The role of the physician dedicated to a football team involves not only the treatment of injuries but also their prevention. Previous studies have documented the high intake of medications among athletes, leading to the assumption of inappropriate and prophylactic use of painkilling agents. Hence, such studies have questioned whether the reported administration of these medicines might endanger players’ health [
Futsal, or “hall football,” is a variant of association football, albeit played on a smaller field and indoors. It was developed as an alternative given the lack of available large outdoor football fields. Considered one of the fastest growing sports in the world, futsal is characterized by the high anaerobic and speed demands imposed on its players [
FIFA (Fédération Internationale de Football Association) organizes the FIFA Futsal World Cup every four years. The matches for each team are played within 48- to 72-hour intervals and the teams participating in the finals play a total of seven matches within 17 days. This leads to a considerably higher exposure time compared to FIFA World Cups [
The purpose of this study is to quantify the prescription of medications and nutritional supplements during FIFA Futsal World Cups and to compare it to other sports. We hypothesize that futsal players have a higher drug prescription rate compared to football players.
This is a retrospective survey of prescribed medications and nutritional supplements for male football players engaged in FIFA Futsal World Cup in four editions: 2000, 2004, 2008, and 2012. Data collection was based on forms every team physician must present to FIFA officials for doping control purposes prior to every match.
Team physicians are required to provide information on any medication and nutritional supplement prescribed for each player 72 hours prior to the doping control, using FIFA Form
Over the four tournaments, a total of 5264 reports on 1064 futsal players were collected in the 188 matches played. The tournament information is provided in Table
Tournament Information.
Tournament | Teams ( |
Players ( |
Matches ( |
Reports ( |
Medications prescribed ( |
Mean intake of medications (per player, per match) | 95% confidence intervals |
---|---|---|---|---|---|---|---|
2000 | 16 | 224 | 40 | 1120 | 1140 | 1.00 | 0.96–1.08 |
2004 | 16 | 224 | 40 | 1120 | 1046 | 0.93 | 0.88–0.99 |
2008 | 20 | 280 | 56 | 1568 | 1067 | 0.68 | 0.65–0.71 |
2012 | 24 | 336 | 52 | 1456 | 984 | 0.68 | 0.64–0.71 |
Total | 76 | 1064 | 188 | 5264 | 4237 | 0.80 | 0.78–0.83 |
The variables analyzed in this study were the total number of prescribed medications and nutritional supplements (according to the classification of pharmaceutical agents shown below) and the number of players taking medications per tournament or per match. For the calculation of drug use per tournament, the players were counted as one for each edition of the FIFA World Cup, whereas, in the calculation per match, the players were counted as one for each match played [
The data were analyzed using frequency distributions. Means are presented with 95% confidence intervals.
The substances prescribed by the team physicians were classified as previously reported into seven main substance classes [ Medications:
NSAIDs (oral, injectable, and topical), analgesics (i.e., paracetamol/acetaminophen, metamizol, and tramadol), injectable corticosteroids and local anesthetics, muscle relaxants, respiratory agents (bronchodilators, antihistaminic agents, and others), other medications (homeopathic substances, benzodiazepines, and others). Nutritional supplements (vitamins, minerals, proteins, and others).
A total of 4237 medications were identified (0.8 medications per player per match). During the 4 tournaments, 681 players (64.0%) were using medications at least once during the competition. When analyzing the use of medications per match, 2264 (43.0%) reports contained at least one prescribed medication. In 9 teams (11.8% of the teams), the same medication was prescribed to every player. The medications used by entire teams included homeopathic substances (4 teams), analgesics (3 teams), NSAIDs (2 teams), antimicrobial agents (3 teams), and substances for skins disorders (1 team). In 3 teams (3.9%), more than one substance was prescribed to all players. In 4 teams (5.3% of teams), no medication was prescribed to any player during the entire tournament. A significant decrease of prescribed medications occurred from 2000 and 2004 to 2008 and 2012 as shown in Table
Tables
Number of players using a substance prior to a match.
FIFA Futsal World Cup | 2000 | 2004 | 2008 | 2012 | ||||
---|---|---|---|---|---|---|---|---|
|
% |
|
% |
|
% |
|
% | |
Any medication | 534 | 47.7 | 544 | 48.6 | 608 | 38.8 | 578 | 39.7 |
NSAIDs | 341 | 30.4 | 319 | 28.5 | 374 | 23.9 | 408 | 28 |
Injections |
6 | 0.5 | 21 | 1.9 | 35 | 2.2 | 30 | 2.1 |
Analgesics | 150 | 13.4 | 166 | 14.8 | 58 | 3.7 | 95 | 6.5 |
|
0 | 0 | 7 | 0.6 | 1 | 0.1 | 2 | 0.1 |
Muscle relaxants | 8 | 0.7 | 28 | 2.5 | 78 | 5 | 88 | 6 |
Any nutritional supplement | 643 | 57.4 | 385 | 34.4 | 742 | 47.3 | 619 | 42.5 |
NSAIDs: nonsteroidal anti-inflammatory drugs.
Number of players using a substance during the tournament.
FIFA Futsal World Cup | 2000 | 2004 | 2008 | 2012 | ||||
---|---|---|---|---|---|---|---|---|
|
% |
|
% |
|
% |
|
% | |
Any medication | 149 | 66.5 | 146 | 65.2 | 171 | 61.1 | 215 | 64.0 |
NSAIDs | 98 | 43.8 | 98 | 43.8 | 125 | 44.6 | 165 | 49.1 |
Injections |
5 | 2.2 | 8 | 3.6 | 16 | 5.7 | 12 | 3.6 |
Analgesics | 40 | 17.9 | 66 | 29.5 | 32 | 11.4 | 51 | 15.2 |
|
0 | 0 | 2 | 0.9 | 1 | 0.4 | 1 | 0.3 |
Muscle relaxants | 5 | 2.2 | 15 | 6.7 | 37 | 13.2 | 48 | 14.3 |
Any nutritional supplement | 123 | 54.9 | 107 | 47.8 | 147 | 52.5 | 175 | 52.1 |
NSAIDs: nonsteroidal anti-inflammatory drugs.
Analgesics were the second most prescribed medication. A total of 525 analgesics were prescribed in the 4 tournaments and were consumed at least once by 189 (17.8%) futsal players during the tournament. Analgesics were prescribed as follows: 48.6% acetylsalicylic acid, 47.1% acetaminophen, and 4.4% opioids. Acetylsalicylic acid was commonly prescribed to players during the 2000 and 2004 tournaments (117 and 134 medications, resp.). Acetylsalicylic acid use decreased dramatically in 2008 and 2012 (2 medications prescribed in each tournament) and acetaminophen was used instead (40 in 2008 and 47 in 2012). The intake of analgesics was significantly higher in 2004 when compared to the 3 other editions of the tournament (
Other painkilling agents prescribed to players were corticosteroid and local anesthetic injections (99 injections) and oral muscle relaxants (218 medications). Among the injections, 59.6% were corticosteroids, 31.3% were local anesthetics, and 9.1% were combined injections of corticosteroids and analgesics. These injections included local and intra-articular injections. The anatomical sites of administration were not available. Forty-two (3.9%) players used injections in at least one match, 24 players (2.3%) used injections in more than one match, and 4 (0.4%) players from the same team required an injection prior to every match of the 2012 FIFA Futsal World Cup. The number of players taking muscle relaxants increased significantly over the 4 tournaments (2.2% in the 2000 FIFA Futsal World Cup to 14.3% in the 2012 FIFA Futsal World Cup,
Substances acting primarily on the upper and lower respiratory tract were prescribed at least once to 83 (7.8%) players per tournament and were prescribed to 195 (3.7%) players per match (Tables
The most prescribed psychotropic medications were benzodiazepines (81.7%). Only one player reported the use of antidepressant medications. The use of narcotics was particularly high for one team prior to its last match whereby the team physician prescribed benzodiazepines to every player. That same team, in the next tournament 4 years later, again presented a high intake of psychotropic medications. During the second phase of the competition, 44 of 70 players on this team received benzodiazepines per match.
The percentages of players receiving other medications per tournament and per match, respectively, were as follows: intestinal drugs (8.8%, 2.9%), antimicrobial agents (8.2%, 5.4%), substances for skin disorders (3.1%, 3.3%), and homeopathic substances (9.5%, 6.3%). During the 2000 FIFA Futsal World Cup in Guatemala, all the players from 3 different teams used antimalarial drugs before every match, and the overall rate of antimicrobial agents prescribed was significantly higher that year (95% CI 2000: 0.19–0.21, 2004: 0.02-0.02, 2008: 0.02-0.02, and 2012: 0.02-0.02). Medications not classifiable in our system accounted only for 0.94% of all medications (i.e., rosuvastatin, levothyroxine, tetanus toxoid vaccine, insulin, and illegible medications).
A total of 8494 nutritional supplements were prescribed during the four FIFA Futsal World Cup editions (1.6 nutritional supplements per player and per match). Vitamins represented the majority (38.2%), followed by minerals (21.6%) and amino acids (13.0%). Nutritional supplements were prescribed at least once during the tournament to 552 (52.0%) players and were indicated on 2389 (45.4%) report forms (Figure
Reported use of nutritional supplements (absolute numbers and percentage of players per tournament) during the FIFA 2000 Futsal World Cup (
This study highlights the high use of medications (64% of players used at least one medication per tournament) and the high prescription rate of NSAIDs (45.7% of players used at least one NSAID per tournament) in top-level futsal tournaments. Nutritional supplements were also commonly prescribed (51.9% of players per tournament). A significant decrease of prescribed medications was found in the 2 last editions of the FIFA Futsal World Cup.
When comparing futsal to association football, the literature reports similar findings between the two sports. In the FIFA World Cups of 2002, 2006, and 2010, respectively, 67.9%, 69.0%, and 71.7% of athletes took at least one medication per tournament; and 54.8%, 54.2%, and 54.8% of players had at least one NSAID prescribed per tournament [
Although the use of NSAIDs in sports is not regulated and valid indications exist for their use in sports medicine [
In contrast, other analgesics were prescribed to 189 (17.8%) players and muscle relaxants were prescribed to 105 (9.9%) players. Both these medications may be prescribed for pain control with fewer side effects than NSAIDs [
This survey demonstrates that
The team physician plays a major role in the systematic use of substances by the players. One example is the high prescription rate of psychotropic substances found in one specific team in 2 consecutive editions of the FIFA Futsal World Cup. Additionally, 9 entire teams received medications (including 3 teams receiving analgesics and 2 teams receiving NSAIDs) and 27 entire teams received nutritional supplements for every match of the competition. Team doctors should educate their players about a rational use of medications and nutritional supplements and attempt to diminish their unnecessary use. It is of paramount importance that team physicians understand their influence in this systematic use of medications and nutritional supplements, so that they may help the sport governing authorities in the crusade against the abusive use of substances.
Factors related to the location where the tournament is being held may have an impact on prescribing habits. The 2000 FIFA Futsal World Cup was held in Guatemala, and a higher use of antimicrobial agents was observed in this tournament. Three teams had all their players receiving antimalarial drugs. Notably, such action underscores the importance of the team doctor as a steward of the overall health of the players.
A high usage of nutritional supplements by futsal players was observed in this study. Nutritional supplements were prescribed to 51.9% of players, and 27 teams had all their players receiving nutritional supplements every match of the competition. The safety, suitability, and efficacy of nutritional supplements, as well as changes in the athletes’ habitual diets, should be fully evaluated by physicians and health care providers [
One of the main limitations of this survey is its retrospective design. Albeit being retrospective, as the forms used in this research are the same used for doping controls, they are very detailed and team physicians complete them thoroughly. Another limitation is that most of the forms analyzed in this study do not contain indications for the drug prescriptions, nor their dosage. It is mandatory in future research to evaluate team physicians’ prescription indications, dosages, and the medication application routes on FIFA Form
The prescription of medications, particularly NSAIDs, to futsal players engaged in the World Cup is high. The futsal prescription rate was similar to rates found in football players and in other sports.
The authors declare that there is no conflict of interests regarding the publication of this paper.
The authors gratefully acknowledge FIFA (Fédération Internationale de Football Association) for funding this study. The authors highly appreciate the cooperation of all team physicians who provided data for this project.