Oscar Pistorius
Oscar Pistorius

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?

Oscar Pistorius

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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.