleisa nationally acclaimed orthopedic surgeon and sports-medicine doctor who cohosts the popular radio showSports Medicine Weekly.Whether you want to know about bunions, better sleep, or running your first marathon without getting hurt, Dr. Cole can offer an experts take. Eric Haunschild, his research assistant, also contributes to this column.Have a question? Email AskADoctor@outsideim.com. The doctor is in.

I keep hearing conflicting things about ibuprofen. My doctor prescribed a steady dose400 milligrams in the morning and 400 in the eveningfor tendonitis, but I always thought it was something to take on an as-needed basis for pain. And 800 milligrams a day sounds like a lot! Also, isnt it bad for my stomach lining? Whats the best, safest way to use ibuprofen?

It sounds like you and your doctor are both right. Ibuprofen can be used to reduce pain and inflammation, but the way you dose depends on which effect you are predominantly trying to achieve. The pain-reducing effects of ibuprofen begin rapidly, usually within 30 minutes of taking a dose, so you can take it as needed, whether you have a headache or an achy knee. To reduce inflammation, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin and Aleve need to be taken regularly over days to quiet the bodys inflammation-producing pathways. For persistent relief of joint pain, you should follow your doctors instructions and take a regular dose as prescribed, even if you arent feeling pain right at that moment.

Its true that ibuprofen can be bad for your stomach and intestines. This is because the same pathway in your body that generates pain and inflammation also produces the mucus in your stomach that protects it from stomach acid. NSAIDs work by blocking cyclooxygenase enzymes, which play a role in producing a type of lipid called prostaglandins, which in turn act like a hormone throughout the body to initiate myriad biologic processes. In particular, they initiate the sensitization of our nerves to send pain signals to the brain, the generation of inflammation in areas where white blood cells signal them to do so, the inhibition of platelet aggregation needed for blood to clot, and the production of the mucous needed to line the stomach. When you take an NSAID, you alter all of these mechanisms, which can, over long periods of time, lead to stomach ulcers and bleeding. Thats why people with gastrointestinal conditions like peptic ulcer disease or Crohns disease, as well as people over the age of 65, shouldnt take NSAIDs without first talking to a doctor. More commonly, taking ibuprofen can cause a mild upset stomach. If you get queasy, take it with food.

As a rule of thumb, you should opt for smaller, more frequent doses when taking NSAIDs. A usual dose is 200 to 400 milligrams every six to eight hours for no more than two weeks. If you miss a dose, dont double up on the next one. Just continue dosing as usual. If you have any questions related to the safety or specific use of NSAIDs, you should consult your physician.

I roll my ankles all the timeon the trail, in heels, when Im just running on the sidewalk. Why? Does this mean I have weak ankles? Are there exercises I can do to make them stronger?And should I be wearing special shoes?

Tweaking your ankle is incredibly common: Americans make more than a million emergency-room visits each year for fractures and sprains of the joint. The ligaments of your ankle are exposed to a lot of stress. They can be torn or strained from a bad ankle roll, but theyre also prone to wear and tear over time with normal movements like walking. Every time you twist your ankle, you contribute to a snowball effect: the ligaments become weaker and more stretched out, which then increases your risk of rolling your ankle again. Without proper treatment, you can develop chronic instability, pain, and degeneration.

Physical therapy that targets and strengthens your ankle stabilizers can go a long way in ensuring your ankle heals correctly. Simple exercises that promote ankle movement in all directions, such as drawing the alphabet in the air with your toes, can help restore range of motion. Calf raises, balancing on one foot, and heel walks can all help strengthen the joint. Once you progress through these exercises, you can further strengthen the ankle with hopping exercises and training with other movements specific to your sport or activity. Find a physical therapist to help you develop your ownpersonalized program.

There arent many conclusive studies about the role of shoe selection in reducing the risk of rolling your ankles. High-top shoes are thought to provide more support, but a number of studies comparing ankle sprains in athletes havent found a meaningful difference between high-top or low-top shoes. There are a number of ankle bracesand taping techniques that can offer supplemental help in stabilizing the ankle. If you feel that additional support helps, theres no reason not to use itbut remember that strong ankle stabilizers are much more critical in preventing future ankle rolls.

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