Last month, I decided to explore the issue of performance enhancement in elite sport, focusing solely on so-called ‘able-bodied’ athletes. It’s more complex than I imagined.
The Paralympics, however, is something else entirely.
With the second of Rio’s 2016 Games in full swing and Team GB once again doing phenomenally well, I got in touch with the University of Birmingham’s Dr Ian Boardley and Loughborough University’s Dr Paul Sherratt, keen to learn more about the slightly murkier side of the Paralympics.
First Stop: Mechanical Doping
Thrust into the public eye by cyclist Femke Van den Driessche at the beginning of the year, mechanical doping is a growing problem in elite sport, and with so many Paralympic athletes forced to rely on equipment like prosthetics and blades in competition, my assumption was that the situation would be far more prevalent here than it is in the Olympics.
“I’m not aware of any real evidence that mechanical doping as seen in cycling earlier this year may be an issue in the Paralympics,” Boardley told me, taking me completely by surprise. “Although there is clear potential in the wheelchair events.”
Sherratt echoes this, explaining, “I think the first thing to highlight is the relatively low level of funding that Paralympic athletes receive compared to other sports. If you consider the mechanical doping issue, there is far more money available and at stake in say, the Tour de France than there is in Paralympic cycling.
“I would also say that the individual athletes receive relatively little support and, as such, they struggle to purchase even the most basic equipment. Jonnie Peacock didn’t run on carbon fibre blades until well into his teens and Liam Malone had to ask the New Zealand public to crowdfund his blades – these are both Olympic champions at the pinnacle of the sport!
“Athletes and governing bodies just do not have the resources to even contemplate mechanical doping.”
Restoring Function and Beyond
Not quite the answers I was expecting. However, a little more probing reveals that technology is still the cause of major concern for authorities and athletes alike.
“I think technology can be a particular issue in the Paralympics, because equipment such as blades are thought to potentially given a performance advantage compared to the human limb it replaces, as has been debated in the 400m in past games and the long jump currently,” says Boardley. “The biggest impact here has been in terms of Paralympic athletes not being permitted to perform in the Olympics unless they can prove their replacement limb offers no performance advantage, which is extremely difficult.
“The International Paralympic Committee sees prostheses as a means of restoring a loss of function rather than a means of performance enhancement. The difficulties lie in being able to make this distinction though, as it is very difficult to know what amount of function has been lost and therefore needs restoring.”
Existing rules limit the length of prosthetic limbs, basing measurements on on the size of a competitor’s body and remaining limbs. Athletes’ equipment is regularly checked for compliance too. However, Boardley admits that the situation isn’t black and white.
“Whether these rules prevent some equipment offering a performance enhancement is the difficult thing to determine as I see it. The bottom line is, it is extremely difficult to determine the difference between restoring function and offering a performance enhancement that is beyond this.”
It’s another point echoed by Sherratt, who introduces me to the head-splitting minefield that is classification. The IPC has established 10 disability categories, which are as follows:
- Impaired muscle power: Reduced force generated by muscles or muscle groups, such as muscles of one limb or the lower half of the body, as caused, for example, by spinal cord injuries, spina bifida or polio.
- Impaired passive range of movement: Range of movement in one or more joints is reduced permanently, for example due to arthrogryposis. Hypermobility of joints, joint instability, and acute conditions, such as arthritis, are not considered eligible impairments.
- Limb deficiency: Total or partial absence of bones or joints as a consequence of trauma (e.g. car accident), illness (e.g. bone cancer) or congenital limb deficiency (e.g. dysmelia).
- Leg length difference: Bone shortening in one leg due to congenital deficiency or trauma.
- Short stature: Reduced standing height due to abnormal dimensions of bones of upper and lower limbs or trunk, for example due to achondroplasia or growth hormone dysfunction.
- Hypertonia: Abnormal increase in muscle tension and a reduced ability of a muscle to stretch, due to a neurological condition, such as cerebral palsy, brain injury or multiple sclerosis.
- Ataxia: Lack of co-ordination of muscle movements due to a neurological condition, such as cerebral palsy, brain injury or multiple sclerosis.
- Athetosis: Generally characterised by unbalanced, involuntary movements and a difficulty in maintaining a symmetrical posture, due to a neurological condition, such as cerebral palsy, brain injury or multiple sclerosis.
- Visual impairment: Vision is impacted by either an impairment of the eye structure, optical nerves or optical pathways, or the visual cortex.
- Intellectual Impairment: A limitation in intellectual functioning and adaptive behaviour as expressed in conceptual, social and practical adaptive skills, which originates before the age of 18.
In addition to these, the IPC says that it takes into account minimum disability criteria, such as “a maximum height for short stature, or a level of amputation for athletes with limb deficiency” and sport class, where the classification panel determines which sport class a Paralympic athlete will compete in.
As explained here, some events, such as powerlifting and ice sledge hockey, only have one sport class. Athletics, on the other hand, has 52 sport classes, as it includes a wide range of different disciplines.
“Classification is a challenging, sometimes controversial and dynamic issue that will become increasingly difficult to manage as the sport grows,” Sherratt tell me. “Many of these classifications use mechanical devices (blades, chairs, etc.) and the regulation of these is also highly complex.
“Athletes are all individuals, and para-athletes will additionally have very individual disabilities and needs which may change over time. This results in many of them needing bespoke equipment, and trying to regulate for this and manage classifications is a considerable challenge. London 2012 saw the debate about running blade length erupt after Alan Fonteles Cardoso Oliveira’s T44 200m final win [a certain Oscar Pistorius wasn't happy, race footage below]. Is the current formula used by the IPC to calculate the maximum length of blades realistic? If it is applied to all athletes in that classification does this make it fair?”
I rub my chin, hoping his questions are rhetorical. I convince myself they are before opening another can of worms, this one labelled ‘Therapeutic Use Exemptions’.
Simply put, a TUE is the green light for an athlete to use a prohibited substance or method for a legitimate medical condition, and it’s yet another source of trouble. Unsurprisingly, the issue of TUEs is more complex in the Paralympics than the Olympics, as para-athletes often require special medications and treatment in order to deal with health issues related to their impairments.
“I think you have to empathise with the athletes on the issue of therapeutic use exemptions,” says Sherratt. “Many of the athletes require medication just to maintain their quality of life and I don’t believe many of them would use this as a cover for performance enhancement. For example, Corticosteroids are frequently prescribed for MS and respiratory conditions, yet the benefits of them as a performance-enhancing drug are not well-documented. Certainly, they increase air flow in the lungs, but as a treatment for a respiratory condition, presumably this is the intended outcome.”
There has been controversy relating to TUEs in the past, particularly with the use of corticosteroids among cyclists, and Boardley seems pretty certain that there’ll be plenty more of it in the future.
“Regarding TUEs, I believe there is potential in the Paralympics – as in the Olympics – for athletes to misuse the TUE system to gain a performance advantage. There is a real ethical debate here, as again it is sometimes very difficult to determine whether a medication is being taken purely for therapeutic reasons. Any such level of ambiguity provides the opportunity for some athletes to mentally ‘frame’ use of a substance in terms of therapy, while being aware they may gain some performance enhancement from it.
“Information regarding TUEs is not publicly available – beyond the total numbers requested/sanctioned each year – so it is very difficult to determine how much of an issue this may actually be or what substances are likely to be involved.”
In short, I'm glad I'm not in charge of keeping the Paralympics clean and fair. It seems a nigh-on impossible task, which is only going to get more difficult as its popularity increases and funding inevitably improves.
“I think that there is potential for mechanical doping and performance enhancement to become more prevalent as the Paralympics becomes more mainstream, and I think this perhaps the greatest challenge facing the IPC,” says Sherratt. “Every single athlete I’ve encountered has an inspiring story that the world needs to hear and it would be a great tragedy if this was lost as the competition develops.”