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Infographic. Doping without drugs: how para-athletes may self-harm to boost performance
  1. Cameron M Gee1,2,
  2. Tom E Nightingale1,3,4,
  3. Christopher R West1,5,6,
  4. Andrei V Krassioukov1,3,7
  1. 1 International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
  2. 2 School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
  3. 3 Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  5. 5 Canadian Sport Institute - Pacific, Victoria, British Columbia, Canada
  6. 6 Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7 GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
  1. Correspondence to Professor Andrei V Krassioukov, ICORD, UBC, Vancouver, BC V5Z 1M9, Canada; krassioukov{at}

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This infographic provides a summary of the use of boosting by athletes with spinal cord injury (SCI); its causes, warning signs and dangers, and the current approach of the International Paralympic Committee (IPC) to testing.

Boosting is the intentional induction of autonomic dysreflexia (AD) to enhance performance. AD is a potentially life-threatening condition experienced by many individuals with a SCI, typically at or above the T6 spinal level. It is characterised by a sudden increase in systolic blood pressure (SBP) >20 mm Hg above baseline due to a noxious or non-noxious stimuli below the level of injury, that excites sympathetic preganglionic neurons resulting in vasoconstriction of blood vessels in the lower extremities and trunk.1 Triggers include, but are not limited to, bladder distension, injury or an innocuous stimulus (eg, a …

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