Glucocorticoids at the Olympic Games: state-of-the-art review

Area of Science:

• Sports Medicine
• Pharmacology
• Anti-Doping Science

Background:

• The prohibition of systemic glucocorticoids (GCs) in the Olympic Games spans nearly three decades.
• The status of non-systemic GCs has fluctuated, impacting therapeutic use exemptions.
• Analytical limitations in distinguishing GC administration routes persist since 1986.

Purpose of the Study:

• To review the history of glucocorticoid prohibition in sports.
• To analyze the implications of proposed WADA regulations on GC injections.
• To discuss the therapeutic rationale and risks of GCs in athletes.

Main Methods:

• Literature review of anti-doping policies and scientific studies on glucocorticoids.
• Analysis of historical trends in GC prohibition and detection methods.
• Discussion of pharmacological effects and clinical considerations of intra-articular GC injections.

Main Results:

• Prohibiting systemic GCs influenced the development of therapeutic use exemptions.
• Current analytical methods cannot differentiate GC administration routes.
• Injecting GCs locally or intra-articularly can achieve desired effects but vigorous exercise post-injection is therapeutically unsound.

Conclusions:

• Injecting GCs shortly before strenuous training or competition is medically inadvisable.
• The management of pre-competition GC injections is a clinical decision for sports bodies, not WADA.
• Sports like cycling and rowing have successfully addressed this issue internally.