Elite cyclist Floyd Landis has Tour de France fans and even many physicians stumped.
How can a guy whose hip is falling apart hop on a bike, let alone be a contender in this most grueling challenge?
His degenerating condition has crumbled the ball of his hip joint so that it no longer fits neatly into the socket, his doctor says. The irregular-shaped bone has ground down surrounding cartilage, and arthritis has set in.
For mere mortals, the pain would be excruciating and they’d be begging for a hip replacement.
Landis is planning to get a new hip after the three-week Tour ends on July 23. But first things first. He is considered a favourite to win this year’s race, and was in fifth place overall heading into Thursday’s 11th stage.
”He must be tough as nails,” said Dr Charles Bush-Joseph, the Chicago White Sox baseball team’s physician. Other doctors say athletic conditioning and the adrenaline surge from racing help explain how he’s doing it.
The 30-year-old Landis broke his right hip and severed its blood supply in a fall on gravel during a steep downhill training ride near his California home three years ago.
”The front wheel slid out, so all of my weight went straight down onto my right hip,” Landis said at a news conference in Bordeaux on Monday’s off-day in the Tour.
”I guess I knew at the time that something was really wrong because it was probably the most painful thing that I have ever experienced, but I didn’t want to believe that it was as bad as it was.”
Three subsequent operations failed to fix the problem, and without blood to nourish the joint, his hip bone slowly has been dying. Doctors call it avascular necrosis.
Specialists say the condition is not uncommon; by some estimates, about 15 000 cases are diagnosed yearly in the United States.
It’s a common reason for young people to need hip replacements, and injury is often the cause. Other causes include long-term use of medical steroid drugs including prednisone for conditions such as asthma or lupus, blood-clotting disorders and heavy alcohol use, said Dr Andrew Urquhart, chief of joint reconstruction at the University of Michigan.
”Some people with this condition are unable to put on their own shoes and socks just because twisting their leg is so painful,” he said.
While cycling is fairly low impact for most people, the worst part for Landis might be getting on and off the bike, Urquhart said.
Landis’ injury is the talk of cycling enthusiasts and one of the biggest stories of the Tour this year, said Kip Mikler, editor of VeloNews, an American cycling magazine based in Boulder, Colorado.
The cyclist’s condition wasn’t known to the general public until this week and Mikler said ”it was a big surprise”.
An amateur cyclist, Mikler said he’d never attempt to ride in Landis’ condition.
”It’s just a testament to his determination,” he said.
Dr Richard Berger, an orthopedic surgeon at Rush University Medical Centre in Chicago, agreed, saying it’s ”such a great tribute that someone can do this, get through his pain, get through his disability. It’s remarkable”.
Berger said the muscular builds of high-performance athletes help cushion them from pain that would crumble amateurs. So does the jolt of adrenaline elite athletes get from racing, he said.
Landis said pain during a time trial is difficult; that’s why he sits farther up on the seat. ”Climbing steep hills is worse because I have to lean forward further,” he said.
Pain tolerance separates elite athletes from the rest of us, said Dr David Prince, a sports injury specialist at New York’s Montefiore Medical Centre.
”If you or I were to undergo what he’s experiencing, we would go nuts and probably have the surgery that night,” Prince said. ”For the average person, on a pain scale of 1 to 10, this would probably be a 50.”
Drugs called nonsteroidal anti-inflammatories, including ibuprofen, are often used for pain, but Prince noted that some can cause drowsiness that would make racing difficult.
So Landis may not have been exaggerating when he said this week that not many medications help, ”so it doesn’t serve any purpose to take pain medication”.
He said cortisone injections this year were ”somewhat successful”.
Doctors briefed on Landis’ condition said getting an artificial hip sounds like the best option. The surgery likely would involve removing the eroded hip joint and replacing it with a metal or ceramic ball, plus resurfacing the socket with similar material.
Whether Landis could return to elite racing after surgery is uncertain. His physician, Dr Brent Kay, is more optimistic than most. He said he has talked to amateur cyclists with hip replacements who ”are doing very well”.
”We haven’t had any Tour de France cyclists do that, but yeah, I think it is certainly possible,” Kay said. – Sapa-AP