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Glucocorticosteroids in football: use and misuse

¹ FIFA Medical Assessment and Research Centre, Department of Neurology, Schulthess Clinic, Zurich, Switzerland
² Department of Orthopaedics, University Clinic Muenster, Muenster, Germany
³ FIFA Medical Office, Zurich, Switzerland

Correspondence to:
Correspondence to:
Professor Jiri Dvorak
FIFA Medical Assessment and Research Centre, Department of Neurology, Schulthess Clinic, Lengghalde 2, 8008 Zurich, Switzerland; jiri.dvorak{at}kws.ch

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.

Abbreviations: ACTH, adrenocorticotropic hormone; EIA, exercise induced asthma; HPA, hypothalamic–pituitary–adrenal; ITBFS, iliotibial band friction syndrome; TUE, therapeutic use exemption

Keywords: glucocorticosteroids; indications; adverse effects; athletes; therapeutic use exemption