Tour de France day 2.
  • Ross

    If there is no negaitive side effect for this “treatment” then there is no need to ban it. Otherwise anything else that is deemed even slightly performance enhancing such as Coke or coffee or vitamin pills should be banned as well.

    • jules

      WADA has 3 criteria:
      1. performance enhancing
      2. harmful to health
      3. against spirit of sport

      2 of 3 must be met for a substance/method to be banned. so it doesn’t strictly have to be harmful – if it promotes treatments that are judged to be against the spirit of the sport then that may lead to a ban. but it has to be performance enhancing in that case.

      • JBS

        Surely, criteria 1 is junk. 99% of what a pro athlete does meets that criteria; taken to the extreme, drinking water is performance enhancing; eating food is performance enhancing. Massage for recovery is performance enhancing and from what I’ve read here in simplistic terms we’re discussing massage via ultrasonic stimulation.

        IMO criterion 2 is the only one that is valid. 3 is too nebulous to be governed by WADA, it should be governed by the individual sports and not under doping rules, but under the rules of the sport in general. If the UCI decides that ultrasonic therapy is against the spirit of cycling then ban it under the rules of cycling, just like sticking a motor in your bike is banned because it against the spirit of the sport. But don’t try and shoehorn it into the WADA code. Having a motor a your bike isn’t against the spirit of moto gp.

        If the procedure is harmful to an athlete’s health ban it under the WADA code, but if not I say let any athlete wanting to try it, go for your life. Otherwise WADA may as well ban massage and sleep because they aid recovery too.

        • jules

          smoking is harmful to health. WADA have no business banning it, that’s why #1 is in there. it’s got to have a sporting/performance association.

          the problem with the UCI banning something separate to WADA is that it doesn’t fall under WADA testing not conducted by the UCI itself. e.g. out-of-competition testing by ASADA or equivalent national body. so it’s immediately compromised in its effectiveness.

          • JBS

            Can I argue that maybe WADA should ban smoking? They do ban a whole bunch drugs that have no evidence to show they’re performance enhancing.

            I can see your point, but from where I’m coming from I think the whole emphasis of WADA seems to be wrong. Something shouldn’t be banned because its “performance enhancing” which is where all the emphasis seems to be. Enhancing performance is the whole point of sport in the first place. Something should be banned because you risk serious health issues by doing it.

            • jules

              the problem with that is that they are anti-doping, which is narrower than anti-vice. if you ban smoking – where does it end? they have enough on their plate with what they are doing, which I suspect is growing out of control anyway.

              their mission is to stop athletes using drugs to compete in sport. if someone wants to smoke, then it doesn’t have a connection to sport, even if they happen to be an athlete.

              • JBS

                Sorry I was mainly joking on the first paragraph.

                But, thinking about it seriously, why is cannabis banned? (it is I just checked the list). Pain relief? Nicotine has a pain relieving effect as well…its a very slippery slope and it reinforces my point about using performance enhancing as a criteria. At the right dose pretty much anything is performance enhancing. At the wrong dose everything is toxic. We should worry a lot more about the latter and not sweat the former so much.

                • jules

                  I don’t know why cannabis was banned and laughed pretty hard when they took that gold medal off the Canuck for smoking it and winning the snowboarding at the Olympics. I agree with you.

                • Sean Doyle

                  Cannibis is banned because of it’s calming affect and the possibility of an athlete taking to great a risk in competition. ie. say in DH racing trying to clear a gap that just isn’t really doable. etc. etc.

      • Liam O’Dea

        Jules, That’s what I thought but am getting old and forgetful these days. So I went searching for this on the WADA website and could find no information on what process is used to make these kinds of decisions. Do you have a source? Or remember where you got your info from?

        • jules

          it’s in the WADA code

      • Craig

        I can understand why some “confusion” may exist among athletes. We know that altitude training is performance enhancing, and so (in a way) is physiotherapy. In fact, all training programs are aimed at enhancing performance. In addition, some (e.g. injured) athletes may be thinking, “This is not enhancing my performance . . . it’s just bringing it back to my ‘normal’ level.”
        There could also be an argument raised in some cases as to whether a particular drug (or process) is in fact harmful to the health of the athlete in question. For some methods of “doping”, there may be few (if any) actual cases of human ill-effects to be found in the literature.
        As for “the spirit of the sport” . . . I guess we all know what that is, but . . . do we all have the same definition of what is acceptable, or what constitutes “against the spirit”? My guess would be that the definition varies from athlete to athlete, and that the lack of a clearly-worded meaning will again lead to blurry boundary-lines for some.
        I recognise that it’s a difficult process (for WADA, UCI, etc) to keep up with all of the technical developments and advancements in doping, and I don’t have an answer to the problem of how to make their position more clear (and less open to interpretation) to athletes.

        • jules

          it’s not blurry for athletes – they don’t need to interpret the criteria. the criteria are used by WADA to proscribe substances and methods – which are allowed and not. the athletes merely have to consult the WADA list.

          so ‘spirit of sport’ is nebulous but that’s irrelevant – just don’t take anything on the list. this is where apologists for Essendon FC went off track, trying to argue that the TB4 they took wasn’t really dangerous, etc. it doesn’t matter – it was on the list. no argument.

          • JBS

            I’m not trying to pick a fight with you Jules (serious), but..

            The Essendon argument is that they didn’t take TB4, but they took a non-banned close relative.

            (cards on the table I’m a EFC member who is disgusted by the stupidity of all involved).

            • jules

              I get that, you’re right. But there was a separate argument made along the lines I gave – by fans mostly, not their legal defence. there is a lot of confusion and ignorance about how the WADA code works and people like to make it up as they go.

              • JBS

                I agree with your general point. Its not for athletes to interpret the criteria. It it’s on the banned list, then those are the rules they have to play under, whether they agree with them or not. The argument is what should be on the banned list and that’s a higher level discussion.

          • Craig

            I agree completely. (And you’re doing a marvelous job of debating the issues here!) If it’s on the list, it’s pretty black-and-white. I guess what I’m thinking is that, for those performance-enhancing methods that are not (yet) on the list, or that merely resemble something that is on the list, or that side-step the letter-of-the-law, young or impressionable athletes may find the ambiguity to be an open door (to a slippery slope). E.G “It’s not on the banned list (yet), it will probably help your performance, there’s no evidence (yet) that it will be harmful, and . . . it’s not against the spirit of the sport, because everybody’s doing something to make themselves perform better (aren’t they?), and if it’s not banned, then it’s fair!”

            I’m thinking that it’s not going to be a new generation of athletes (and “doctors”) with new ways to beat testing for old drugs and methods . . . but rather a new generation that simply views new (and not-yet-banned) methods of performance enhancement as “fair game” until officially deemed otherwise . . . and then we simply search for the next best thing around the next corner. Seems this is kind of what’s already happening. The root cause is perhaps not “What methods are available”, but rather, “I will ALWAYS be on the lookout for a new method of gaining an advantage.”

            • jules

              I think that’s the problem too. There is so much money and fame involved with elite sport, that athletes and their crew will inevitably spend more money and time crawling down rabbit holes looking for new and strange doping methods. We saw that with meldonium where WADA was watching it and then acted when it became evident that athletes were abusing it in significant numbers. When I hear athletes say “I’m clean, my results will stand” I suspect that means “They’ll never retrospectively ban what I’m taking/doing, so I’m safe as long as I stop taking it as soon as it’s eventually banned*”

              * Note to self – don’t use any blood bags from before the substance was banned and suffer a ghost positive. Not that that ever happens, eh Maria?

            • Sports-Medicine-Law

              Thanks for those wonderful comments Craig.

              Whilst no athlete has yet come out in public declaring its use, and the cited paper was only informed as a hypothesis, the concept has very strong theoretical underpinnings. There are also many published clinical studies on related concepts.

              It may also be useful to note that a similar situation occurred with another article we previously published ( Two years after that, WADA declared multiple anti-doping rule violation convictions.

          • Sports-Medicine-Law

            Hi Jules,

            Just a point of fact: TB4 was not actually specifically named on the WADA list; Nor were the other alleged “non-banned relative” etc. This point seems to be confused in the popular media.

            ASADA (and later WADA) determined after-the-fact that TB4 “fit” the “catch-all” criteria of one section of the WADA list. The determination was made neither in consideration of the health, the performance-enhancing effect, nor the spirit of sport.

            If we draw the same conclusion of how substances will “fit” the “catch-all”, then many substances (including natural foods common in various cultural diets around the world) would be included. In the Kittel’s case, for example, CAS made the point that eating blood pudding (apparently a German delicacy) would be considered banned and fit the idea of the “catch all” of the list. For another more local example, quinine in your gin-and-tonic could also be considered banned. For more on this:

            The point I am making is: for athletes who are neither pharmacologically, medically or legally trained, they cannot simply read the packaging of something and compare it to the WADA list to determined whether something is banned or not. For that matter, neither can doctors! The substance could still fit the “catch all” based on its chemical structure or its (theoretical) biological function even if it is not specifically named as a banned substance and is often a twin medical and legal interpretation of the rules. TB-4 was such a case. See for further discussion:

            And in case you are wondering, calling the national anti-doping organisation (ASADA for Australia) may not be useful either for the athlete as the personnel providing the information would not know how the “catch all” will be legally interpreted; this is even assuming s/he knows the substance the athlete is calling about. The confusion surrounding AOD9604 is an example in point. See

            To add further mischief into the mix, a substance listed by one name on the list may be named differently on the packet of a over-the-counter supplement from the supermarket. DMAA, for example, is known by at least 31 different names. Only one of those was specifically named in the supplement which resulted in the anti-doping rule violation in USADA v Flavia Oliveria, CAS 2010/A/2107. You can read more on this issue here: (see chapter 11).

            Hope that was useful.

            • jules

              thanks, that’s really good. I acknowledge TB4 wasn’t explicitly listed. it comes under a classification – based on its properties as a growth factor. as this was the very reason Dank had selected it, I would be very hesitant to accept any argument that it ‘slipped through the cracks’. Dank is an expert and 5 minutes of research shows me that it is obviously banned.


              it’s not the same as eating blood pudding or buying a sports supplement for consumption. the TB4 was injected into the players. for WADA-sanctioned athletes, this is a step that shouldn’t be taken other than under strict medical supervision and with careful consideration of the substance’s status and any necessary TUEs. the only one of those I’d say Essendon (or at least Dank) had was carefuly consideration of TB4’s status – and it is plainly banned.

              in summary, in no way was Dank caught out by an opaque system. he knew what he was doing and Essendon – by extension – are guilty.

              • Sports-Medicine-Law

                Thanks for citing my article in The Conversation :) Bear in mind though, that my article was written after the initial reports of the possible substances that might have allegedly been used– perhaps 12-18 months prior. Before then, most of the information was in very technical scientific reports.

                You will have no arguments from me that an injection regime should be done by someone qualified to do so (i.e. a registered medical practitioner). This would apply whether in the AIS or AFL. Unfortunately for the athletes in Essendon, I think few would have known (or thought to question the authority) that the person entrusted wasn’t. Unfortunately for athletes, whether in AIS or AFL, they are still held liable under a strict liability rule. So who can athletes trust? No one apparently.

                I will refrain from providing a view on whether there was a malicious intention by the cast of characters to break the rules. I will note however that every athlete and organisation (including the AIS: ) is constantly seeking ways of improving sporting performance. I think that is the true nature and spirit of sport: pushing the human limits. Citius altius fortius. That is also why we as humans have sought to climb the highest mountains and dive the deepest seas.

                The issue as I see it is ensuring that ALL the rules are clear and known. If the limits of imprecise rules are unknown, unclear or inconsistent, it would be unfair to penalise the athletes for any perceived infringement. Having “catch alls” is not consistent with a fairness ethos. For example, if there is a strict liability penalty for speeding and there are no road signs or speed criteria to tell you what that limit is, a driver would be dependent on the subjective whim of the police in determining what is speeding and what is not. That is not the rule of law:

                Just my humble opinion.

                • jules

                  I must disagree. the intent of the WADA code, in its complex form, can be reduced to – preventing precisely the sort of shenanigans that the Essendon FC engaged in. you can argue that the rules were subjective or opaque, but I’d argue that’s not the case if you stay away from needles. I don’t accept that athletes will ‘go there’ because ‘they just will’ – you can play elite football without needles and dubious compounds. but if you choose to push the limits – you’d better be damn sure you’re on the correct side of those limits. I don’t accept that the rules are to blame. using the speed limit analogy, it’s like knowing that under 60 km/h is always legal, but up to 65 legal in some, ambiguous circumstances. you can’t just do 65 and argue it’s all unclear.

                  • Sports-Medicine-Law

                    This is an interesting debate.

                    Firstly, under the WADA rules on prohibited substances it is immaterial if the banned substance is ingested, injected, nasally sprayed, rectally inserted, given via eye drops or applied on the skin. It is the substance that is banned not the mode of administration. There is a separate section on banned methods which deals with the mode of delivery, but is not relevant for present discourse.

                    So on the issue of needle injections, whilst tacitly dubious and not a good look, it has no bearing on the WADA assessment of rules violations on banned substances.

                    Secondly, if TB4 fitted the catch-all rules (and as my article in The Conversation has shown, I have no objection to such a view), then why is Actovegin and PRP injections not?

                    In regards to the analogy on driving, bear it mind it is just an analogy to illustrate a point and not a perfect description of a given circumstance. What I was trying to show (poorly it seems) was in a world where there was no concept of a speed limit (in law) that is precisely defined. Since the concept of speed is relative and when no objective numeral is defined, then one cannot know that under 60km/hr is always legal. 50km/hr may seem fast for a granny in a beat-up ute, and 80 km/hr slow for a teenager in a Ferrari.

                    • Rodrigo Diaz

                      I am not 100% sure on this. There were some cases where some substances where allowed in some conditions and not in others. If I remember correctly Mosquera alleged that hydroxyethyl starch was only banned for intravenous use, not for intramuscular or oral use.

                    • Sports-Medicine-Law

                      I think you may have been referring to the Prohibited Method alluded to in my other response post. In such instances, the substance itself is not banned. But if given in an intravenous form over a specified volume over a specified period of time, it is banned as a method.

                      Take for example paracetamol (or also known by the brand name as Panadol in Australia; or acetaminophen in the US). It is not banned if taken orally or given as a per rectal suppository. But if given intravenously at a volume of more than 50 mL over a 6 hour period than that is a violation of the anti-doping rules.

                    • Rodrigo Diaz

                      Weren’t some steroids subject to a similar rule? Specifically some anti-asthmatic compounds found in inhalers. Maybe clenbuterol? Although now very seldom used in inhalers, at least where I live.

                    • Sports-Medicine-Law

                      No. Steroids are banned under the “substance” rules and not the “methods” rule.

                      Yes, some substances found in anti-asthmatic drugs remain banned.

                      Most asthmatic drugs were previously banned only if the levels were above a particular threshold when tested: this “threshold rule” was subsequently abolished when the scientific community conclusively showed that athletes using normal therapeutic dose to treat a medical condition could inadvertently fall foul of the rule. This is due to how each individual metabolises the medication much slower than others. Having such a rule puts athletes’ health at risk because they would rather risk dying from asthma than be treated.

          • Aaron Heaysman

            TB4 wasn’t on the list when Essendon used it, it made the list a year later, the ban the players are currently facing is because WADA or Essendon can’t identify the other substance administered. Also the reason a court found them not guilty because there is no evidence to support that a banned substance was taken. While the court needs evidence WADA can accept that there was negligence in not knowing. At least that is my understanding

            • jules

              TB4 is definitely banned as a type of growth factor. as mentioned below by S-M-L, it comes under that category of banned substance. the players are banned for taking TB4 – they were deemed by the CAS to have taken that specific substance. the court the case was heard in last was the CAS – they were found guilty on the basis of evidence. it’s untrue to say there was ‘no evidence’ – there’s a whole report full of it. the question is over its strength. the CAS found the evidence of sufficient strength to convict. people who insist there was ‘no evidence’ are talking rubbish.

              • Aaron Heaysman

                I know TB4 is banned now but if my memory is correct the AFL released a statement that siad they were advised by ASADA that it wasn’t at the time.
                And my mistake saying ‘no evidence’. But again I believe the initial court (not CAS) ruled that there wasn’t ‘enough evidence’ to support a conviction. Hence the reason WADA stepped in and took it to CAS.

                • jules

                  that was AOD 9604. yes, the AFL Tribunal did rule that and cleared it.. I mean Essendon’s players. have you ever wondered why the CAS exists?

        • xuxumatu

          the problem here is money it would produce an unfair state for poor countries

      • Ross

        What about altitude training or tents that simulate altitude, surely they are perfomance enhancing and have known negative side effects (refer recent CT article about Cannondale’s altitude training camp).

        • Sean Doyle

          They are banned in Italy. Not sure if else where.

      • David9482

        This definitely meets both criteria 1 and 3.

        Some people are arguing that criteria 3 cannot be adequately measured, applied, etc. But one test for criteria 3 is “can an amateur athlete acquire this product, use the method, etc.” OR “can all athletes in the peleton/group/etc. acquire and use this product”. And absolutely, no amateur can afford these treatments. Further, the poorer pro cyclists cannot afford this treatment, therefore it fails this test.

  • 900Aero

    PFP is usually made from the recipients own blood – its autologous. If its from a donor’s blood (allogenic) then its a transplant – which is much less common. With respect to the authors and while this piece is a reasonable start, an exploration of the topic may benefit from input by a haematologist or similar specialist. There are some big jumps and assumptions here.

    • Off topic, but I had to chuckle at your mention of PFP (Pauline Ferrand-Prevot?). I wrote those initials so many times in drafting the piece.

      • 900Aero

        Oh crap, meant to write PRP but was at work (where we have so many acronyms there is even an internal Wiki to track them all) and PFP is something else (not the French world champ) that was on my mind….Well spotted – and funny that you wrote the same thing in error for a completely different reason.

  • Lyndon

    Not usually one to comment but felt compelled to say this discussion is great, reading comments such as these really is such a fantastic addition to Cycling Tips. Well done Gents.

    • Thanks Lyndon. We’re fortunate to have such an intelligent and engaged community here in the comments and we don’t take that for granted.

  • HakuinEkaku

    How does WADA regard the administration of other drugs, etc. by sonophoresis?

    • Sports-Medicine-Law

      There is no specific view on this matter as far as I am aware.

  • JasonM

    There are some massive jumps in logic here. There is nothing to show that this can work yet. The direct injection of PRP into a joint or tendon still has not been accepted as a proven method. To start calling for a idea, because that is all it is, that is even less concentrated to be a concern is woeful.

    Did anyone actually read the so called “study”?

    “Transdermal bFGF delivery using low-frequency sonophoresis: An innovative potential therapy for osteoradionecrosis of jaws”

    It is only a hypotheses and its proposed to be applied to the jaw which is very close to the skin. This is the kinda crap you see on FB claiming the new proven wonder food and should never of got past the ideas list. Really CT??????

    • SLH

      I agree. The study is rubbish. The concept of PRP is that it induces an inflammatory response is an area which has a paucity of vasculature, thereby inducing a healing response. The biological plausibility of its application to recovery and performance enhancement is flawed. However, as had been alluded to above, the broader issue is that athletes seeking marginal gains are prone to unregulated self experimentation if it means performance gains. It has no longer become about doing what is legal, its about not doing what is explicitly illegal. How WADA stays ahead of this curve to protect athletes (largely from themselves) from embarking on unproven therapies with unknown side effects and long term consequences is the challenge for governing bodies in modern sport.

      • Melissa Clarke

        Spot on. The studies on PRP and autologous blood injections for musculo-skeletal injuries show no statistically significant improvement on recovery over control groups (well, at least not in the cases for plantar fasciitis that I read before getting an ABI regardless out of desperation). But trends in drug use/treatments is something that WADA, international federations and NSO’s need to be constantly monitoring and evaluating.

    • Rodrigo Diaz

      Still problematic for athlete doping issues. See the doping cases with non-human approved substances such as GW1516 and AICAR cited in one of the links. Some people will take anything they believe will give them an edge – 20 bananas a day, bull’s blood, rat poison…

    • David9482

      Hey, some athletes already use similar techniques, such as Kobe Bryant and Alex Rodriguez. They visited a clinic in Germany during the offseason to get plasma treatments.

  • Larry @CycleItalia

    Interesting stuff, thanks for sharing this. Meanwhile, wasn’t the decision on the Puerto blood bags supposed to be made by now? Just wondering.

  • PRP is very much on the fringe when it comes to clinical effectiveness, cyclists and trainers swear by it, read placebo. I suppose it’s all about the 1%ers and when it comes to improving recovery , most cyclist would consider anything that appears safe and condoned by WADA

  • Berne Shaw

    This is a clear attempt by pseudo scientific medical people to make athletes think this method works and start paying them under the table to get these so called unproven treatments. Hello Dr Ferari mentality that this is all perfect fully acceptable by obscuring the facts and making it all look therapeutic and ethical. It’s another example of how the sprirt of sport is destroyed by exploitive greedy people

  • disqus_U85waxYyKN

    I Am Not A Prp Or Prf Expert and have never actually used it.I Have Read several papers on it and investigated purchasing a prf PFP centrifuge etc For Bone And Soft Tissue Grafting In The Oral And Peri Oral Tissues. Getting Prp Or Any Material To Pass Through Oral Mucosa To Bone Will Be Many Many Times More Efficient Than Through Skins Keratinized Layers . The Energy Used To Push The Material Through The Tissue Would Need To Be Very Well Controlled, So Not To Damage The Tissue. Prp encourages Healing Molecules to join from The Blood Supply, Many Times Greater Than What Is In The Pfp Itself.
    I think its use for recovery of muscle is a bit far fetched and would either have a placebo effect or be damaging or just a waste of your blood ,which is probable better inside you than out. PS sorry about the capitulation.

    • pedr09

      I fully accept that you capitulated. Now just stop that cat from stepping on your caps lock key and we’re all good. |x| I am not a robot.

  • NedHed

    I’ve had PRP three times in order to treat stubborn long term injuries. It is extremely painful and for it to stand a chance to work effectively you need to wait 4-6 weeks during which time activity is curtailed, significantly in some places. This substance causes immediate swelling and inflammation and anti-inflammatories cannot be taken to alleviate that swelling and pain. Does this sound like something that would fit with a riders training/race plan for the year ? PRP creams – I don’t buy that just yet – the healing effect would be much reduced. PRP has been used in athletics and American Handball (football) for years. There is no performance enhancing story here – but there might be a good injury recovery story there – but not all people get the same results or benefit, even with the same injury.

  • Deryck Walker

    I had hoped this was an april fools post.


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