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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. 1International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
  2. 2School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada
  3. 3Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
  5. 5Canadian Sport Institute - Pacific, Victoria, British Columbia, Canada
  6. 6Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
  7. 7GF 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 tight …

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  • Twitter @CameronMGee, @Tnightingale10, @DrCRWest

  • CMG and TEN contributed equally.

  • Contributors We confirm that ICMJE recommendations pertaining to authorship credit were followed; substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data, and drafting the work or revising it critically for important intellectual content. Final approval of the version submitted/published has been agreed by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AK has previously consultant for the IPC.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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