One of the most inspirational stories to come out of the London Olympics was that of Oscar Pistorius, the South African double below-knee amputee known as the “Blade Runner”. He made the semi-finals in the men’s 400m competition, showing that even without legs he was one of the 24 fastest men in the world at this distance. He also qualified for the finals as a part of the South African 4x400m relay team, ultimately finishing 8th.
Being a sports medicine orthopaedic surgeon, I found his story perhaps even more intriguing than most. I first wanted to know what led to his amputations. With a little research I discovered that he was born with bilateral fibular deficiency (formerly called fibular hemimelia), which means he was born without the smaller bones in his legs that serve as the attachment of many of the muscles that control foot and ankle movement. This condition also usually causes deformities of the foot and ankle, as well as bowing of the tibia. Since this condition causes severe problems with gait, the recommended treatment is early below-knee amputation. Pistorius had his amputations before ever learning to walk, and was fit with prostheses six months later.
The next thing that captured my attention was his perseverance, his dedication, and his strength of character to not let a potentially completely disabling condition limit him. Knowing many of the orthopaedic and medical difficulties that amputees face, as well as the phschological and social obstacles, I am even more impressed with his achievements.
Perhaps the most interesting sports medicine topic that comes out of Pistorius’ story is the question of competitive advantage. It wasn’t until 2007 that he was allowed to compete in official events with able-bodied athletes. He had initially ruled ineligible because it was felt that his springy leg prostheses gave him an advantage over other runners because they are lighter and more efficient than biologic legs. Eventually, a hearing regarding his case allowed scientists to present biomechanical data that shows his prostheses do not confer any advantages over biological legs.
His blade prostheses are called running specific prostheses, or RSPs. They are elastic springs that help return stored energy. They are not motorized and do not generate any energy on their own. A company called Ossur makes his blades, and the model is called the Flex-foot Cheetah. This specific RSP has an elastic return of 92%, compared to biologic tendons that return 94-95%. They are lighter than biologic legs, but review of running films show that Pistorius does not have a faster leg swing than other elite runners due to the lighter weight.
Many in the sport are still skeptical, and perhaps the most prominent and outspoken critic is former Olympic gold medalist sprinter Michael Johnson. Johnson was quoted recently as saying that “…because we don’t know for sure whether he gets an advantage from the prosthetics that he wears it is unfair to the able-bodied competitors.” He goes on to say that people want to let Pistorius run because his personal best times are not good enough to medal, but his concern is more with how this will affect the rules in the future.
Johnson raises an interesting point. Pistorius was not fast enough to medal in this Olympics, so there was not much controversy this year. But what if he would have finished third? What if he would have won gold? What if he had set a new world record in the 400m? I’m sure there would have been more of an outcry from the other athletes and from many others if this were the case. What if new prostheses in the future are better than current ones and do give amputees a significant advantage?
In my opinion the evidence shows that Pistorius does not have a competitive advantage because of his blades. If anything, he has been at a disadvantage for most of his life and he has found a way to overcome it. Studies have shown that amputee athletes sustain more injuries during training and competition than their able-bodies counterparts.
I found Mr. Pistorius’ story not only very interesting on a professional level, but also extremely inspiring on a personal level. The fact that he was one of the most humble and likable athletes at the Olympic games during all of his interviews was very refreshing. I found myself rooting for him as much as I did for some members of Team USA. I was surprised how saddened I was when he finished last in his semifinal in the 400m. I am sure that he has been a positive influence on not only disabled athletes around the world, but on anyone who is trying to overcome adversity. I don’t know if his presence this year will lead to changes in any Olympic or international rules, but I sure hope that I get to watch him again in Rio in 2016.
How do you feel about Pistorius competing against able-bodied athletes? Other comments?