The muscle relaxants have adverse effects that the athletic trainer should be aware of when talking with the athlete taking these drugs. The main adverse effect is drowsiness.13 The instructions on the prescription container will indicate that the athlete should not drive a motor vehicle or perform other activities requiring a high level of motor functioning or reaction capabilities. The athlete may also experience lack of muscle coordination, dizziness, headache, or nausea when taking these medications. These drugs are known to become addictive, and the athlete can develop a tolerance to them. Additionally, the muscle-relaxant drugs can have an additive effect with alcohol that creates an increased sedative effect, sometimes resulting in death.7,11 When skeletal muscle relaxants are taken in combination with antihistamines, other CNS depressants, or monoamine oxidase inhibitors, there is an additive effect creating increased CNS depression (Box 4–1).
BOX 4–1 Adverse Effects of Skeletal Muscle Relaxants
Drowsiness (warning against operating machinery or performing activities that require mental alertness)
List compiled from Waldman, HJ: Centrally acting skeletal muscle relaxants and associated drugs. J Pain Symptom Manage 9:434, 1994.
Muscle relaxants can be abused by some athletes, can be obtained illegally, and have a potential for dependence.13 The athletic trainer should encourage the athlete to discontinue the use of these drugs as soon as he or she is able to function without them. Additionally, skeletal muscle relaxants are among the most commonly reported drugs of abuse by health-care professionals.9 In addition to monitoring your athletes' use of these drugs, you may want to watch for signs of abuse among your fellow athletic trainers and the other health-care professionals you work with on a daily basis. Take the appropriate steps to assist those in need if they are abusing skeletal muscle relaxants or any other drugs.
Implications for Activity
The athletic trainer needs to remind the athlete who uses skeletal muscle relaxants that these drugs have a mild general sedative effect and produce overall relaxation. This general relaxation effect may make the athlete unable to practice or compete because of being tired or even sleepy from the medication. The combination of skeletal muscle relaxants with alcohol or other CNS depressants can be dangerous or even lethal to the athlete. The use of skeletal muscle relaxants by physicians working with athletes is not a common procedure and should be monitored closely.
What to Tell the Athlete
The athlete should understand that the use of muscle-relaxant drugs is not a first line of resolution for muscle tension resulting from trauma or irritation. Skeletal muscle relaxants really treat only the symptoms and not the underlying cause of the problem.7 Here are some tips for the athletic trainer when educating the athlete about these drugs:
Before the physician prescribes a skeletal muscle relaxant, thermal modalities and manual techniques should be tried.
Encourage the athlete to continue scheduled therapy even after the physician has prescribed a skeletal muscle relaxant.
The overall sedative effect of the drug will reduce the energy level of the athlete.
Therapy sessions should be scheduled during times when the drug is getting to the end of its duration of action.
Scenario from the Field
At a university in Utah, athletes reporting minor injuries were admitted to the physician's examination room in the athletic training facility, where they stole pages from the physician's prescription pad. They then wrote their own prescriptions for skeletal muscle relaxants. Because the athletes were well known in their own town, they went to a pharmacy in a nearby, smaller town to have the prescriptions filled. Fortunately, the pharmacist suspected that something was amiss. She made a phone call to the physician of record to inquire about the prescriptions. The athletes were apprehended and charged by the police. This incident illustrates that it is important to maintain security in the physician's examination room.
Why would an athlete abuse a skeletal muscle relaxant during practice, in competition, or during the season?
Explain the difference between skeletal muscle spasm and spasticity.
Why would a physician prescribe skeletal muscle relaxants for an athlete?
Why would a physician not prescribe skeletal muscle relaxants for an athlete?
Muscle spasm is typically caused by trauma or irritation to the muscle.
Muscle spasticity is a result of a CNS lesion.
Muscle relaxant drugs can act either centrally or directly on the system.
Centrally acting muscle relaxants are commonly prescribed for muscle spasm in the athlete.
Prescription muscle relaxants are often combined with an analgesic to reduce the pain associated with muscle spasm.
Muscle relaxants cause a general sedative effect on the athlete. Some authors believe that the sedative effect allows the athlete to gain proper rest, allowing the muscles the time needed to heal.
Common adverse effects of muscle relaxants are drowsiness, dizziness, headache, and nausea.
Muscle relaxants have an additive effect when combined with alcohol; therefore the athletic trainer should discourage any use of alcohol by athletes who are taking these drugs.
The athletic trainer should work with the physician and the athlete to provide adjunct therapies so that the athlete can overcome muscle spasms.
The athletic trainer should encourage the athlete to discontinue the use of prescription muscle relaxant drugs as soon as possible.