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The Paralympics begin in London next week and despite the euphoria from the Olympics, the buildup to the disabled Games has been blighted by tales of deliberate "performance enhancing" injuries.
The practice of "boosting", where wheelchair-bound athletes hurt themselves to increase blood pressure and endurance, is banned by the International Paralympic Committee (IPC) but is surprisingly common.
A survey of athletes at the 2008 Beijing Paralympics showed around 17 percent had used boosting.
Able-bodied athletes naturally increase blood pressure through certain exercise and can therefore push themselves harder but those with spinal injuries cannot do so easily.
One way of increasing blood pressure is to injure yourself with common ways of boosting including breaking toes, letting your bladder overfill, sitting on sharp objects, wearing overly tight leg wear or even trapping the scrotum.
British media outlets have suddenly cottoned on to the practice with widespread reports this week but the IPC and London organisers LOCOG will try to root out any cheats.
"There is testing (for boosting). Our medical team work with the IPC over testing," a LOCOG spokeswoman said.
Checks for boosting, which is considered dangerous by doctors as it can induce strokes or intracranial haemorrhage and death, include blood pressure tests and monitoring for tell-tale signs such as skin blotches.
However, doctors in the Beijing survey acknowledged that "it is possible that some athletes could have induced boosting during the competition and circumvented the initial screening process. This is difficult to monitor and poses a real challenge to the procedures for monitoring boosting in these athletes".
Boosting, known medically as the intentional induction of autonomic dysreflexia, has been compared to doping in Paralympic circles.
"ParalympicsGB have included education about (boosting) for all our athletes and we do not perceive this to be an issue with any British athletes," the British Paralympics Association told Reuters.
The Paralympics in London run from Wednesday to Sept 9.