Sonography in the 29th Olympic and Paralympic Games: a retrospective analysis

Objective

The purpose of this study was to evaluate the application of sonography at the polyclinic of the Olympic/Paralympic village during the Olympic/Paralympic Games.

Methods

We retrospectively reviewed 759 consecutive patients who underwent sonography at the ultrasound division of the polyclinic in the Olympic/Paralympic village from July 20, 2008, to September 20, 2008. Prevalence of emergency sonography after sports injury and non-sports-related urgent conditions during the games was analyzed. The benefit of sonographic services in large sporting events was discussed.

Results

There were 759 patients (484 athletes, 101 coaches, 88 team officials, and 86 volunteers; 462 men and 297 women) in the ultrasound division at the polyclinic. The indications for sonography included abdominal pain (315 cases, 41.50%), muskuloskeletal disorders (228 cases, 30.04%), gynecology related (104 cases, 13.70%), cardiac conditions (49 cases, 6.46%), small parts (29 cases, 3.82%), and vascular problems (34 cases, 4.48%). The rates of positive findings on sonography were 46.03% in the abdomen, 70.17% in musculoskeleton, 41.34% in gynecology, 10.20% in the heart, 75.86% in small parts, and 38.24% in vessels, respectively.

Conclusion

Sonography plays an important role in the medical services at the polyclinic in the Olympic/Paralympic village. The benefits of sonography in such large sporting events are accuracy, fast result, portability, and noninvasiveness.     

An investigation of home advantage in the Summer Paralympic Games

Purpose

There is a paucity of home advantage research set in the context of para-sport events. It is this gap in the knowledge that this paper addresses by investigating the prevalence and size of home advantage in the Summer Paralympic Games.

Methods

Using a standardised measure of success, we compared the performances of nations when competing at home with their own performances away from home in the competition between 1960 and 2016. Both country-level and individual sport-level analyses were conducted for this time frame. A Wilcoxon signed rank test was used to determine whether there was a genuine difference in nations’ performance under host and non-host conditions. Spearman’s rank-order correlation was run to assess the relationship between nation quality and home advantage.

Results

Strong evidence of a home advantage effect in the Summer Paralympic Games was found at country level (p < 0.01). When examining individual sports, only athletics, table tennis, and wheelchair fencing returned a significant home advantage effect (p < 0.05). Possible explanations for these findings are discussed. The size of the home advantage effect was not significantly correlated with the quality or strength of the host nation (p > 0.10).

Conclusion

While our results confirm that home advantage is prevalent in the Summer Paralympic Games at an overall country level and within specific sports, they do not explain fully why such an effect does exist. Future studies should investigate the causes of home advantage in the competition and also draw comparisons with the Summer Olympic Games to explore any differences between para-sport events and able-bodied events.

     

An analysis of the pacing strategy adopted by elite competitors in 2000 m rowing

Objectives: To determine the pacing strategies adopted by elite rowers in championship 2000 m races.

Methods: Split times were obtained for each boat in every heavyweight race of the Olympic Games in 2000 and World Championships in 2001 and 2002, and the top 170 competitors in the British Indoor Rowing Championships in 2001 and 2002. Data were only included in subsequent analysis if there was good evidence that the athlete or crew completed the race in the fastest possible time. The remaining data were grouped to determine if there were different strategies adopted for on-water versus ergometer trials, "winners" versus "losers", and men versus women.

Results: Of the 1612 on-water race profiles considered, 948 fitted the inclusion criteria. There were no differences in pacing profile between winners and losers, and men and women, although on-water and ergometry trials showed a competitively meaningful significant difference over the first 500 m sector. The average profile showed that rowers performed the first 500 m of the race faster than subsequent sectors—that is, at a speed of 103.3% of the average speed for the whole race, with subsequent sectors rowed at 99.0%, 98.3%, and 99.7% of average speed for on-water rowing, and 101.5%, 99.8%, 99.0%, and 99.7% for ergometry.

Conclusions: These data indicate that all athletes or crews adopted a similar fast start strategy regardless of finishing position or sex, although the exact pace profile was dependent on rowing mode. This strategy should be considered by participants in 2000 m rowing competitions.

     

Dental data of the Athens 2004 Olympic and Paralympic Games

The Athens University, School of Dentistry, accepted the challenge to organize the Dental Health Services in the Athens 2004 Olympic and Paralympic Games in order to provide the best quality of oral health services to the athletes, coaches, escort members and Olympic Village personnel. Data from the whole activity protocol of the Athens 2004 Games Dental Health Services - the reception, admission and treatment protocols, the facilities and the infrastructure, the number of cases treated per specialty and the experience gained - were recorded. During the Olympic Games, there were more than 1400 dental cases in more than 650 patients, elite athletes, escort members, coaches and staff of the Olympic Village. Among them 313 fillings, 100 root canal therapies, 57 mouthguards and 9 dental trauma cases were treated. During the Paralympic Games, there were more than 240 dental cases in more than 220 patients. Among them 73 fillings, 12 root canal therapies, 21 extractions and 3 dental trauma cases were treated. In such events, highly trained dentists are needed and if possible, specialized in operative dentistry or endodontics. The role of team dentist seems to be of great importance.     

Review of physiotherapy service for athletes of 2018 Olympic Winter games: Consideration of preparation for two polyclinics

ObjectiveThis study will provide to better understand the needs for physiotherapy services during the 2018 PyeongChang Olympic Winter Games (POG) from two polyclinics. It is necessary to understand the needs and what physiotherapists do during the Olympic Winter games for first time.DesignAn observational study.Setting2018 PyeongChang Olympic Winter Games.ParticipantsAthletes who visited the physiotherapy department of polyclinics.ResultsDuring 25 the days of the POG, a total of 125 athletes (n = 125, 83 males, 42 females) visited the two polyclinics. Of all visits, 69.6% were from the mountain polyclinic and 30.4% from the city. There were three reasons for visit, most of the reason for visit was injury and injury with recovery or injury prevention. Overall, the injury rate (per 1000 athletes) was 42.8 across 13 sports visited the physiotherapy department during the POG. Total numbers of treatments sessions were 823 provided and electrophysical modalities (36.2%) was the most utilized service in POG. And also there were significant differences in the physiotherapy services provided at the two polyclinics.ConclusionAs each polyclinic differed in location, they addressed different populations of athletes; hence, the study provides insights into the injury trends and different physiotherapy treatments.     

Patterns of allergic reactivity and disease in Olympic athletes.

OBJECTIVE: Because the Sydney Olympic Games were being held in the spring, we wished to examine the prevalence of allergic disorders in the Australian Olympic and Paralympic athletes and to examine patterns of allergic reactivity and medication use for the treatment of allergic symptoms. DESIGN: A survey case series of Australian Olympic and Paralympic athletes. SETTING: Screening was conducted on team processing days. PARTICIPANTS: Prospective members of the Australian Olympic and Paralympic teams. INTERVENTION: A questionnaire seeking information on the presence of allergic disorders, symptoms, family history, and medication use was administered. Skin-prick tests (SPT) for sensitivity to common aeroallergens was performed. OUTCOME MEASURES: Athletes were classified as atopic or non-atopic, and patterns of reactivity were examined according to sporting category. RESULTS: Of the athletes, 56% had a positive SPT to at least 1 allergen, with 34% reacting to at least 1 seasonal allergen. There was no significant association between skin test reactivity and sporting category. Of the athletes, 37% had allergic rhinoconjunctivitis (AR/C), whereas 24% had seasonal allergic rhinoconjunctivitis (SAR/C). Approximately one-third of all those with AR/C had a history of asthma, whereas approximately one-fifth had a history of atopic dermatitis. Swimmers were most likely to have asthma, AR/C, and positive skin tests to any allergen. Very few athletes with self-reported AR/C took any medication to relieve their symptoms. CONCLUSIONS: Allergic disorders are common among athletes from all sports. The known impact of AR/C on quality of life necessitates that it be screened for and managed appropriately.     

The 2004 Olympic Games: physiotherapy services in the Olympic Village polyclinic

Objective

First, to document the injuries sustained during the 2004 Olympic Games in a sample of patients visiting the physiotherapy department of the Olympic Village polyclinic. Second, to provide information and data about the physiotherapy services for planning future Olympics and other mass gatherings.

Design

Observational study.

Setting

Olympic Village polyclinic.

Participants

457 patients aged 15–72 years visited the physiotherapy department from 30 July through 30 August.

Results

The department''s workload was at a peak during the last 15 days of the Olympic Games (periods B and C). The most common injuries were overuse injuries (47.3%). The most common pathology for physiotherapy attendance was myofascial pain/muscle spasm (32.5%), followed by tendinopathy (19.2%) and ligament sprain (18.7%). The most prevalent site of injury was the thigh (21%), followed by the knee (14.1%) and the lumbar spine (13.5%). Most injuries had symptoms of <7 days'' duration. The geographical region with the greatest demand for physiotherapy services was Africa (40.6%). Most patients were athletes (74.8%), although team officials accounted for a considerable number (14%).

Conclusions

The smallest national teams—especially those from developing countries—were more likely to take advantage of services, probably because the larger teams had their own medical and physiotherapy staff. The characteristics of patients, their sustained injuries and the subsequent treatment varied by the accreditation status of the patients. The physiotherapy department''s workload was dependent on the Olympic Games schedule.     

Oral health among Dutch elite athletes prior to Rio 2016

Objectives: Elite athletes are at high risk for poor oral health. A screening program to assess oral health and create dental awareness can improve oral health among elite athletes but has not been performed in the Netherlands before. We summarize the first results from such a screening conducted in Dutch elite athletes of the Nederlands Olympisch Committee*Nederlandse Sport Federatie (NOC*NSF, Dutch Olympic Committee).

Methods: In this cross-sectional study, 800 Dutch athletes eligible for the Olympic and Paralympic Games in Rio de Janeiro 2016 were invited to a costless and voluntary oral examination. The decayed, missing, and filled teeth-index (DMFT), the basic erosive wear examination (BEWE) and the Dutch Periodontal Screening-index (DPSI) were used to evaluate athlete’s oral health. Information on sociodemographic variables and sport performance were collected in questionnaires.

Results: In total, 116 Dutch elite athletes were included in the study. The median (90%-range) DMFT-score was 3.0 (0.0–16.0), the median BEWE-score was 2.0 (0.0–10.0), and the mean± SD DPSI-score was 2.0 ± 0.73. Oral health-related quality of life was generally high, although only 28.2% of the athletes reported never having problems with their dentition or mouth. In 43% of the athlete’s clinical findings were reported which needed a direct referral to the general dentist.

Conclusion: Oral health in this subsample of Dutch elite athletes was surprisingly affected as almost half of them needed dental treatment. Further research is needed to allow conclusions about oral health in Dutch elite athletes more broadly. However, regular screening of oral health incorporated into the general preventive health care of elite athletes is necessary to ensure athletes are fully healthy during competitions like the Olympic and Paralympic Games.     

A congested football calendar and the wellbeing of players: correlation between match exposure of European footballers before the World Cup 2002 and their injuries and performances during that World Cup

Objectives: To investigate the correlation between exposure of footballers in European clubs to match play in the months before the World Cup 2002 and their injuries and performances during that World Cup.

Methods: The team doctors at 11 of the best football clubs in Europe prospectively recorded players' exposure and injuries during the 2001–2002 season (July 2001–May 2002). Sixty five players participated in the World Cup in Korea/Japan (June 2002). During the World Cup, the clubs reported injuries sustained by these players, and their performance was evaluated by three international experts.

Results: The number of team matches during the season varied between 40 and 76 for the different countries involved. The individual player had a mean of 36 matches during the season. Top players played more matches, especially during the final period of the season. Players who participated in the World Cup played more matches during the season than those who did not (46 v 33 matches). World Cup players did not show any increased risk of injury during the season. About 29% incurred injuries during the World Cup, and 32% performed below their normal standard. The players who underperformed had played more matches during the 10 weeks before the World Cup than those who performed better than expected (12.5 v 9, p<0.05). Twenty three (60%) of the 38 players who had played more than one match a week before the World Cup incurred injuries or underperformed during the World Cup.

Conclusions: There is considerable variation in the number of matches played per season in European professional football leagues. Top level players are obliged to play many matches especially during the final period of the season.

     

Effects of prolonged strenuous exercise (marathon running) on biochemical and haematological markers used in the investigation of patients in the emergency department

Objectives: To investigate the effects of strenuous exercise on commonly used biochemical and haematological variables in subjects running the 2002 London marathon.

Methods: 34 healthy volunteers (7 female, 27 male) were recruited for the study. Blood was taken before the start (at registration) and immediately after completion of the marathon. Samples were analysed for urea and electrolytes, liver function tests, creatine kinase (CK), CK-MB isoenzyme, myoglobin, troponin I, full blood count, a clotting screen, and D-dimers. The results before and after exercise were compared. Pearson's correlation coefficients were calculated for all variables.

Results: Significant increases were found in CK, CK-MB, aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and myoglobin following the marathon. However, there was no significant change in the level of troponin I. There was also evidence of activation of the coagulation and fibrinolytic cascades following the marathon, with a reduction in activated partial thromboplastin time, a reduction in fibrinogen, and an increase in D-dimers.

Conclusions: The results confirm previous individual studies on marathon running and the biochemical and haematological tests routinely carried out in hospital. These are affected by prolonged exercise, and "abnormal" results in these tests may be normal after prolonged exercise and therefore not diagnostic of a disease process. The results of investigations in patients who have been exercising should be interpreted with caution.

     

Men, muscles, and body image: comparisons of competitive bodybuilders, weight trainers, and athletically active controls

Objectives: To investigate body image and psychosocial adjustment among competitive bodybuilders, non-competitive weight trainers, and athletically active men.

Methods: Participants were 40 men in each of the three groups who were assessed on body composition and multiple facets of body image evaluation, investment and anxiety, eating attitudes, and social self esteem.

Results: Relative to the other two groups, competitive bodybuilders had greater body mass due to fat-free body mass. Although groups did not differ in their situational body image discomfort, competitive bodybuilders and weight trainers had a more positive global appearance evaluation and were more psychologically invested in their physical appearance. Compared with active controls, men in both weightlifting groups were more satisfied with their upper torso and muscle tone. Competitive bodybuilders reported more mid torso satisfaction than the other two groups. Competitive bodybuilders also wished to be significantly heavier than controls did and reported higher social self esteem but greater eating disturbance.

Conclusions: The findings suggest that competitive bodybuilders as a group are not more "muscle dysmorphic" than either non-competitive weight trainers or physically active men who do not train with weights.

     

Abnormally high serum ferritin levels among professional road cyclists

Background: An international, longitudinal medical follow up examination of male professional road cyclists revealed excessively elevated serum ferritin levels.

Objective: To evaluate the importance of elevated ferritin values among professional cyclists, their relationship with age and nationality, and their evolution over 3 years.

Methods: Over 1000 serum ferritin values were collected. Other parameters were included in order to exclude conditions which might have increased ferritin levels without changing body iron stores.

Results: In 1999, over 45% of riders displayed ferritin values above 300 ng/ml and one fourth levels over 500 ng/ml. These percentages had decreased to 27% and 9%, respectively, 3 years later, while the overall average, which was above the normal limits in 1999, had decreased by 33% in 3 years. Older cyclists had higher ferritin values than younger cyclists. There was also a relationship between ferritin levels and the nationality of the cyclists. Analysis of 714 riders in 2000 and 2002 showed only a slight and insignificant decrease in the mean ferritin value although those with initially elevated iron stores had a much greater decrease.

Conclusion: Professional road cyclists used excessive iron supplementation leading to high serum ferritin levels correlating with increased body iron stores. Although the situation progressively improved over 3 years, it remains worrying as increased body iron stores are related to health complications. Therefore, prevention in addition to the fight against doping should be a main goal of the UCI. Aggressive therapy for athletes with excessive ferritin values should be carried out at or before the end of their careers.

     

Characteristics of motivational patterns for sporting activity of swimmers with psychophysical disorders

The article provides an insight into the characteristics of motivational patterns for sporting activities of swimmers with psychophysical disorders. The research has identified the relationship between motivational patterns and dominant motivational tendencies of swimmers with visual impairments and musculoskeletal system disorders. The subjects’ qualification level: elite athletes, 26 persons; athletes of high qualification, 41 persons. The age of the participants ranged from 14 to 32 years. Methodology: theoretical analysis and systematization of data available from specialized scientific and methodological literature, empirical—discussions, interviews of trainers and athletes, psychognostic—a questionnaire initially developed by B. Kretti and upgraded by I. Yurov (Psychological testing and psychotherapy in sport. Sovetskiy Sport, Moskva, 2006) aimed to determine a motivational pattern and to assess motivation intensity of sporting activities of athletes with nosology; achievement motivation and failure avoidance (questionnaire test developed by M. Muhammad-Eminov); statistical—the method of averages, χ ²-criterion, t-criterion, the correlation coefficient (r), using STATISTICA-6 software program for the Windows and Microsoft Excel (2007). It has been proven that one of key components of the patterns of motivation for sporting activity of high-skilled swimmers with visual and mobility impairments is the need for public recognition through financial remuneration and moral incentives. It was proven that at a 5 % significance level, the motivation intensity of visually and mobility impaired male swimmers depends on their achievements in Paralympic sport. It has been determined that achievement motivation is dominant among athletes with visual impairments compared to athletes with musculoskeletal disorders.     

Online pre-race education improves test scores for volunteers at a marathon

Objectives: This study examined whether an online course would lead to increased knowledge about the medical issues volunteers encounter during a marathon.

Materials and Methods: Health care professionals who volunteered to provide medical coverage for an annual marathon were eligible for the study. Demographic information about medical volunteers including profession, specialty, education level and number of marathons they had volunteered for was collected. A 15-question test about the most commonly encountered medical issues was created by the authors and administered before and after the volunteers took the online educational course and compared to a pilot study the previous year.

Results: Seventy-four subjects completed the pre-test. Those who participated in the pilot study last year (N = 15) had pre-test scores that were an average of 2.4 points higher than those who did not (mean ranks: pilot study = 51.6 vs. non-pilot = 33.9, p = 0.004). Of the 74 subjects who completed the pre-test, 54 also completed the post-test. The overall post-pre mean score difference was 3.8 ± 2.7 (t = 10.5 df = 53 p < 0.001). While subjects with all levels of volunteer experience demonstrated improvement, only change among first time marathon volunteers was significantly different from the others. Subjects reporting all degree/certification levels demonstrated improvement, but no difference in improvement was found between degree/certification levels.

Conclusion: In this follow-up to the previous year’s pilot study, online education demonstrated a long-term (one-year) increase in test scores. Testing also continued to show short-term improvement in post-course test scores, compared to pre-course test scores. In general, marathon medical volunteers who had no volunteer experience demonstrated greater improvement than those who had prior volunteer experience.     

Stress, control, and coping in elite athletes

The main object of this study was to explore different dimensions of the stress experience and the following coping efforts among elite athletes. Sixty-nine Norwegina Winte Olympic athletes, competing in the Lillehammer Games in 1994 participated in the study. Recall of the most stressfull experiences was reported through open-ended questions following the Olympic Games, and the actual time of the experience with the following coping efforts were measured with the COPE inventory (19). The stress was mainly experienced during the time period prior to the competition. External distractions and expectations were the most frequently reported stress experiences. The coach was viewed as a major source of stress by some athletes, with a subsequent lack of control and low satisfaction with performance. Type of stress more than the time of the experience seemed to have a deterimental effect on performance. Problem-focused coping strategies were employed at all times, while cognitive defense strategies were employed more days before (time phase 1) and after the competition (time phase 4).     

The power of competence support: The impact of coaches and athlete leaders on intrinsic motivation and performance

Grounded in the Cognitive Evaluation Theory, a mini‐theory of Self‐Determination Theory, this experimental field study sought to examine the impact of competence support of both coaches and athlete leaders on athletes’ competence satisfaction, intrinsic motivation, and subjective as well as objective performance. Male basketball players (N  = 120) were allocated to groups of 5 players. These groups were then randomly assigned to a control group or to 1 of 3 experimental conditions. In these experimental conditions, either the coach, the athlete leader, or both provided motivational feedback to their team. The provision of motivational feedback by either the coach or the athlete leader was sufficient to increase athletes’ competence satisfaction, intrinsic motivation, and objective performance (i.e., enhanced execution time without a decrease in scoring percentage) relative to the control group. Interestingly, when both the coach and the athlete leader provided competence support, a surplus effect was observed on objective performance compared with when only the coach provided competence support. Furthermore, structural equation modeling revealed that players’ competence satisfaction mediated the relationship between the provided competence support and players’ intrinsic motivation, while a direct effect was observed on objective performance. In conclusion, the study findings indicate that also athlete leaders can adopt a motivating role, and that by doing so, their impact is as strong as the impact of the coach. Both coaches and athlete leaders can thus boost athletes’ objective performance and foster competence satisfaction, with the latter resulting in increased intrinsic motivation.     

Lower-extremity isokinetic strength ratios of elite springboard and platform diving athletes

Objectives: The purpose of the present study was to examine knee extensor and flexor muscle strength ratios of an elite group of diving athletes.

Methods: Sixteen divers (10 females and 6 males) from the Brazil national team were assessed for lower-body strength. They had participated in international competitions such as the 2016 Olympic Games and 2015 Pan American Games. The dynamic concentric torque of their knee flexor and extensor muscles were evaluated using a Biodex isokinetic dynamometer. Bilateral tests were performed at 60º s^?1. Flexor to extensor (F/E) peak torque ratio and percentage bilateral difference (BD%) was also measured.

Results: The results revealed that elite diving athletes produced higher than usual reported in previous studies for relative knee extension torque (3.2 for females and 3.6 for males N?m?kg^?1). However, they presented low levels of knee flexor torque (1.5 for females and 1.8 for males N?m?kg^?1). These results are reflected in a low F/E ratio (0.39 to 0.49). Males presented a greater BD% in knee flexors when compared to females (12.4% vs 6.6%).

Conclusion: Elite diving athletes demonstrated high knee extensor and low knee flexor strength. This partially explains their low F/E ratio, which might increase risk of knee injuries. Strength and conditioning programs should strive to correct knee strength imbalances in diving athletes where necessary.     

Effect of static stretching of quadriceps and hamstring muscles on knee joint position sense

Objectives: To evaluate if a stretch regimen consisting of three 30 second stretches would alter joint position sense (JPS).

Methods: A blinded, randomised, cross over design with a washout time of 24 hours was used with 20 healthy volunteers. JPS was estimated from the ability to reproduce the same position in one knee (target versus estimated angle) expressed as the difference between target and estimated angle (constant error, CE). Measurements were repeated three times in a sitting and a prone position on the dominant leg measured before and immediately after the static stretch. The static stretch consisted of a 30 second stretch followed by a 30 second pause, repeated three times.

Results: At baseline, the mean (SD) CE was –2.71 (3.57)° in the sitting position. No difference (p = 0.99) in CE between stretching and control was observed (0.00; 95% confidence interval –0.98 to 0.99). At baseline, the CE was –3.28 (4.81)° in the prone position. No difference (p = 0.89) in CE between stretching and control was observed (0.12; 95% confidence interval –1.52 to 1.76).

Conclusion: A static stretch regimen had no effect on JPS in healthy volunteers.

     

Long term outcomes of inversion ankle injuries

Background: Ankle sprains are common sporting injuries generally believed to be benign and self limiting. However, some studies report a significant proportion of patients with ankle sprains having persistent symptoms for months or even years.

Aims: To determine the proportion of patients presenting to an Australian sports medicine clinic who had long term symptoms after a sports related inversion ankle sprain.

Methods: Consecutive patients referred to the NSW Institute of Sports Medicine from August 1999 to August 2002 with inversion ankle sprain were included. Exclusion criteria were fracture, ankle surgery, or concurrent lower limb problems. A control group, matched for age and sex, was recruited from patients attending the clinic for upper limb injuries in the same time period. Current ankle symptoms, ankle related disability, and current health status were ascertained through a structured telephone interview.

Results: Nineteen patients and matched controls were recruited and interviewed. The mean age in the ankle group was 20 (range 13–28). Twelve patients (63%) were male. Average follow up was 29 months. Only five (26%) ankle injured patients had recovered fully, with no pain, swelling, giving way, or weakness at follow up. None of the control group reported these symptoms (p<0.0001). Assessments of quality of life using short form-36 questionnaires (SF36) revealed a difference in the general health subscale between the two groups, favouring the control arm (p<0.05). There were no significant differences in the other SF36 subscales between the two groups.

Conclusion: Most patients who sustained an inversion ankle injury at sport and who were subsequently referred to a sports medicine clinic had persistent symptoms for at least two years after their injury. This reinforces the importance of prevention and early effective treatment.

     

Drug use in English professional football

Objectives: To examine several issues related to drug use in English professional football. More particularly the project sought to gather data on: players' use of permitted supplements (mineral and vitamin pills and creatine); whether they sought advice, and if so from whom, about their use of supplements; their experience of and attitudes towards drug testing; their views on the extent of the use of banned performance enhancing and recreational drugs in football; and their personal knowledge of players who used such drugs.

Methods: With the cooperation of the Professional Footballers Association (PFA), reply paid postal questionnaires were delivered to the home addresses of all 2863 members of the PFA. A total of 706 questionnaires were returned, a response rate of just under 25%.

Results: Many players use supplements, although almost one in five players does so without seeking qualified professional advice from anyone within the club. Blood tests are rarely used to monitor the health of players. One third of players had not been tested for drugs within the preceding two years, and 60% felt that they were unlikely to be tested in the next year. The use of performance enhancing drugs appears to be rare, although recreational drugs are commonly used by professional footballers: 6% of respondents indicated that they personally knew players who used performance enhancing drugs, and 45% of players knew players who used recreational drugs.

Conclusions: There is a need to ensure that footballers are given appropriate advice about the use of supplements in order to minimise the risk of using supplements that may be contaminated with banned substances. Footballers are tested for drugs less often than many other elite athletes. This needs to be addressed. The relatively high level of recreational drug use is not reflected in the number of positive tests. This suggests that many players who use recreational drugs avoid detection. It also raises doubts about the ability of the drug testing programme to detect the use of performance enhancing drugs.