Abuse of medication during international football competition in 2010 – lesson not learned
Tscholl PM & Dvorak J. British Journal of Sports Medicine. March 22, 2012. doi:10.1136/bjsports-2011-090806 [Epub Ahead of Print]
Medication use among athletes is extremely common. Previous research has shown high use of non-steroidal anti-inflammatory drugs (NSAIDs) in the soccer population. The purpose of this study was to compare medication use within 72 hours of a competition in 2010 to previous years. Prescription medication use was recorded by team physicians during the FIFA 2010 World Cup for 736 players over the course of 64 matches. Medications were classified as NSAIDs, injected corticosteroids and local anesthetics, muscle relaxants, respiratory drugs, medications for gastrointestinal and antimicrobial purposes, as well as others. The methods in this study were similar to data collection at past FIFA competitions. Throughout the tournament over 70% of players took medication. Prior to each match, nearly half of the players (48.2%), regardless whether they competed in the match, took some sort of medication. The primary type of medication taken prior to a match was NSAIDs (~35%). The rate of medication per match was significantly higher in the later round games as evidenced by higher NSAID and injection use. Furthermore, the rate of medication was twice as high for players from North and South America than any other area of the world. Also, the rate of medication use was higher for the 2010 World Cup in comparison to the 2006 and 2002 World Cups in nearly all categories.
Athletes are constantly looking to “gain an edge” during crucial tournaments or events. The immediate solution that athletes often turn to is in the form of a pill. The findings of medication use in the 2010 World Cup showed that that despite the known abuse of medication during previous World Cups as well as medication-use guidelines in this population, abnormally high utilization rates still exists. Team physicians in these settings are working outside of guidelines during these high profile events. It warrants the question what is our primary concern; is it the healthcare of the athlete or their performance in the event? Healthcare decisions may be swayed by the level of play or importance of the match as evidenced by the higher use in later round games. Is this a sign of physical wear and tear in late rounds of play or a psychological increase due to the importance of the game? These rates were driven by increased NSAID use as well as an increased number of injections (corticosteroid or local anesthetic). What was also interesting was that previous research has suggested that medication use in this population often did not correlate with previous or current injuries or minutes played (Tscholl 2009 & 2010). The implications of this medication abuse could have a potential rippling effect. Furthermore, these elite athletes are often who younger athletes strive to be. A young aspiring athlete may start to take medication because that is what they hear or see the elite athlete doing. Taking medication prior to the game may become part of the soccer culture and this could trickle down into the collegiate, high-school, and even junior high school levels of play. Just as the NFL has finally brought heightened attention to the importance of concussion diagnosis and management, FIFA has the potential to start to raise awareness regarding appropriate medication use. Some of these elite athletes are used to doing anything that they are told to do, especially by a team physician or medical professional. This includes obtaining corticosteroid injections prior to a competition, which is contraindicated. Has anyone encountered an athlete or patient that has thought they need to take an NSAID prior to a game “just in case” or because it was a game day? It may be that players are taking medication as part of a pre-game ritual. How do we change this culture of thinking? This may be important to do, particularly because NSAIDs may negatively impact tissue healing/recovery time.
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
Related Posts:Tscholl, P., & Dvorak, J. (2012). Abuse of medication during international football competition in 2010 - lesson not learned. British Journal of Sports Medicine DOI: 10.1136/bjsports-2011-090806