Rafael Nadal’s infiltrations: law, ethics, health risks… Four questions surrounding this controversial practice in elite sport

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By revealing that he daily resorted to anesthetic injections at Roland Garros, Rafael Nadal opened the debate on this legal medical practice, between ethics, anti-doping rules and differences with other sports.

What does the regulation say?

“We blocked (the pain) by injecting anesthetic before every match,” explains Rafael Nadal, who suffers from Müller-Weiss syndrome in his left foot. Narcotic products are not banned by the World Anti-Doping Agency (WADA) World Anti-Doping Code.

However, another way to deal with pain, the use of corticosteroids has been banned during competitions since January 1. “The use of anesthetics is a practice that has certainly become more frequent since this year, as it is all that is possible to limit pain locally,” said AFP Dr. François Lhuissier, President of the French Association of Exercise and Sports Medicine (SFMEs ).

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However, an athlete could use corticosteroids in competition, possibly by injection, if he had a Therapeutic Use Authorization (TUE). “No TUE committee would issue a TUE because of Nadal,” said Mr. Lhuissier. “A TUE is when you have a health problem that will hinder you in daily life, not just in sports, for example. For example, asthma or hypertension TUEs do not become given to allow athletes to resume their sport, but to return to a normal level of health.

Football, athletics… Different situations depending on the sport

“In football, infiltrations are very widespread”, assures AFP from a general point of view, doctor Jean-Pierre de Mondenard, sports doctor, who maintains a blog (dopagedemondenard.com). “But these are not treatments, you treat the outcome but not the athlete,” he warns. In athletics, “these are not common practices at all, at least not in France,” AFP Dr. Antoine Bruneau, doctor of the French teams at the French federation.

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“Whether using an anesthetic or the injection method, both are not common at the time of competition. It is probably more common in championship team sports with games ending every weekend.”

“It’s part of the therapeutic arsenal we have at our disposal. But putting a nerve on a lower limb to sleep would cause problems in terms of balance, gesture control. There’s a difference between translational running and tennis slides and the quality of the foot necessary for a jump or an athletic race where you need all the sensations seems to me in principle hardly possible.

An ethical practice?

Only cycling, a sport that regularly mocks doping, has gone further than WADA by including in its sporting regulations the prohibition of any injection during a race. Thibaut Pinot, who was involved with the Movement for Credible Cycling (MPCC) with his team, chided Nadal on Twitter “today’s heroes…”, before developing on the ethics of high-level sport: “We see that too many athletes practice this type in recent weeks”.

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“From an ethical point of view, the only thing that interests me is whether it is authorized or not,” points out Mr. Luissier. The AMA has ruled on this matter. They have ethics specialists. Wouldn’t do it for me, but if an athlete asked me As long as it’s allowed, I would.” For Mr Bruneau, the new regulation on corticosteroids is “a message to the sports world about injections” and their symbolic needles.

A health risk for Nadal?

“Injecting anesthetics will not affect his health, says Mr Luissier. On the other hand, anesthesia means you feel less of your foot and its supports, increasing the risk of a sprain.” “Pain is a natural alarm signal of the human body,” Bruneau recalls. I wonder if it’s useful to stun during a competition by depriving an athlete of his feeling…”