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The Paralympics is to get tough on scrotum-squeezing as athletes have been risking their lives to gain an athletic advantage of up to 10 per cent using the bizarre practice.

Wheelchair-bound athletes with spinal cord injuries can flush their bodies with adrenaline through sitting on their scrotums or clamping off catheters to fill their bladders then tapping upon them.

This tricks the brain into triggering 'autonomic dysreflexia' — allowing them to achieve more power and greater oxygen uptake during races.

However it also results in elevated heart rates and extremely high blood pressure, potentially leading to strokes and even death.

Officials said the International Paralympic Committee is reviewing guidelines against 'boosting', which has been banned for more than a decade, ahead of next year's Rio Games.

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Endurance events such as long-distance wheelchair races are under scrutiny as well as athletics disciplines, hand-cycling, rowing and wheelchair rugby.

"The problem with the pathology of a spinal cord injury is that this response is deviated to the cardiovascular system, including hypertension and increased heart rate," IPC medical and scientific director Peter Van de Vliet told Reuters.

"About 30 to 40 out of 4,300 athletes for Rio are vulnerable to this mechanism."

Paralympic athletes 30-40 Vulnerable to 'boosting' 4,300 Total

The Paralympic movement has largely escaped the drugs scandals that have tainted able-bodied athletics.

Revelations of state-backed doping among Russian athletes are the latest in a string of high-profile disclosures to hit the sport.

But with the Paralympic Games in Rio de Janeiro aiming to cement its position as a major global sporting event, the movement is strengthening its defences against cheating.

"The profile of Paralympics sports has increased and that carries with it an intrinsic risk that people will try to stretch boundaries, by means of technology, by means of unauthorised substances and whatever is humanly possible," Van de Vliet said.

He said the IPC is considering plans to lower the 180 mm of mercury threshold it uses in a standard blood pressure test to detect boosting.

"We now have the data and it shows the majority of athletes are way below 180 mm," Van de Vliet said of a testing and education program in place since Beijing 2008.

If an athlete's blood pressure is over 180, they are given 10 minutes to cool off before another pre-race test.

The normal blood pressure during a rest period for high spinal cord-injured athletes is around 100 over 60 or 90 over 60.

Blood pressure mercury levels for high spinal cord-injured athletes

Imposing a lower threshold could detect more boosters and have a deterrent effect, said Van de Vliet, adding that no athlete has so far ever been handed the minimum two-year sanction.

However, this could change should the new rules be adopted, he said.

Most of the IPC's doping sanctions, which include life bans, involve athletes competing in power-lifting.

"People think that the Paralympics is a more benign version of the Olympic Games and that it is not as pointed, as targeted and as fierce," said Wayne Derman, the IPC's chief medical officer at October's Doha championships.

"That is such a wrong misconception."