Boosting: Risking lives to stroke egos

The practice of self-induced Autonomic Dysreflexia or Boosting is illegal, but also extremely dangerous. GEORGE LOUW investigates

Since the beginning of time there have been those who put their lives on the line. Some do it for a cause; like soldiers. When the cause is good, we call them heroes. When it is preceived to be bad, they are called villains…

Some do it for the sheer exhilarating joy of the rush; mountaineering, extreme sport and rowing across the Atlantic, to name but a few.

But then, there are those who place their lives on the line to stroke their egos. The driving need is to outperform, to win at all costs. It sucks the joy out of the action and they become slaves to their egos. These ego-driven fanatics often become dopers, using forbidden performance-enhancing chemicals to push their bodies beyond its natural limits.

In the spinal cord injury (SCI) community, ego has found another source of “extra energy”; self- induced Autonomic Dysreflexia. This has become popularised under the term “Boosting”.

With the upcoming Paralympics, boosting is possibly on the minds of many athletes; to be selected for the team as well as to excel in their events. Even though it is illegal and, if found out, they face expulsion, there are still those who will push their luck and put their lives on the line; boosting for the glory of winning. The enjoyment of the Games is sacrificed for the sake of their egos…

So, let’s first explore the Autonomic Nervous System (ANS) and Autonomic Dysreflexia (AD). The Somatic Nervous System links the muscles to the brain, allowing the muscles and the brain to talk to one another. It facilitates power, coordination and voluntary movement. It gets us going.

The ANS on the other hand manages the body’s support systems. It regulates the input of energy according to the immediate needs of the body – more energy in times of action and less in times of rest. It regulates the body temperature according to need – it dissipates heat when the body is using a lot of energy and it retains body heat when it is cold outside.

It regulates blood pressure and the flow of blood through the body. It also regulates the digestion of food and the disposal of waste through the kidneys and the bowel.

In an SCI, the vertebral level of the injury and the extent of the injury to the ANS will have varying impacts on the function of the kidneys, the bowels and temperature regulation. But injuries above the sixth thoracic vertebra can also lead to Autonomic Dysreflexia (AD) – an abnormal overreaction of the ANS to painful or uncomfortable stimuli below the level of the lesion.

AD “scrambles” blood pressure and heart rate regulation (and also temperature regulation). This can present as excessively high, fluctuating blood pressures, pounding headaches, excessive sweating and other symptoms that relate to the ANS.

So, in a nutshell, the damaged ANS reacts to uncomfortable or unpleasant stimuli in a haphazard and disorganised manner. A broken response by a broken system. The danger is that, over and above feeling very sick and uncomfortable, it can also lead to strokes and sudden death. Imagine going from an active, sport-loving, highly competitive Paralympic athlete to becoming an SCI with a stroke…

So, now that we have covered the ANS and AD, let’s explore the concept and practice of Boosting. It is the intentional induction of AD to enhance performance. The result is a dramatic increase in blood pressure just before a competitive event. The background to Boosting is that athletes with SCIs above T6 cannot regulate their blood pressure and heart rates in the same way as other athletes. Consequently, a wheelchair athlete’s heart rate and blood pressure does not respond according to the demands that the competition places on the athlete. It stays low.

This compromises the increase in oxygen uptake that is so necessary in sport. Performance is therefore lower and endurance reduced.

Boosting bumps up the blood pressure, improves blood flow to working muscles and, in so doing, improves oxygen supply to the muscles. So, more energy, better performance and greater endurance.

But, as with life, it is not that simple. The ANS is damaged and messing with damaged systems, more often than not, has serious consequences.

Autonomic Dysreflexia is not a stable, consistent increase in blood pressure and heart rate. It fluctuates. This is where the danger lies. If the athlete’s blood pressure spikes significantly during a moment of intense strain, it can cause an artery in the brain to pop.

As with a balloon that bursts, it only needs a fraction of a second for an artery to pop. That fraction of a second can change your life for ever…


“Even though it is illegal, there are still those who will push their luck.”


But let’s step away from the scary talk and have a look at what these boosters actually do to induce AD. In their minds, it is really quite simple: AD is a response to a painful or uncomfortable situation. So, cause pain or discomfort and Bob’s your Uncle! Increased energy! The logic is mind boggling. Here are some examples of what they do:

  • They clamp urinary catheters to produce bladder distension. Imagine taking a tumble with your chair and rupturing an overfull bladder.
  • Excessive tightening of leg straps. Non- functioning bones have a tendency to become osteoporotic. So, again imagine taking a tumble and breaking a leg.
  • Sitting on your own testicles – obviously a male thing.
  • Breaking a big toe. This defies comment.

All of the above methods are somewhat crazy, but a thought to hold onto is: “If boosting is not controlled, someone will die.”

Life is there to be enjoyed and to add value and joy to the lives of others. There lies true fulfilment. Life is not about proving a point. That is ego-talk and it saps the joy out of life. Boosting, as with doping, turns us into criminals.

We start lying, we distrust, we become defensive and we become paranoid. The goals that we strive for become our slave masters. Is it worth it? Is the prize worth the deceit? Is it a life worth living?

So, to the Paralympic athletes: Go to the Olympic Games as you are. Compete according to your natural abilities. Make new friends as you go along. If you do happen to win gold, you will have the satisfaction of knowing that you achieved it honestly and with integrity.

Ida’s Corner is a regular column by George Louw, who qualified as a medical doctor, but, due to a progressing spastic paralysis, chose a career in health administration. The column is named after Ida Hlongwa, who worked as caregiver for Ari Seirlis for 20 years. Her charm, smile, commitment, quality care and sacrifice set the bar incredibly high for the caregiving fraternity. email:



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