Up to one-third of all professional soccer players use NSAIDs prior to every match, regardless of whether they took the field or not, a review finds. 

Overall 54.5% of male players, 51% of female players and 43% of adolescent players participating in the last four FIFA World Cups used an NSAID at least once during the tournament.

On average, more than seven male and female players per national team were using NSAIDs prior to every match, as were 4.5 players in U-17 and U-20 tournaments found the review.

The gout medication allopurinol — thought to prevent skeletal and cardiac muscle damage — was also prescribed to 40% of players from one country during the 2002 tournament.

Writing in the British Journal of Sports Medicine the researchers from the FIFA Medical Assessment and Research Centre (FMARC) said that despite an initiative to reduce NSAID use prior to the 2010 FIFA World Cup the reported intake remained unchanged in subsequent tournaments.

“The reported incidence is alarming, and moreover is most probably underestimated, since self-medication by the players or treatment already prescribed by club physicians is not included in the published reports,” they wrote.

According to the authors the review poses several salient questions:

What is the indication for which one-third of players use NSAIDs prior to every match?;

Is the high prescription practice due to a high number of non-time loss, chronic and overuse injuries?;

Are painkilling medications used routinely by the players to overcome fatigue and muscle soreness due to physical overload, or even improve recovery?

“Or has it simply become ‘part of the game’ for players and team physicians?” they asked.