When Canadian para-athlete Martin Larocque wheeled onto the track for the 100-metre final at the 1992 Paralympic Games in Barcelona, Spain, he felt invincible.
In the warm-up area, the then-25-year-old from Embrun, Ont., drank a gallon of water and positioned his bent knees tightly against his chest in the racing chair. Before being ushered to the start line, he reached down and pushed hard on his gut to compress his ready-to-burst bladder.
Moments later, he felt a familiar rush. The hairs stood up on the back of his neck, his pupils dilated and he started to sweat. He felt alert and ready, awaiting the bang of the start gun.
Larocque was “boosting” — a potentially life-threatening form of self-harm used by athletes with spinal cord injuries to enhance performance.
Now retired, Larocque is confident that boosting remains a common practice among para-athletes, including some of the approximately 500 injured and ill servicemen and women competing at the Invictus Games in Sydney, Australia from Oct. 20 to 27.
In 2010, a team of researchers led by Dr. Yagesh Bhambani at the University of Alberta published an anonymous survey of athletes with the ability to boost. Nearly 17 per cent admitted to boosting.
Described as “doping without drugs,” it only works in people with spinal cord injuries at or above the sixth thoracic vertebra, located just under the shoulder blades. These athletes have a blunted response to exercise, meaning they are unable to increase heart rate and blood pressure in line with the demands of sport. To beat it, they can use various forms of self-harm to trigger a “fight or flight” response.
Larocque chose to compress his full bladder, but he says he has competed with athletes who sat on thumbtacks or fastened a tight strap over an open wound to get the same effect.
“It does help. It does enhance your performance,” Larocque said.
In 1994, he participated in a study led by Dr. Robert Burnham at the University of Alberta that found elite wheelchair athletes who boost experience a 9.7 per cent improvement in race time.
When an athlete boosts, signals from pain travel up the spinal cord and induce autonomic dysreflexia, a condition that increases heart rate and elevates blood pressure to dangerously high levels. But the spinal injury prevents pain signals from registering in the brain, so the athlete can’t feel it. If the cause of pain is not removed and their blood pressure remains elevated, the potential for seizure, stroke, or heart attack can be fatal. The trade-off: power and speed.
There are no published reports of severe health complications from boosting in competition, but clinical evidence reviewed by researchers at the University of British Columbia in 2013 showed that autonomic dysreflexia can result in death.
The International Paralympic Committee has banned athletes from competing in a dysreflexic state, intentional or not, since 1994. The organization’s medical and scientific director, Dr. Peter Van de Vliet, says the policy is aimed at protecting the health of athletes, and competitors would only be sanctioned for anti-doping violations if intent were demonstrated.
However, the question of personal agency complicates the rules around boosting, and some wonder whether a natural bodily response should be regulated at all.
The World Anti-Doping Association does not recognize boosting as a prohibited method and is “satisfied with the way boosting is controlled under the IPC medical rules,” according to spokesperson James Fitzgerald.
To date, no sanctions have been laid, yet athletes contend that boosting is still an issue. Brett Babcock, a Paralympic-hopeful who trains in Ottawa, Ont., said he saw a competitor fill his spandex shorts with ice to boost before a race in 2015.
“It’s this huge throbbing in your head,” Babcock said. “It honestly feels like your head is going to explode.”
He doesn’t boost because he knows the health risks, but he experienced an involuntary dysreflexic state while competing at the 2016 and 2017 national track and field championships in Ottawa, Ont. While waiting to race in the summer sun, the heat was enough to cause a pain response that triggered the condition.
Although Babcock isn’t willing to break the rules, not all athletes see boosting as cheating.
“It’s what your body does as a quad(riplegic) … I don’t agree that it’s doping at all,” Larocque said.
Doping or not, the potential for harm is real — and with glory on the line at the Invictus Games, some competitors may think boosting is worth the risk. And if they do, it’s hard to detect the difference between an induced physiological response and an accidental one.
Veronica Allan holds a PhD in kinesiology and conducts research in sports psychology. She is a fellow in global journalism at the Munk School of Global Affairs at the University of Toronto.