Prophylactic misuse and recommended use of non-steroidal anti-inflammatory drugs by athletes: Figure 1

Superstitions and rituals are commonplace in sports and range from simple activities such as each player touching a special inanimate object before entering the field of play to more extreme behaviours such as not washing a uniform or wearing the same underwear during a winning streak. These practices are relatively harmless and may reduce precompetition anxiety, but a concerning ritual that has recently developed in sports is the prophylactic use of non-steroidal anti-inflammatory drugs (NSAIDs). Athletes have relatively unrestricted access to NSAIDs, as they are readily available over-the-counter preparations and not considered as performance-enhancing drugs by the World Anti-Doping Agency.1 It has been known for some years that athletes are frequent users of NSAIDS,2 with approximately a quarter of athletes competing at the Sydney 2000 Olympic Games reporting NSAID use in the 3 days before random drug testing.3 Such prevalent NSAID use may reflect the physical rigors of elite athletic endeavours, but more recent data suggest athletes misuse their open access to NSAIDs. Tscholl and colleagues4 recently reported in this journal that 23% of top-level male football players used NSAIDs in two out of three matches during the 2002 and 2006 …