Thursday, September 11, 2008

Cutting Edge Research - Medications and Supplement Use During the World Cup

** UPDATE **

The main focus of drug use in sports has focused on doping agents or banned substances. Several studies have characterized the magnitude of banned substance use among various groups of athletes. however, the extent to which athletes use legally prescribed medication, over-the-counter medications and nutritional supplements is not widely known. This is certainly the case with professional soccer.

In a study appearing in the British Journal of Sports Medicine, researchers at the FIFA Medical Assessment and Research Center surveyed teams participating in the 2002 and 2006 world Cup. Their goal was to determine the types of legal medications and nutritional supplements being used and the incidence of their use. The result show high incidences of pain medication and vitamin and mineral supplementation. However, there was a relatively low incidence of nutritional supplement use.

The authors of the study surveyed all of the team doctors of teams participating in the 2002 and 2006 World Cup competitions. The physicians were asked to record any prescription medications, non-prescription medications or nutritional supplements taken by the players during the 72 hours prior to each match.

By far the most common medications taken were non-steroidal anti-inflammatory drugs. NSAIDs are over the counter medications like ibuprofen (e.g. Advil®) and acetaminophen (e.g. Tylenol®). More than half of the players took NSIADs at least once during the two tournaments and one-third took the medications immediately prior to the match. Less than 10% of the players used medications such as corticosteroid injections, prescription analgesics and respiratory agents.

The most common NSAIDs used were dichlorfenac and ketoprofen. These drugs are sold over the counter, mostly in Europe under the trade names Volterol® or Cataflan® and Ketoflan® or Orudis KT®. Of the players taking NSAIDs, 11% took them prior to every match that they played in. What was surprising to the investigators was that some of the players taking NSAIDs before matches took more than one compound and some took as many as five different drugs at a time!

As for supplements, more than 90% of the players took some form of supplement. The most common supplements were vitamins and minerals. Iron supplements were the most common mineral used by a large number of players. As for nutritional supplements, only a small percentage of players took things amino acid (11%), creatine (7%), or herbal supplements (7%).

The research shows that the most common compounds consumed by players during the 2002 and 2006 World Cup were NSAID over the counter pain medications as well as vitamin and mineral supplements. Surprisingly, nutritional supplements such as creatine and amino acid and herbal supplements were not widely used. The authors of the study felt that the considerable use of NSAIDs was “alarming” and they suggested that there needs to be more debate use and possibly abuse of these medications. They point to guidelines for NSAID use provided by Great Britain’s National Health Service. These guidelines caution against log term use, taking multiple compounds simultaneously, and mixing NSAIDs with other medications such as anti-asthmatic drugs.

A second study, just released by the American Journal of Sports Medicine, focuses on women and youth players and shows the same trend. Tscholl and colleges examined players in the U17 and U20 World Cup competitions as well as the Women's World Cup. They found that 1/3 of the women and 1/5 of the males used NSAIDs prior to one or more matches. The same disturbing trend of multiple medications was also observed. Thus, the over-use of pain medications is not limited to the adult males. It may be a growing problem in both women and youth players.


Tscholl P, Junge A, Dvorak J (2008) The use if medication and nutritional supplements during FIFA World Cups 2002 and 2006. British Journal of Sports Medicine, 42:725-730.

Tscholl P, Feddermann N, Jung A, Dvorak J (2008) The use and abuse of painkillers in international soccer. American Journal of Sports Medicine, in press.