Role of Physiotherapist in
Doping Control
shohaim
According to International Olympic Committee ,
Doping is the ‘administration of or use by a
competing athlete of any substance foreign to
the body or any physiological substance taken
in abnormal quantity or taken by an abnormal
route of entry into the body with the sole
purpose of increasing in an artificial and unfair
manner his / her performance in competition.’
Defination of doping as per WADA -
Doping is defined as the occurrence of one
or more of the anti doping rule violations
mentioned in the WADA code.
The following constitute anti doping rule violations
1. Presence of prohibited substance or its metabolites
in an Athlete’s bodily specimen
2. Use or attempted use of a prohibited substance or
prohibited method
3. Refusing to submit sample collection without justification
after notification.
4. Violation of applicable requirements regarding athlete
availability for out of competetion testing including failure
to provide required whereabouts information which are
based on reasonable rules
5 . Tampering or attempting to tamper with any part of
doping control
6 . Possesion of prohibited substances and methods.
7. Trafficiking in any prohibited substance or prohibited
method.
8. Administration or attempted administration of a prohibited
substance or, prohibited method to any athlete or
assisting , ,encouraging,,aiding in violating any anti
doping rule or any attempted violation.
Why do Athletes take drugs ?
• Belief that their competitors are taking drugs
• A determination to do anything possible to attain success
• Direct / Indirect pressures from Coaches, Parents and Peers
• Pressure from Government and / or authorities themselves
• Lack of access to legal and natural methods to enhance
Performance (Nutrition, Psychology)
• Community attitudes and expectations regarding
success and performance
• Financial rewards
• Influence from media in facilitating these expectations
W.A.D.A
WORLD ANTI DOPING AGENCY
Established in 1999 from an initiative of IOC
It is a private Organization constituted under
Swiss Law
MISSION : To promote and coordinate internationally
the fight against doping in sports.
Prohibited Substances[all
time]
• Anabolic Agents
• Hormones
• Beta-2 Agonists
• Agents with anti –Oestrogenic activity
• Diuretics and other Masking agents
Prohibited Methods [all
time ]
• Enhancement of oxygen transfer
• Chemical and physical manipulation
• Gene doping
Prohibited Substances [in competition ]
• Anabolic Agents
• Hormones
• Beta-2 Agonists
• Agents with anti –Oestrogenic activity
• Diuretics and other Masking agents
• Stimulants
• Narcotic analgesics
• Cannabinoids
• Glucocorticosteroids
Androgenic Anabolic Steroids
Nandrolone ,Stanozolol, Testosterone, Norethandrolone,
(Durabolin,Decadurabolin,Neurabol,Stromba,Aquaviron)
DHEA
Other Anabolic Agents
(Clenbuterol, Salbutamol,Terbutaline)
Effects
• Increases Muscle bulk
• Increases Strength & Power
• Improves competitiveness
Adverse Effects
Retards growth, Liver cancer,
Aggressive behavior,
Risk of heart disease.
In Males : ↑B.P,
Atrophy of testis,
Gynaecomastia,
↓ sperm count.
In Females : Masculinization,
Facial hairs, Infertility
Menstrual disturbances,
Deepening of voice.
The 1988 Seoul Olympics Doping
Scandal Involving Ben Johnson
Canada’s Ben Johnson was defending 1987 World
Champion and World Record holder in the 100 meters
The Seoul Olympics 100 meter final between Ben
Johnson and defending Olympic Champion American
Carl Lewis, was becoming the feature event of the
Games
The 1988 Seoul Olympics Doping Scandal Involving
Ben Johnson
Seoul Olympics, September 24, 1988
In front of 88,000 amazed spectators, Johnson won the
Seoul Olympics 100 meter final in a new Olympic
record of 9.79 seconds
Hours later Johnson’s gold medal and Olympic record
were removed due to a doping infraction
( anabolic steroid stanozonol)
Carl Lewis (USA) was subsequently awarded the gold…. !!!!
2.HORMONES & ANALOGUES
1.Erythropoetin (EPO)
It increases rate of RBC production
Increases oxygen availability to tissue
↓
↑ Adenosine Phosphate production
↓
Resulting in improved aerobic performance
Adverse Effects
Thrombosis,Increased blood viscosity,
Headache ,seizure
left ventricular failure ,
2. Human Growth Hormone (HGH) (Somatotrophin)
Increases muscle mass & strength
Adverse effects
,Arthritis,gigantisam,
enlargement of fingers and toes
Impotence,cardiomeagly
Growth of orbit ,
lengthining of jaw ,
impaired glucose regulation ,
skeletal changes)
3. Gonadotrophin (LH, HCG)
Stimulates the production of Testosterone &
Epitestosterone
4 .Insulin
In conjunction with A.S increases muscle mass
5. Corticotrophin (ACTH)
Increases the blood levels of endogenous corticosteroids.
Reduces lethargy and elevates the mood (Euphoria)
3. BETA- 2 AGONISTS
Only Formeterol, Salbutamol (lesser than 1000 ng/ml),
Salmeterol and Terbutaline are permitted
by inhalation to prevent/treat Asthma
Requires:
Abbreviated Therapeutic Use Exemption ( A.T.U.E )
Adverse effects
Cardiac muscle Atrophy,
Tachycardia,
Anxiety,palpitations,
Myocardial infarction
4.Agents with Anti- Estrogenic
Activity
• Aromatase inhibitors including, but not limited
to, Anastrozole, Letrozole, Aminoglutethimide,
exemestane, Formestane,Testolactone
• Selective estrogen receptor modulators
including, but not limited to, raloxifene,
tamoxifen, toremifene.
• Other anti estrogenic substances including, but
not limited to, Clomiphene, Cyclofenil,
Fulvestrant.
5.DIURETICS &
Other MASKING AGENTS
Furosemide, Spironolactone, Hydrochlorthiazide
(Lasix, Lorvas, Esidrex, Dytide)
- Reduces Body weight by increasing urine output
- To overcome the fluid retention induced by Anabolic Steroids.
- Reduces the concentration of drugs in urine and
thus minimises their detection chances
Adverse effects :
Dehydration, Electrolyte imbalance,Muscle cramps
Other Masking agents
Epitestosterone, Probenecid
Plasma expanders (Dextran, Starch)
Used for :
Impairing the excretion of Prohibited substances
Conceal the presence in the samples
Change haematological parameters
Prohibited Methods
- Enhancement of Oxygen transfer
Blood doping, Erythropoetin
- Chemical & Physical manipulation
Masking Agents, Catheterisation,
Urine substitution/tampering
Intravenous infusions (except for medical treatment)
Gene Doping
Gene or Cell doping is defined as the
non-therapeutic use of Genes, genetic elements or
cells that have the capacity to enhance athletic
performance
Substances and Methods
Prohibited in Competition only
Stimulants
Amphetamine, Cocaine,Ephedrine,Pemoline,
Strychnine
(Aspro, Corex, Phensydyl, Actifed, Polaramine, Solvin,
Sudafed, Triaminic, Tixylix, Alerid-D, Vita X-Gold)
Caffeine,Phenylephrine,Phenylproponalamine,
pseudoephedrine are permitted
Cathine – limit is 5 microgrammes per ml
Ephedrine & Methyl ephedrine – limit is 10 microgramme/ml
Increases Blood flow
Increases competitiveness
Decreases sensitivity to pain
Decreases fatigue
Increases alertness
Side effects: Increased heart rate,Irregular heart beats,
Anxiety, tremors, dehydration, loss of judgement
NARCOTICS
Morphine, Pethedine,Heroin,Fortwin etc
Blocks (masks) the pain sensation
Causes Euphoria (excitement- delirium)
Respiratory depression, Low Blood Pressure
Physical & Psychological dependence,
Mental clouding
Contact Sports
Cannabinoids
Hashish, Marijuana
Results in - impairment of Balance & Co- ordination
Drowsiness
Loss of Concentration
Hallucinations
Glucocorticosteroids
Reduce inflammation,Causes mood changes including
Euphoria, Osteoporosis, Softening of connective tissue and
weakening of an injured area in muscles, joints, tendons or
ligaments.
Prohibited ; orally, intravenous,intramuscularly, rectally. Use
requires T.U.E
Other routes of administration
(intraarticular/periarticular/peritendinous/epidural/intraderm
al injections and inhalation require ATUE.
Permitted : Topical preparations when used for
dermatological, auricular,nasal,ophthalmological,gingival
and perianal disorders.
No TUE/ATUE required.
Substances prohibited in particular sports
1. Alcohol
2 .Beta Blockers
ALCOHOL
Prohibited in :
Aeronautic ( 0.20 g/L) , Power boating (0.30 g/L) , Archery,
Automobile,Motorcycling, Karate, Modern Pentathlon
including shooting
( all 0.10 g/L)
Breath or blood alcohol levels may be determined at the
request of a Federation.
Side effects - CNS depressant.
Results in impairment of judgement, reflexes and muscular
coordination
BETA BLOCKERS
Atenolol, Propanolol, Acebutalol etc
Prohibited in :
Archery, Gymnastics, Shooting, Wrestling, Sailing,
Aeronautic, Billiards, Motorcycling, Curling, Bridge,
Nine-pin Bowling
Reduces hand tremors
(Decreases heart rate &Cardiac output)
Side effects : Head ache, Depression, Fatigue,
Muscle cramps, Hypoglycemia
Specified Substances
The prohibited list may identify specified
substances which are particularly susceptible
to unintentional anti doping rule violations
because of their general availability in
medicinal products or which are less likely to
be successfully abused as doping agents.
A doping violation involving such substances may
result in a reduced sanction provided that the
“.Athlete can establish that the use of such a
specified substance was not intended to enhance
sports performance..”
Specified Substances
• All inhaled Beta-2 agonists, except
Salbutamol ( greater than 1000 ng/ml) and
Clenbuterol
• Probenecid
• Cannabinoids
• All glucocorticosteroids
• Alcohol
• All beta blockers
• Specified Stimulants :
• Cathine, cropropamide, crotetamide, ephedrine,
etamivan, famprofazone, heptaminol, isometheptene,
octopamine, levmethamfetamine, meclofenoxate,
oxilofrine,p-methylamphetamine, methylephedrine,
nikethamide, propylhexedrine, ortetamine,
propylhexedrine,selegiline, and any other stimulant
not expressly listed under the category of
Stimulants .
How can a physiotherapist play a
vital role in doping control
• Team physiotherapists can create awareness about
the WADA rules among athletes.
• They can educate the athletes about various
hazardous and even life threatening effects of drug
abuse
• Guide the athletes to achieve success
by legal and natural methods to enhance Performance
(Nutrition, Psychology)
• Convince the sportsmen to think upon long term effects rather
than short term effects
Thank you
