Birmingham, England
Wednesday 13th February 2013
Last week's blog regarding the NFL Players' Association members confidence in their team medical staff prompted a great deal of interest & debate.  Of those athletic trainers & physiotherapists who took the time to comment & have been exposed to such environments (be them professional, collegiate or high school sports teams), many were quick to agree that those holding the purse strings don't have enough insight into the matter & aren't keen to spend the money as a result.  

Interestingly, a number of clinicians also lay a proportion of the responsibility at the feet of "old school" medical staff who are rather set in their ways or are too focussed on using the high profile sports work as a marketing vehicle for their private ventures.

Either way, it shows that educating the ignorant & promoting the work that proactive, evidence-based & clinically experienced medical, therapy & science staff can do to enhance the performance, prolong the careers & reduce missed field time of the players, is critically important.  We all need to stand up & act.  We need to support the players' associations such as the NFLPA & in turn we can only hope they will support us in vastly improving the provision of care in these establishments.

To follow on, I'm going to make a rather controversial but topically pertinent link given the headlines coming out of Australasia this week.

Is is possible, that given the lack of individual contact time that high school, collegiate & professional players have with medical, physical therapy, sports science & conditioning staff during & after training, that these players are turning to more desperate means of getting bigger, faster, stronger to perform better & become more resilient to injury?  Is it, therefore, possible that the doping culture considered so rife in US sport, is actually nurtured by the lack of investment in man hours.  

Can't get enough time with the conditioning coaches to get an individualised & suitably periodised programme?  No worries, I'll just take matters into my own hands & get something from the internet to help...maybe some HGH (human growth hormone).

Can't get enough time with the therapy staff to treat the niggles?  Oh well, I'll just look out for myself & take something I can buy online that will help my recover quicker & ease the pain, so I can play on.    

It's a leap of faith to suggest this link but we know the problems exist & yet, no one has really got to the bottom of why & what we can really do about it.

Today (13th February, 2013), Arizona Cardinals running back, Javarris James was suspended by the NFL for violating the league's substance abuse policy.  James tested positive whilst spending the season on the injured reserve with a knee injury & subsequently received the appropriate punishment...a 4 game ban.  

Yes, all you athletes, cyclists & soccer players out there, you read that correctly.  He tested positive for taking a banned substance & received a 4 game ban!!!!

What sort of message does this send out to kids in high school football?  What measure of deterrence does that indicate to a young running back playing in the NCAA?  This lenient approach does nothing but encourage substance abuse at all levels - in fact it positively condones it.  

This tolerance of doping practice ignores the potential side effects that accompany HGH administration, such as increased risk of developing diabetes, the potential contribution to the growth of cancerous tumours, increased cholesterol levels & other hazards.  In fact, given that the NFL doesn't even perform blood testing (only urine samples are taken), their doping control program wouldn't even detect HGH use.

Is it any surprise, then, that an open discussion with high school athletes from the Washington metropolitan area, as far back as 2005, revealed that the use of performance-enhancing substances was taking place openly in the locker rooms, gyms & cafeteria of many of the public & private high schools?

Should we be amazed that the same discussions highlighted the widespread acknowledgement of both coaches & athletes that the practice is rife & despite the risks, many are happy to sacrifice long term health for short term gain?  And yet, 8 years later, this is still regarded as a serious problem.

Similar attitudes & patterns of use exist in collegiate sport, yet speaking to my friends that have & do work in that environment, they have a dilemma.  Do they ask the probing questions & find an answer that they are morally obliged to act upon but are in fact practically helpless to do anything about?  Or do they just continue prescribing generic conditioning programmes for 20 or 30 players, given the knowledge that those "supplementing" their diet are going to comfortably tolerate the loading, whilst those that exhibit some morals might struggle to recover between sessions & break down?

Interestingly, during the recent NFL labour negotiations, the owners proposed the idea of bringing WADA (the World Anti-Doping Agency) into the fold, to test for HGH - but can you imagine that the players would condone such an introduction, when the usage of that substance alone is estimated by the players themselves at around 30%?  

Having said that, if Commissioner Goodell is serious about expanding the league internationally, it is critical for the NFL's image that this doping issue is addressed because European sports bodies & politicians won't tolerate the current attitudes, along with the messages it sends out to the youngsters in those countries.

Yet, the problem is far from just an American one.  

Over the last couple of weeks WADA President, John Fahey went public to respond to the revelations by the Australian Crime Commission & the federal sports ministry that claimed widespread corruption & use of illicit performance-enhancing substances by athletes.  Fahey suggested that the extent of the problem & the number of sports affected by the epidemic was yet to be fully established but would take years to resolve, citing the example of the Armstrong case that took two years to collate the evidence against the disgraced cyclist.

Fahey is of the opinion that the long-term approach to combating the issue of doping should be underpinned by education programmes, with modules being taught in schools & universities to highlight the negatives of such courses of action taken by the drugs cheats.  

The Australian Crime Commission has also stated the need to increase the war against the import of substances from places such as China, which Fahey believes is responsible for "99 per cent of illegal substances".

Yet in Australia the spotlight has also been turned on the sports scientists, with the Australian Crime Commission reporting that entire teams have been undertaking sophisticated doping programmes lead by the sports scientists employed by the franchises, using substances including growth hormone releasing hexapeptide (GHRH).

Therefore, is this the problem on the other side of the coin, where instead of under-investment, the money ploughed into performance is so great that marginal gains are sought in much more under-hand ways, as many of the more legitimate approaches have already been exhausted by the scientists, therapists & conditioning coaches?  

Whichever way you want to look at it though, the same answer comes to the fore.  More investment is required.  Investment for education.  Investment for therapy, medical & conditioning.  Investment for doping control programmes.  But whilst this may be an uncomfortable truth, particularly in the current economic climate, it's effectively an investment in the physical & moral health of our adolescent athletes & that cannot be ignored.  

Hey, & if money is short, then fine the drug cheats, their franchises & their suppliers big bucks, then reinvest that revenue back into the programmes.  That would send the right message.

After all, the athletes & coaches have had enough of the uneven playing fields.  The debates are long established in athletics & cycling but tennis is joining the fray, with Roger Federer being the latest high profile player to support the idea of introducing biological blood passports & soccer isn't opposed to increasing the testing.  

Of all the sports in which I have worked, soccer had probably the second most regular testing itinerary (after athletics), although the testing was limited to urine testing & this week FIFA has stated that it wants to introduce biological blood passports at the 2014 FIFA World Cup.  After all, as Arsene Wenger says, "It is very believe that at a World Cup, where you have 740 players, you come out with zero problems.  Yet, mathematically, that is what happens every time".

It's easy for me to hop on my soapbox, however, as despite my 14 years spent in elite sport, including rugby, NFL, athletics, soccer & tennis, I have yet to encounter an instance of active doping.  I worked on the Football Association anti-doping programme & have been present chaperoning athletes, tennis players & NFL players to tests & fortunately, none of those have returned positive.

However, I'm not naive enough to think that it doesn't happen & I have seen evidence of doping in the changing room of other teams at international track meets, whilst I  have also worked with individuals that have served bans for doping before I knew them.

In my opinion, we all need to do our bit.  Whoever we are & whatever our role is in sport.  Physiotherapist, medic, scientist, strength coach, athlete, technical coach, owner, sponsor, agent, manager & lecturer alike.  We all have a responsibility to promote our work, what we can achieve with hard work & dedication, given the appropriate resources & the dangers of taking the short cuts both financially, in training & in the class room.

To find out more about what performance enhancing drugs are out there & their effects, click on the link below for a brief but insightful overview.

Thoughts below please!

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