INTERVIEW.  “With his injections, Nadal improves his performance at that time!  says a doctor

INTERVIEW. “With his injections, Nadal improves his performance at that time! says a doctor

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Rafael Nadal’s revelations have not finished speaking. As a reminder, after his fourteenth coronation this Sunday at Roland-Garros, the Spaniard revealed that he had received several injections of anesthetics, at the height of the foot, during the fortnight in Paris, in order to allow him to play and be competitive. For many years, the tennis player has suffered from Müller-Weiss syndrome (necrosis of a tarsal bone in the foot).

These few words, therefore, made the sports world react quickly. Some cyclists like Guillaume Martin or Thibaut Pinot, for example, did not hesitate to share their doubts and questions. According to them, beyond the differences in regulations between sports (any injection in cycling is already prohibited), it is a real ethical problem that goes beyond the issue of doping and performance improvement. Clearly, can a seriously injured or ill athlete turn to medicine to remain competitive and aim for high honors?

READ ALSO. Four questions raised by Rafael Nadal’s injections.

Adrien Roux is a doctor, radiologist at the Saint-Grégoire Private Hospital Center (Ille-et-Vilaine). His field of practice covers, among others, the performance of joint and spinal, cervical and lumbar infiltrations. He regularly treats players from the Stade Rennais, as well as other professional athletes. He testifies.

Infiltration or injection?

“I already find the term “infiltration” wrong because it implies the injection of a local injectable corticosteroid, which is absolutely not the case in this case. Although we have not had an accurate medical report, it is prohibited by the World Anti-Doping Agency (WADA) since January 1, 2022. An injection of corticosteroids can participate in the treatment or improve the recovery of an athlete injured over a long period, for example. It is practiced during a break, but not before a competition. Already because it is prohibited in the five days prior to a competition, but above all because a good efficiency of the gesture requires 36 to 48 hours of joint rest in the suites. »

“What emerges, therefore, is that he would have received an injection of local anesthetic intended to numb the painful area. To anesthetize the sensory nerves (those of sensation) and not motor. However, the nature of the product remains uncertain. Is it Xylocaine as we have heard a lot? I don’t think so, personally. It is a short-acting, fast-acting anesthetic. This is ideal for dental care, for example for a procedure that takes up to 30 minutes or for a simple suture. With Xylocaine, effective for an hour at most, he should have had multiple injections per match, which was obviously not the case. I am more inclined towards Naropeïne or Chirocaïne, anesthetics with a longer effect. »

Dr. Adrien Roux, radiologist. | DR

Doping or not?

“From a legal point of view, no. Nadal did not cheat in any way, there are no rules that prohibit injections of anesthetics in tennis. In addition, injectable anesthetics do not have anabolic or exciting properties, regardless of their mode of administration. This is not the case with corticosteroids taken by mouth, which can have an anabolic effect if taken regularly. Corticosteroids administered by infiltration do not have a doping effect because they hardly pass systemically (in the blood). »

“But going back to Nadal and these injections, in my opinion this poses a real problem. The definition of doping is an external chemical substance that will make you perform better, physically or mentally. There we put a nerve to sleep to put a painful area to sleep, even ultra-pain because its pathology is “a lot of pain”. A normal individual would probably barely be able to walk without pain. Putting this nerve to sleep improves, in my opinion, your performance at the time in the sense that it helps reduce your pain, perhaps even erase it, allowing you to maintain your usual level of performance. Pain normally reduces performance, but the injection allows him to be just as efficient, which is why he has turned to assistance to improve his performance as an injured athlete. From an ethical point of view, this is highly questionable. »

Rafael Nadal, last Sunday in Paris. | AFP

“He suffers from a pathology that is supposed to not allow his body to withstand such a workload. The pain is the consequence of a heavy workload, your body can’t take it anymore and logically you have to stop and treat it over time. Take the example of the semi-final: Alexander Zverev injured his ankle. He writhes in pain, returns to the locker room and leaves the match. There, in my opinion, it is not the result of chance. His body said loud, in a way it is a physical defeat of a player who chained world-class performances for two weeks. So it is also a sports defeat. For Nadal, this injection will mask his physical pathology for a certain period or the level of performance must be maximum. The border is tenuous, because during a period of rest, an injection, in particular intra-articular corticosteroids, could be part of the treatment of a patient suffering from Muller-Weiss Syndrome in a non-surgical stage. »

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“An injection, no. But many, yes, can damage the nerve, leading to its dysfunction: paresthesia (tingling), hypoesthesia (fewer sensations), anesthesia (the initially painful area is no longer felt at all), hyperesthesia (exaggerated painful sensation in relation to to a stimulus). »

“The real danger is that an injection of local anesthetic does not cure the pathology but rather masks the pain that is a warning signal and, consequently, can aggravate the pathology. An injection of anesthetic can be effective to stop feeling pain occasionally, but repeated injections will allow the pathology to persist and then worsen. Rest continues to be the main axis of the treatment of a mechanical pathology linked to the practice of sport in professionals and a fortiori in amateur athletes. »

Rafael Nadal with a 14th Roland-Garros trophy on Monday in Paris. | EPA

The reactions of the athletes?

“I fully understand that some athletes are embarrassed, I agree with them. Just like those who lost to Nadal at Roland-Garros may be upset. We are in an overmedicalization of the player that poses a problem. He does not cheat, in fact, he is authorized, but from an ethical point of view there is a real reflection. »

“Is it fair that, thanks to an injection, an athlete wins a test when logically he should leave due to his pathology? Does he really go further in the pain as sports promotes, or does he use some substance to erase or attenuate that pain? »

“I take the example of a cyclist in the Tour de France who, within two weeks, would develop windshield wiper syndrome (tendinitis on the side of the knee). It hurts a lot, a runner may no longer be able to pedal due to pain. Imagine the same process as Nadal at Roland-Garros: would we inject him with an anesthetic so that he could cycle again and finish the Tour de France? To me, that would be inequity. This tendonitis would be a sign that the body is surrendering to the sporting challenge, that it is losing, in a way. An injection could put him back in the race, or even win. Would that be fair? »

The future ?

“All of this needs to be clarified and legislated at the AMA level. You have to know what you can do in terms of injections, when, how fast, with what and in what dose. Above all, standardize this for different sports. You really have to take stock of injections in general, supervise them, to avoid abuse”

INTERVIEW. “With his injections, Nadal improves his performance at that time! says a doctor

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