Walking the line? An investigation into elite athletes’ sport-related use of painkillers and their willingness to use analgesics to train or compete when injured

Pain and injuries are inevitable occupational hazards and health risks in athletes’ working lives. The sport-related use of analgesics with and without injury is widespread. Taking analgesics to compete while injured is conceptualised as a sickness presenteeism problem. This study examines the complexity of the sport-related use of analgesics in elite sport. A mixed-method design was adopted consisting of a survey (n=775) and interviews (n=21) with elite athletes. Many athletes reported a sport-related use of analgesics. Analgesics had commonly been used to enable an injured athlete to: compete in an important match; train during an important period; qualify for an important match/final; and keep one’s position on the team or have one’s contract prolonged. In particular, team-sport athletes had experience of such use. Apart from the therapeutic use of analgesics, they were sometimes integrated into different routines: for example, enhancing performance, avoid lowering performance, aiding recovery, training/competing injured and prophylactic use. Simultaneously, many had refrained from using or sought to minimise their sport-related use of analgesics; reasons were related to: trust in/feeling the body, side-effects, knowledge and social norms. Social norms and interaction with support personnel played a key role. Physiotherapists and doctors often advised athletes on analgesics, but self-administered use was widespread. How risk cultures manifested themselves varied greatly between sports, and gender differences were scarce. Although ‘absenteeism’ is also present, a majority of athletes would be willing to ‘walk the line’, using analgesics to compete when injuries may threaten their career or sporting success.