With today’s final imminent it is worth asking what, if any, role doping played in the World Cup? It is true that football teams today are required to be much fitter than before; it is unlikely that even some of the great teams of the past would have performed optimally in the last 30 minutes of a modern match. However, the endurance levels required for the footballers of today still require little more than a sensible diet and a lot of hard work in the gym or training field (although it has to be said even this does seem beyond some players).
Unlike athletics or cycling, In terms of performance enhancement it is difficult to make dramatic changes in skills-based team sports performance by chemical enhancement. It is theoretically possible that “cognitive enhancers” might make a player more alert, even when tired, such that they find that critical defence splitting pass. But I suspect any change would be small, and there is no evidence that teams are attempting to use this route.
Where there is more concern in drugs that are “performance enabling” i.e. that make a player play in a match that they would otherwise not be able to. Painkillers fall into a ‘doping grey-zone’  because there is an obvious need to treat an athlete if they’re injured but they can also be used to shorten the recovery time needed if given in high enough doses. Non-steroidal anti-inflammatories (NSAIDs) in particular have been shown to effectively decrease pain and improve early muscle recovery . Footballers in particular might tend towards painkillers before and during games as it may allow them to both get back on the pitch sooner after an injury and reduce the severity of any injury that may occur .
Whilst their use post match to treat an injury is an accepted exercise, what happens when an athlete takes them before playing? Here we do have evidence from the football world cup. FIFA’s chief medical officer, Dr Jiri Dorvak, published a paper looking into the use of medication during the 2010 World Cup [3,4]. He asked team physicians to provide them with details of all of the medications each player took ahead of the games. His study showed that 39% of players took a painkiller in the 72 hours before every game they played in  and that overall painkiller use was increasing year on year. This study accounted for the number of players taking prescribed medication; due to the easy availability of painkillers it is likely that the true number is much higher.
Dr Dorvak believes that one of the factors that has resulted in this rise is the increasing pressure put on team doctors by managers and sponsors to get players fit and healthy again ; with the incredibly high potential earnings of top international players it is also unsurprising that the players themselves want to make sure they keep hold of the job or shine in a match that could get them their next big transfer. And who would want to miss a World Cup Final if at all possible?
Another issue that arose from the study was the likelihood of further increase in painkiller use in youth teams, with 16-19% of under-17 football players abusing them . Due to the sometimes severe effects that painkillers (NSAIDs in particular) can have on the kidneys and liver, it is a worrying sign that consumption at this level is seen at a young age.
As I say in my book , we have been here before, and not just in football. Peter Elliott won a silver medal for Britain in the 1988 Olympic 800m; but only after receiving five cortisone injections in seven days. Hailed by many at the time (including me) as an example of bravery, some were critical of the methods employed.
It is no doubt that injecting an athlete with a range of drugs can aid recovery and enable them to compete at an enhanced level than they would have been able to without the drug. In many cases this is at the cost of possible future injury or disability. So, as far as the individual themselves is concerned, this is not much different from risking long-term health damage by using a banned performance enhancing drug. And we know this is not a deterrent for many dopers. The difference, if there is one, is that the level reached is not “superhuman” i.e. it could be reached without doping if someone could avoid injury.
I think in this area the medical care of an athlete is paramount. It is surely the responsibility of the athlete’s doctor to advice on the health benefits or damage of any treatment. This is yet another reason why advocates of “clean sport” needs to focus as much on coaches and support team (including medical staff) as the athletes themselves.
[I would like to thank Jess Pritchard, a student at the University of Leicester in the UK, for doing some of the original research on this story and writing a preliminary draft. However, as always all the comments expressed in this blog are my own and not those of Jess, my publisher or my university].
 Mehallo, C et al, Practical Management: Nonsteroidal Antiinflammatory Drug (NSAID) Use in Athletic Injuries, Clinical Journal of Sports Medicine 2006:16:170-174
 Tscholl, M., Dorvak, J., Abuse of medication during international football competition in 2010 – lesson not learned,