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Sonia O’Sullivan: TUEs an easier way to cross the pain barrier

Love of sport for its purity, natural ability and talent in athletes is being diminished

I was back in the swimming pool this week, starting to feel more comfortable in the water after some regular training, and with that able to push a little more out of the comfort zone. One of the main reasons I maintain a regular swim session is because it allows me to test myself, mentally and physically, in ways my body just won’t allow me in running anymore.

Which of course is an important part of any training regime, amateur or professional. Back in my competitive days, I always felt I had an advantage in being able to step outside that comfort zone, push myself through the pain barrier. It’s a little more difficult these days and sometimes you have to find ways of tricking the mind into doing this, something that might help block the pain or give you some little edge.

There were plenty examples of this in Henry Shefflin's documentary Winning, which went out on RTÉ recently, and which I made a small contribution to. Certain athletes will always find it easier than others to rise to the challenges, find a way to win, but it's also interesting how the brain can influence how the body reacts in these situations.

Professor Ian Robertson from Trinity College made some interesting observations in Winning, that if you can get the mind to believe what you want to achieve, then the body will respond; then, once you get that winning feeling you want to have it more and more, because the feeling you get in the reward centre of your brain is something we all crave.

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With that in mind there are also a lot of questions right now over what exactly should constitute a therapeutic use exemption (TUE), and what role they may play in this process of pushing through the pain barrier. Like most athletes I would sometimes reach for an anti-inflammatory, but I never once had a TUE. I actually had to look up the exact definition of a TUE, because they weren't so common in my competitive days, even though they were starting to creep in.

I never had a cortisone injection during my competitive career either, although in recent years yes, after a minor surgery, long after I’d stopped competing internationally. My physio Ger Hartmann always believed in the holistic approach, not the quick fix, and I always listened to him.

Only now it seems all competitive athletes are after that quick fix, and part of the reason for that is because sport has become increasingly professional. Ten or 20 years ago I think we were still bridging that gap between amateur and professional, and athletes were maybe more willing to take the time out to recover from injury.

Now time is money, and there’s a lot more money to be made. Less time on the sidelines equals more money, and with that the motivation for decision making also changes. So where do you draw the line? If there is a line in sport that defines cheating, is it okay to work close to the line and get extra benefits in recovery and fending off pain so that you can work harder for longer?

Part of the winning process in sport is the ability of one person to tolerate pain more than another, to push through that barrier. Because eventually all athletes reach a point where pain starts to inhibit your efforts.

One of the big questions over a TUE is whether it is considered performance enabling or performance enhancing, or if indeed there is any major difference. Dan Carter certainly sounds convinced he was doing no wrong by taking a corticosteroid injection, and, to a lesser extent maybe, Bradley Wiggins in using the anti-inflammatory drug triamcinolone before his Tour de France win in 2012

There are also an increasing number of reports of athletes using substances that are otherwise banned but allowed for a medical condition, such as thyroid or asthma medication. It is a worry that more of the world’s top athletes appear to have a medical conditions that requires them to take an otherwise banned medication just to be able to train and compete at a normal level. You don’t hear of too many TUE applications being rejected.

It may be available, and may not be illegal, but is it in the spirit of sport to abuse the system? That’s the question on a lot of people’s minds right now.

Along with the physical and mental training, if an athlete has taken something that blocks pain, will they get an edge from this to allow them to be more confident when that question enters their mind? Even if it is some kind of positive placebo effect.

And if that something is a little stronger, changes the chemistry in the body, then that athlete certainly has an advantage: this is where I question the ethics of the TUE in crossing the line between cheating and staying within the rules.

If this is the path we are going to take with sport, then the parameters need to be harder. Everyone should have the option to be on the same page, to have the same access to medication that will allow them to compete on the same level playing field as your competitor, but knowing that they’re not cheating.

Team sports seem to benefit more from such systematic medical intervention because they continually have the support teams behind them: how ethical and fair is this if it’s not so easily accessible to all athletes, especially those working in the more individual environment?

To me, the love of sport for its purity, for the natural ability and talent in athletes, is being diminished. Are we watching great athletes compete and deliver results that showcase the increasing ability of the human body? Or the ability of science and medicine to push the human body to achieve results beyond its natural limits?

You also have to question is it ethically right to encourage the use of any banned substances, and if so, how do you determine if an athlete has a condition that requires medication to allow them to compete. Maybe if everyone was allowed to top up to a certain limit, an upper threshold, it would be no different than all of us standing on the starting line and competing to the best of our natural ability and without any extra medical interventions, although is that an acceptable solution to an already grey and secretive area in sport?