Is cortisone injection doping?

[Anthony Treacher]

I have had an intraarticular injection of Lederspan cortisone (Triamcinolon Hexacetonide). I read that Lederspan injection is forbidden “in connection with” athletics competition or “in competition.“ Is that right?

And what does “in connection with” or “in-competition” mean here? Same (calendar) day as my event? How many days or hours previous to my event?

[d pickup]

I have had an intraarticular injection of Lederspan cortisone (Triamcinolon Hexamcetonide). I read that Lederspan injection is forbidden “in connection with” athletics competition or “in competition.“ Is that right?

And what does “in connection with” or “in-competition” mean here? Same (calendar) day as my event? How many days or hours previous to my event?

Anthony, I haven't looked at where one should look (? are you quoting an IAAF document?) to answer your question, or reflected on that specific nuance of our language, but can I suggest that you might be more likely to get an answer via 'Doping news' in 'Current events', which has had 17000+ viewings in 6 months.

Meanwhile, a druggie or not (joking), I hope your injection has a beneficial effect medically.

[Anthony Treacher]

David. Thank you so much. No flowers. Think of the British Masters Arthritis Foundation.

[fangio]

Anthony

Assuming that it is a glucocorticosteroid, which cortisone is, section S9 of the WADA prohibited list is most relevant.

S9. GLUCOCORTICOSTEROIDS
All glucocorticosteroids are prohibited when administered by oral, intravenous, intramuscular or rectal routes.

In accordance with the International Standard for Therapeutic Use Exemptions, a declaration of Use must be completed by the Athlete for glucocorticosteroids administered by intraarticular, periarticular, peritendinous, epidural, intradermal and inhalation routes, except as noted below.

Topical preparations when used for auricular, buccal, dermatological (including iontophoresis/phonophoresis), gingival, nasal, ophthalmic and perianal disorders are not prohibited and require neither a Therapeutic Use Exemption nor a declaration of Use.

If a TUE is required it is needed PRIOR to use not after.

This was dated 1st Jan 2010, don't know if it has been superseded.

It looks like you should have got a TUE prior to using an intraarticular injection of a glucocorticosteroid, and should you now compete and be tested you will have broken the WADA anti-doping regulations.

[Anthony Treacher]

Ah fangio. Don't tell the BMAF lawyer.

[Anthony Treacher]

fangio, I do not need a TUE. The masters athletics TUE requirement is different. UKA has informed me that I only need a WMA TUE if I intend to compete in World or European Masters events in the near future.

I do not intend to compete in World or European Masters events in the near future.

[Anthony Treacher]

Question for a sports doctor.

The cortisone is injected intra-articular - into the knee. I am curious here. In what way is this performance enhancing?

[d pickup]

Anthony

Back in the 50s / 60s the naughty druggie talk in athletics was steroids, with horror stories emerging of the side effects. Steroids have been used though for all sorts of other things: burn victims, the elderly... your injured knee.

How to walk the tight rope between being classed as a druggie, and in your case dealing with an injury is not easy.

WADA has approved the 2011 Prohibited List but perhaps it is not yet available.

see
www.wada-ama.org/en/News-Center/Article ... r-Funding/

Roaming round WADA's web site might be a fruitful trip - in many ways.

see
www.wada-ama.org/en/World-Anti-Doping-P ... ited-List/

[Anthony Treacher]

Thanks David. Actually what I am really after is how this cortisone stuff in my left knee is “performance-enhancing.” That is, how exactly does it make me run faster or jump further. Anyone?

[sleady]

It's enabling you to train beyond your physical capabilities, much as EPO does. Whether it's illegal or not... consult the rule books.

[Anthony Treacher]

Sleady, sports medicine and the law perhaps are not for you. Don’t quit your day job.

[Pete S]

Anthony - I'm a bit late to this discussion (4 months..!) but..

In this particular instance the cortisone injection (if it has been successful) has enhanced YOUR performance. So, to that extent, it is performance enhancing.

The mechanism by which the steroid group of drugs enhance performance is, to be very basic about it, by enabling your body to heal from muscular exertion more quickly - thereby enabling you to work harder. An athlete attempting the same work programme without drugs would break down.

Your question cuts to the heart of the drugs debate - no one wants to see drugged up superhumans competing in athletics but does this also mean that top athletes are forbidden from taking anything that you or I could take just to help us over a minor ailment?

In LA in 84 Jurgen Hingsen received 2 injections (cortisone in his ankle I think?) to enable him to continue in the high jump in the Decathlon. This was certainly performance enhancing at the time but does it put him into the same league as someone who systematically uses drugs over the long term..?

Anyway - I sincerely hope that your knee has improved. I'm going to have a look through my medical textbooks again today to refresh my memory on the peptide hormones and their mechanisms of action - a fun-filled Sunday..!

[Anthony Treacher]

Pete S. Thank you.

The cortisone treatment was completely unsuccessful.

After months of wasting time with conventional medicine and two cortisone injections INTO the knee, an elite long-jumper advised me to go to a specialist sports naprapath. The naprapath immediately diagnosed that I instead had an injury in the Popliteus muscle BEHIND the left knee. Three recent (very painful) hands-on treatments by the naprapath and I am now practically OK. This was my very first and rather sceptical visit to a naprapath and it worked. Halleluja.

I had trained and competed despite/around the injury. I did not feel better for the cortisone. The knee area still hurt. The cortisone did not enable me to train and function normally. In no way did it enhance my (miserable) performance.

So where does that leave us in the debate on this intra-articular cortisone as a PED? Well nobody has shown to me how intra-articular cortisone injection in an otherwise fit athlete can enhance performance. So again, why is intra-articular cortisone on the WADA list? Here I really would like some professional input, preferably citing strange chemicals, hormones and things.

Furthermore, in this cortisone context you could say I was and am a fit athlete. As a fit athlete subject to UKAD testing and not having a Therapeutic Use Exemption (TUE) for the cortisone, I could have been tested positive and eventually been banned for using something that was NOT performance enhancing for me and in fact completely useless and irrelevant to my health and athletic performance.

[Bonnie]

It is. Cortisone elevates your blood pressure and it has adrenaline, allowing you to be more active.

[trickstat]

It is. Cortisone elevates your blood pressure and it has adrenaline, allowing you to be more active.

Yes but these are short-term affects and you should not compete or train hard after a cortisone injection.