Sport in general has consistently been shown to have beneficial health effects, resulting in fewer medical consultations17
and a lower use of medication in physically active people.18
Top athletes, however, face a higher incidence of osteoarthritis and greater risk of injury than employees in most other occupations.19
Competing athletes also seem to have a higher intake of medication than non-competing athletes.18 20
postulated that there are four types of medication use in professional athletes: legitimate therapeutic use, performance continuation (treatment of sports injuries), recreational/social use, and performance enhancement. Athletes trying to enhance their performance by taking pharmaceutical agents and large quantities of nutritional supplements are predominantly healthy athletes.22
Whilst the present study was able to document the prevalence of medication use in top athletes, it was not able to scrutinise the underlying motivations for, or the likely implications of, such use.
The present results show a widespread use of prescribed medicines in professional football, with 0.8 substances per player per match being reported. NSAIDs represented nearly 50 percent of all substances, with one in three players being prescribed NSAIDs prior to a match, one in ten taking two or more different preparations, and some taking as many as five different preparations.
No relationship was observed between team success and the amount or type of prescribed medication. However, players with a high average playing time were prescribed more medications and more NSAIDS per match than were substitutes.
A wide range was reported for nutritional supplement use (0–7.4 nutritional supplements per player, per match), with as many as ten different substances being taken prior to a match in some cases. Coaches have been found to have a greater influence than doctors and sports dieticians on the nutritional supplements taken by athletes;12
this could have biased the figures of intake reported by the team physicians.
Earlier studies have analysed the use of prescription medicines and nutritional supplements in national Olympic squads participating in winter and summer sports,9 23
in athletes during the Olympic Games (OG) (information gained from doping controls)10
and in professional soccer players during one season.13
In the latter study, data were collected from personal interviews with the athletes themselves.13
This differs from the method employed in the present study, in which information was obtained solely from the team physicians; further – but similarly to the investigation conducted by Corrigan et al10
– in the present study, information was collected for each participating player, prior to every match.
Compared with the information acquired during the doping controls at the Olympic Games in Sydney,10
significantly more football players did not use any substance (22% in Sydney vs. 38% here); however, more were reported to use NSAIDs. Similar results to the present study were found in Finnish athletes participating in the Winter Olympic Games.23
In professional football players in Italy, however, 86% were reported to be current NSAIDs users.13
As reported previously,10
antiasthmatic medication is rarely prescribed in international football. In the present study, 2.2% of all players (ten players treated with β-2-agonists, 13 with inhaled corticosteroids and ten with combined therapy) were being treated for asthma; this compares with 5.2% (607 out of 10
672) during the OG 20004
(p<0.001), 4.2% (445 out of 10
653) during the OG 20044
(p<0.001) and 7.0% (31 out of 446) of all Finnish athletes competing at the Winter OG 2002(p<0.001).23
A total of 148 injections of local anaesthetic were reported, that is, nearly 1.2 injections per match. Similar incidences have been reported for rugby and for Australian rules football (1.7 and 1.4 injections per match, respectively).24
Although there are reports of a high prevalence of sustained adverse effects with NSAID use in athletes23
and alternative substances are well-known,6 25
the indication for NSAIDs appears to have been broadened to almost any painful condition.26
The current literature does not provide any conclusive evidence to justify this high usage. On the one hand, the pain-relieving qualities of NSAIDs are uncontested;5
however, their influence on the healing process is controversial5
and their adverse effects in sport, for example in the context of dehydration and the kidney, are not fully understood.7
The success of therapy seems to depend on many injury-specific21 27
and pharmacological variables.5
Animal studies have found potentially deleterious effects of NSAIDs on the healing process.28
Porucznik et al
found a higher prevalence of suprascapular neuropathy in collegiate volleyball players who used NSAIDs than in athletes who did not.29
Paolini and Orchard6
discussed the issue of soft-tissue injuries and concluded that paracetamol had similar efficacy to NSAIDs in soft-tissue injury but had a lower side-effect profile. The authors concluded that paracetamol is the analgesic of choice for most soft tissue injury.6
The NSAID guidelines from the National Health Service16
- Lowest possible dose and for shortest possible period.
- One preparation at a time.
- Prudent application in asthmatic patients.
- Avoid long-term use.
- Lowering gastrointestinal adverse effects by paracetamol with or without codeine.
- Use gastroprotective agents and or/COX-2 inhibitors in patients at high risk of gastrointestinal bleeding for whom NSAID therapy is necessary.
These therapeutic recommendations have not yet been adopted in international football. In the present study, more than one in ten players taking NSAIDs were using at least two preparations, NSAIDs were used 8.5 times more frequently than other analgesics, 10% of all players used NSAIDs prior to each of their matches, and 11 players were using antiasthmatic medication and NSAIDs at the same time. These findings are not unique to football, however.10 23 29
The substantial variation in the participating teams’ reported medication use – especially with respect to NSAIDs – highlights the difference in therapeutic concepts that currently exists in sports medicine; the majority are most likely based on individual empirical evidence or experience rather than on any firm evidence base.
In general, nutritional supplementation is not considered necessary, for either nutritional or immunological reasons, in athletes with an “adequate” diet.30
Additionally, there is not only the possibility of contamination,31
but also the potential for detrimental effects if different substances are misleadingly taken in excess.30
When competing at top level, therefore, professional advice on the quality and quantity of supplementation is essential.