| Verified against primary record | |
| Who grants an exemption | A national anti-doping organisation or an international federation, not the world agency[1] |
|---|---|
| One body only | An exemption can be submitted to only one anti-doping organisation[1] |
| Treatment before approval | One federation has required that, outside medical emergency, no prohibited substance be administered before it grants an exemption[2] |
| Records read | Anti-doping agency pages, a federation circular and clinical guidance, 2 October 2026 |
| Independently reported | |
| Volume | No source located measures travel by athletes for treatment |
| Bands apply only to the rows beneath them. The federation circular is dated 2017 and is almost certainly superseded; it is used only to show that such rules exist. | |
Sports medicine travel is travel for musculoskeletal and performance-related treatment, whether by professional athletes, amateurs or people seeking the same interventions outside sport. It has one feature that distinguishes it from every other sector covered on this site: for a competing athlete, treatment abroad takes place inside a codified international compliance regime, and a legitimate medical decision taken in one country can produce a rule violation in another.
Why the destination matters more here
Anti-doping rules work from a list of prohibited substances and methods, which designates what is banned both in and out of competition and what is banned in particular sports. The list is one of eight mandatory international standards that signatories must follow, and it is updated annually: the revision process begins in January and concludes by 1 October. The list in force from 1 January 2026 was approved on 11 September 2025 and published on 25 September 2025. For a substance or method to be included it must meet at least two of three criteria: potential to enhance sport performance, actual or potential health risk to athletes, and violation of the spirit of sport.[3]
Where an athlete has a legitimate medical need for something on that list, the formal mechanism is a therapeutic use exemption. Its purpose, in the words of the international standard that governs it, is to establish the conditions that must be satisfied in order for an exemption to be granted, permitting an athlete to use a prohibited substance.[4] The granting conditions themselves sit in Articles 4.1 to 4.3 of that standard.[5]
A 2019 peer-reviewed review of the regime states those conditions as follows: that the athlete would experience significant health impairment if the substance or method were withheld; that its therapeutic use is unlikely to produce any additional performance enhancement; that there is no reasonable therapeutic alternative; and that the necessity is not a consequence of prior use, without an exemption, of something prohibited at the time.[6] That wording is reproduced from the review rather than from the standard itself, and the standard has been revised since, so it should be read as the shape of the test rather than as current text.
An exemption is not a passport
Who grants an exemption depends on the level at which the athlete competes. National-level athletes apply to their national anti-doping organisation and international-level athletes to their international federation, with each application reviewed by that body’s therapeutic use exemption committee, and decisions rendered within 21 days of a complete application. Athletes do not apply to the world agency at all; it outlines the rules and process, hears appeals and monitors the decisions that other bodies make. Appeals run to a national appeal body or, for international-level athletes, to the Court of Arbitration for Sport. Crucially, an exemption can be submitted to only one anti-doping organisation.[1]
The common assumption that one exemption is valid everywhere does not follow from any of that, and a federation circular from December 2017 shows the opposite in practice. Under the rules it set out, exemptions granted by the world football federation transferred automatically to that confederation’s competitions, but recognition of an exemption granted by a national anti-doping organisation was conditional on three things: that the national body had followed the confederation’s own criteria, that the confederation’s medical unit received a copy of the original application including all the medical information submitted, and that its own committee confirmed compliance with its rules. The same circular stated that except in cases of medical emergency, doctors must not administer a prohibited substance or method before the confederation has granted an exemption.[2]
That last sentence is the point of this entry. A clinician abroad, treating in good faith and within the law of their own country, may administer something the athlete’s own governing body requires to be authorised in advance. The circular is nine years old and almost certainly superseded, and current federation rules were not read for this entry, so it is used here only to establish that governing bodies impose such requirements.
Interventions marketed in this sector
Autologous blood-derived injections, in which plasma is taken from the patient’s own blood and injected into a joint, are heavily marketed in sports medicine. English clinical guidance covering this procedure for knee osteoarthritis, last reviewed in January 2019, states in its plain-language version that the procedure can be used for knee osteoarthritis but only where patients are having regular checks on how well it is working or whether it has caused problems, and that there is not enough evidence to be sure how well it works.[7] That guidance addresses knee osteoarthritis specifically and should not be read across to tendon, ligament or muscle indications.
A separate and broader regulatory position applies to cell-based products. The United States regulator states that regenerative medicine therapies have not been approved for the treatment of any orthopaedic condition, naming osteoarthritis, tendonitis, disc disease, tennis elbow, back pain, hip pain, knee pain, neck pain and shoulder pain.[8] That page concerns stem cell and similar unapproved biologic products and does not mention platelet-rich plasma, which is regulated differently; the two should not be run together.
No source located measures how many athletes, or how many other patients, travel for musculoskeletal treatment. The compliance regime described above is normative rather than statistical: it establishes that the rules exist, not how often they are engaged.
See also
- Orthopedic medical travel, the surgical end of the same field
- Rehabilitation abroad, the recovery phase these injuries depend on
- Stem cell tourism, which markets overlapping interventions
- Medical travel for unavailable treatments, where regulatory status differs between countries
References
- World Anti-Doping Agency. Therapeutic Use Exemptions. Page carries no date. Verified against primary record: agency page opened and read. Retrieved 2 October 2026.
- Union of European Football Associations. Circular on the 2018 WADA Prohibited List. 22 December 2017. Verified against primary record: federation circular opened and read. Almost certainly superseded; used only to establish that such rules exist. Retrieved 2 October 2026.
- International Paralympic Committee. WADA publishes 2026 Prohibited List. Independently reported: a code signatory relaying the agency’s announcement; the agency’s own list pages could not be opened. Retrieved 2 October 2026.
- World Anti-Doping Agency. International Standard for Therapeutic Use Exemptions. Page dated 19 December 2025; current version effective 1 January 2027. Verified against primary record: agency page opened and read; the standard itself was not read. Retrieved 2 October 2026.
- World Anti-Doping Agency. Therapeutic Use Exemptions, science and medicine section. Verified against primary record: agency page opened and read. Retrieved 2 October 2026.
- Anti-doping Policy, Therapeutic Use Exemption and Medication Use in Athletes with Asthma: A Narrative Review and Critical Appraisal of Current Regulations. Sports Medicine, vol. 49, 2019. Independently reported: peer-reviewed review; the granting conditions are quoted from it rather than from the standard. Retrieved 2 October 2026.
- National Institute for Health and Care Excellence. Platelet-rich plasma injections for knee osteoarthritis: information for the public. Parent guidance last reviewed 23 January 2019. Verified against primary record: plain-language guidance opened and read; the formal recommendations chapter could not be opened. Retrieved 2 October 2026.
- United States Food and Drug Administration. Important Patient and Consumer Information About Regenerative Medicine Therapies. Published 3 June 2021, updated 8 April 2024. Verified against primary record: regulator page opened and read. It does not mention platelet-rich plasma. Retrieved 2 October 2026.
Sourcing note: the anti-doping agency pages, the federation circular and the clinical and regulatory guidance were opened and read on 2 October 2026. The agency’s own prohibited list pages could not be opened, so the list’s status and revision cycle are reported from a code signatory’s announcement and attributed accordingly. The granting conditions for an exemption come from a peer-reviewed review rather than from the standard itself, and the standard has been revised since that review, so they are presented as the shape of the test rather than as current wording. The claim that an exemption is portable between bodies is not made, because nothing read supports it and the federation circular shows conditional recognition. The clinical guidance concerns knee osteoarthritis only, and the regulator’s orthopaedic statement concerns cell-based products and not platelet-rich plasma; the two are kept apart.