My sprained ankle is hurting my tummy ASK THE DOCTOR

I’ve been taking painkillers for a sprained ankle and now my stomach is really playing up. The ankle is still bad so I need to take them, what can I do? Should I stop or has it got nothing to do with them?

FIRSTLY, sprained ankles take six weeks to recover. What is important is that you do a series of exercises over this period of time to build strength and restore joint flexibility.

You should be able to teach yourself these exercises by using an online resource or ideally you could see a physiotherapist. The physio will run through appropriate exercises and can also carry out local treatments, like ultrasound perhaps, to facilitate recovery.

So while painkillers play a role, you shouldn’t rely on them alone.

In general you will be offered anti-inflammatory tablets for a joint sprain, which include ibuprofen, naproxen and diclofenac. Their gastric effects occur because, unlike regular painkilling medication, they reduce both pain and swelling.

Unfortunately, it’s this chemical mode of action which can also result in increased stomach acid production, the main sideeffect being heartburn (acid reflux).

In addition, as a result, your stomach can also become inflamed (gastritis) or, in the worst case scenario, you can develop a stomach ulcer.

If you have a history of stomach ulcers you should not take these medications. If you are suffering merely from heartburn you can probably manage this and remain on the meds.

Take your medicine on a full stomach and avoid gastric irritants such as alcohol, curry and caffeine. Always ensure where possible that your tablet is enteric-coated — this means it protects your stomach.

You can further protect your stomach by taking antacids or acid suppressant tablets available through pharmacies. Chat to your pharmacist about suitable choices. But if things worsen in any way, you must seek medical advice. Prolonged use of anti inflammatories is not a good idea.

You can also take something simple like paracetamol. This kills pain without any impact on the stomach.

My 12 -year-old son got knocked out playing rugby last week and they said he had a mild concussion. He ended up in Accident and Emergency. He chilled out over the weekend

and just moped around on his computer and watching telly. Despite this rest he is still not feeling right. Should I be doing anything further?

FIRSTLY, after a concussion you require a full 24 hours rest. This means you do nothing. There is quite specific advice to avoid any screen time, reading or other activities which require concentration.

In addition to this, there are very specific guidelines about returning to play. It is incredibly dangerous to simply ‘go back out there’.

He needs to have two full weeks of rest and be symptomfree before he then does what’s called gradual return to play.

He then needs to have eight days’ gradual return to play. This is light training, not a match!

In an under-19 player the advice is to miss three weekends of rugby. You have to be very strict on this or he may run in to problems further on down the line.

Most people recover from concussion in seven to ten days but do note that he may be fatigued, have poor concentration and so on over this period.

A minority of people get what’s called post-concussion syndrome, with symptoms lingering for months or even indefinitely. These range from insomnia to fatigue, irritability, poor memory and headaches, but are more common in women and the elderly.

Injuries are often seen as ‘character building’ in rugby.

Concussion is not. It needs to be taken seriously and your son needs to be reviewed by a doctor now if you have any concerns and ultimately before he is cleared to play.