Glucocorticosteroids in football: use and misuse: Figure 1

Abstract

Background and objectives:Glucocorticosteroids are widely used in medicine and have shown unchallenged therapeutic potential in several chronic inflammatory and other diseases. They are also widely used in sports medicine for the treatment of conditions such as asthma and acute injuries. In fact, as banned substances, most requests for therapeutic use exemption concern glucocorticosteroids. Nevertheless, their beneficial effect in certain conditions in sports, where inflammation is only a secondary reaction, remains to be validated. This paper aimed to provide a comprehensive review of the literature covering the therapeutic use of glucocorticosteroids since 1977 in conditions ranging from chronic rheumatic illness to peritendinous or intra-articular injection in acute injuries.Methods:Search of the medical literature published between 1977 and 2006 using PubMed. Articles relevant to the question “When and if at all is the use of glucocorticosteroids justified in football?” were selected and analysed.Results and conclusions:The findings clearly point out that, despite the common use of glucocorticosteroids in acute injuries in sports, there is actually limited evidence of the true benefits of such a practice. Physicians must take the possible adverse effects into consideration. In an athlete with clinically verified asthma, inhalational glucocorticosteroids remain first line therapy. Finally, for the purposes of education and prevention of misuse, it should be stressed that a measurable performance enhancing effect of glucocorticoids could not be proved on the basis of the results of the scientific studies to date.

No variation of physical performance and perceived exertion after adrenal gland stimulation by synthetic ACTH (Synacthen®) in cyclists

“…Glucocorticoids are also becoming more popular for the treatment of acute and chronic asthmatic symptoms (Fitch 1986). Due to the higher physical exertion, pain and incidence of injuries in some sports, glucocorticoids have also been widely used for improving performance since the 1960s (Dvorak et al 2006;Nichols 2005). Administration of these substances (except topically-as deWned) is prohibited by the World Anti-Doping Agency (WADA), while their use is allowed for local treatment and legitimate medical purposes (WADA 2008).…”

Hormone Use and Abuse

“…In addition, GCs prevent an overreaction of the immune system as a result of exercise-induced muscle damage (immunosuppressive and antiinflammatory effects) (Sapolsky et al, 2000). The influence of GCs on the majority of cells involved in inflammatory reactions explains their antiinflammatory effects (Dvorak et al, 2006) (Table 7). GCs were first purified and manufactured in the 1930s and 1940s following the discovery of their potent antiinflammatory actions (Yeager et al, 2004;Nichols, 2005).…”

“…Nevertheless, their beneficial effect in certain conditions in sports, where inflammation is only a secondary reaction, remains to be validated (Dvorak et al, 2006).…”

“…Administration of GCs by all other routes requires an abbreviated TUE, except dermatological preparations, which are not prohibited (Dvorak et al, 2006). Because of the complexity of GCs, determining the boundaries between their medical use and abuse is a constant challenge for antidoping organizations.…”

The Effect of Long Term Administration of Glucocorticoid to Bone Lining Cells Apoptosis

“…Glucocorticoid therapy can save many lives, however its long term administration can cause life-threatening side effects, one of them is bone mass loss which increases the risk of bone fractures (Adler 2003, Dvorak 2006. Epidemiologic data suggests that glucocorticoid therapy can double the risk of femur and distal radius fractures and even four times higher risk for spine fractures.…”