Are You Overdosing on Ibuprofen?
In a new column, Dr. Brian Cole answers readers' questions about over-the-counter meds and weak ankles
Dr. Brian Cole is a nationally acclaimed orthopedic surgeon and sports-medicine doctor who cohosts the popular radio show Sports Medicine Weekly. Whether you want to know about bunions, better sleep, or running your first marathon without getting hurt, Dr. Cole can offer an expert’s 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 dose—400 milligrams in the morning and 400 in the evening—for 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, isn’t it bad for my stomach lining? What’s 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 body’s inflammation-producing pathways. For persistent relief of joint pain, you should follow your doctor’s instructions and take a regular dose as prescribed, even if you aren’t feeling pain right at that moment.
It’s 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. That’s why people with gastrointestinal conditions like peptic ulcer disease or Crohn’s disease, as well as people over the age of 65, shouldn’t 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, don’t 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 time—on the trail, in heels, when I’m 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 they’re 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 own personalized program.
There aren’t 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 haven’t found a meaningful difference between high-top or low-top shoes. There are a number of ankle braces and taping techniques that can offer supplemental help in stabilizing the ankle. If you feel that additional support helps, there’s no reason not to use it—but remember that strong ankle stabilizers are much more critical in preventing future ankle rolls.