Good Luck Oscar qualifying for the Olympics tomorrow!

Posted By: JNBillock on May 24, 2012

Outside Online
Thursday, May 24, 2012

Oscar Pistorius and the Imperfect Science of Classifying Disability
Our quadrennial celebration of idealized human form and physiology
discomforts at least one rehabilitation physician like a tight pair of slacks. Do
the Olympics end up ranking people, or their bodies?
By: Ford Vox

Every week I welcome a new wave of injured, impaired and even unconscious
people into the brain injury rehabilitation unit at my hospital. For every
one of my patients, life has just gotten a lot messier. Some will work with
us a few weeks and graduate—I will never see them again. Other survivors
will learn that life’s challenges require ceaseless adaptation.

These are the cases I continue to work on in my clinic, and they are some
of the most rewarding. Recovery takes as many paths as there are ways
through life.

I’m a physical medicine and rehabilitation physician. In the daily work of
my field we use cumbersome orthotics riddled with velcro straps to help
paralyzed people walk, and we use prosthetics that damage skin and create
arthritis to replace missing limbs. We'll silence muscles gone haywire with
injections of neurotoxin. We depend on rote practice and prisms to bend the
world into view when patients lose part of their visual field. The high-tech
tools we have require plenty of elbow grease.

My job is messy by its nature. This is why I’m celebrating that the 2012
London Olympics are poised to sweep the world straight from saccharine
choreography into the complexity of the human condition, the reality of
imperfection my patients and I face down daily. I base my hopes on the
International Olympic Committee’s agreement to accept a 25-year-old South African man
named Oscar Pistorius into the 400-meter dash at this summer’s Olympics if
his times qualify him. Pistorius, a double below-the-knee amputee who’s been
dubbed the “blade-runner” for his carbon-fiber running prostheses, has to
sprint just once more under 45.30 seconds to qualify. The IAAF's Ostrava
Golden Spike meet on Friday is his next chance of several before his June
30th deadline.

The idea that a disabled athlete is on his way to the Olympics has drawn
widespread criticism, with some critics singling out the “unfair advantage”
that they feel Pistorius stands to gain from his artificial legs. Pistorius
relies on carbon fiber prosthetic technology common in many orthotics and
prosthetics. The material can store and release some of the kinetic energy
you put into it, but they're only a pale imitation of the superior energy
return capacity muscles and tendons provide. From the vantage point of a
doctor who's spent time working with amputees on all the complications that
occur when we meld flesh with plastic and metal, it's a surreal experience to
hear anybody claiming Pistorius might have a technological edge.

There's no question that Pistorius runs differently, and that his feats in
the 400 meters wouldn't be possible without technology developed in the
last 15 years. Standing on his blades, Oscar Pistorius forces us to accept the
imperfections in ourselves and each other. He's a bright, shining reminder
that all athletes are physically unique in ways that profoundly impact
their performance in sport. Every seemingly unadulterated athlete has unique
biomechanics thanks to variations in limb length, bone density, tendon
lubrication and joint range of motion. Long hours of hard training powered by an
indomitable spirit will indeed speed the rate your muscles clear lactic
acid and get oxygen, but a genetic lottery has already set you on an unequal
training ground.

For years the Paralympics, where Pistorius is a champion, have practiced
the imperfect science of classifying athletes by varying levels of
disability. But by breaking into the Olympic games with his world-class times,
Pistorius is up-ending the entire concept of disability, its classification, and
its containment.

Despite our living in times where many of Pistorius' competitors can credit
their own lives and health to medical technologies like bronchodilators,
antibiotics and orthopaedic surgeries, and despite an uneasy suspicion that
winning edges often boil down to epigenetic predispositions, only once this
young man fits on his carbon fiber legs and strides from the sidelines to
his starting point in the Olympic Stadium will we all get up to speed. The
normal range of human variation must allow for our repair and adaptation.
This summer we’ll share a transformational moment for rehabilitation, and
for humanity, because whoever’s in the race with Oscar, we’re all chasing
with him a life unlimited by our physical imperfections.

This article will also appear in the summer 2012 issue of Tufts Medicine.

The message above was posted to OANDP-L, the e-mail discussion list for orthotics and prosthetics.