What is “boosting” in athletes with high-level spinal cord injury?

Many of us enjoyed the 2012 London Paralympics. The spots also drew attention to “boosting.” The practice of boosting is when an individual with a high spinal cord injury (T6 and above), intentionally elicits autonomic dysreflexia in order to enhance their athletic performance. AD is an acute hypertensive syndrome due to noxious stimuli to the central nervous system, which results in reflex dysregulation due to the spinal cord injury.

How can someone intentionally cause autonomic dysreflexia? By not emptying the bowel or bladder, or intentionally causing intense skin pressure somewhere in the wheelchair seating system. The physiological advantage of inducing hypertension during athletic competition is that there can be an increase in cardiac output. The increase in cardiac output can compensate for the limited physiologic potential for improvements in cardiac output (therefore, oxygen uptake) in athletes with a higher level spinal cord injury.

Although the practice of boosting can lead to significant improvements in performance, especially in endurance sports, it can be very dangerous. An acute hypertensive syndrome will elevate the blood pressure to very high levels and can cause a stroke. Boosting was deemed a prohibited method by the International Paralympic Committee in 1994, but this was later changed to being classed as a health risk and prohibits athletes from competing in a dysreflexia state whether intentional or not.

There is a need for educational programs directed toward enhancing the autonomic dysreflexia knowledge of rehabilitation professionals, coaches and trainers working with individuals with spinal cord injury.

Reference: Boosting in athletes with high-level spinal cord injury: knowledge, incidence and attitudes of athletes in Paralympic sport. (Disability and rehabilitation, 2010; 32(26): 2172-2190, Y. Bhambhani, et. al)

Dr. Wolfe is a physiatrist who is licensed to practice medicine and surgery in Minnesota. She is a Board Certified Independent Medical Examiner (disability medicine expert). daynawolfemd@yahoo.com