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SPRAY 'EM, PLAY 'EM

June 15, 1981
June 15, 1981

Table of Contents
June 15, 1981

Belmont
French Open
NCAA Track & Field
Hans Kraus
Baseball
Racquetball
Soccer
Lee Trevino
For The Record
19th Hole: The Readers Take Over

SPRAY 'EM, PLAY 'EM

Getting an injured athlete back on his feet in a hurry, within reason, is the essence of Dr. Hans Kraus' technique

By William Oscar Johnson

There is an aura of energy about the man. He is small (about 5'3") and he is old by most standards—he will turn 76 this year. Yet the impression he gives is one of sizzle and spunk, exuberance, confidence, great physical strength, high-voltage enthusiasm, bursting vitality.

This is an article from the June 15, 1981 issue Original Layout

This is Hans Kraus, the Austrian-born physician, skier, mountaineer, rock climber and proponent of physical fitness. He has been a leading practitioner of sports medicine since the 1930s, when an athlete with a badly sprained ankle would commonly find himself clapped into a heavy plaster cast and sentenced to a month of immobility. That would be followed by another eight weeks of slow, painful reconditioning therapy before he could expect to get around normally again. In the intervening decades, Kraus has devised techniques for treating such serious injuries that often have an athlete back playing his game within days.

Kraus was an advocate—an evangelist—of physical fitness long before the U.S. embarked on its fitness binge. He shocked one President (Eisenhower) in 1955 with a study demonstrating that American children were weaklings compared with the kids of Europe, and he was a White Household name in the early 1960s when he treated another President (Kennedy) for a debilitating and excruciatingly painful chronic back condition. Kraus became famous as "The Back Doctor" after Backache, Stress and Tension became a popular book in 1965. He could become even more widely known after his Sports Injuries (Playboy Press, $11.95) is published next month. A friend suggested recently that the new book may be a self-help text of such vast appeal that it will become a kind of "Spock for Jocks." Kraus vehemently disagrees—not because he resists the idea of multimillions in sales, but because he disapproves of some of Dr. Benjamin Spock's permissive child-rearing theories.

It is not only Spock who elicits Kraus' criticism. For example, Kraus says, "The average coach knows more than many men in the medical profession about truly efficient reconditioning of sports injuries. Always I have learned more from coaches than from surgeons about this area of medicine." Although Kraus is revered by many of his colleagues, he decries them for ignoring—or avoiding—one vitally important area of orthopedic treatment. "The human muscular system is a wide blank field in medicine in general," he says. "It is poorly taught in medical schools. People specializing in orthopedic medicine just aren't interested in muscles. That's because the big breakthroughs in the field have focused on surgery. There have been tremendous things done in traumatic surgery, but that doesn't mean that surgery should be applied to everything. Exercise as a treatment has been given little but lip service."

Unlike many other physicians, Kraus considers early, properly executed exercise to be effective for the treatment of most orthopedic injuries. "I learned as a young man that immobilization isn't necessary to healing," he says. "Ever since then I have been an enemy of immobilization and bed rest. I have seen too many patients who were sent to bed healthy and got up sick. Almost every injury heals quicker and better with movement."

Not all experts agree with Kraus, among them Dr. James A. Nicholas of New York, the founder of the Institute of Sports Medicine, who has known him for decades. "He's a wonderful man, thoroughly reputable and, certainly, in the area of physical fitness, he was a pioneer," Nicholas says. "He laid the basis for the United States' great interest in fitness. He was the major influence in arranging a transition between Old World and New World views. He was a pioneering advocate in America of the European approach to physical conditioning as a major force in sports medicine. The emphasis was on non-surgical, manipulative programs based on scientific methods. However, when he implies that we depend too much on surgery, he is wrong. He is expressing a view that had some validity before 1950. But there has been an explosion in the field of sports medicine in recent years, and with it there have been tremendous surgical advances. The implication of what he is saying is that he is not aware of some of the great changes that have occurred in the field."

But Dr. Willi Nagler, professor and chairman of the department of physical medicine and rehabilitation at New York Hospital-Cornell Medical Center, an old friend of Kraus', brooks no criticism of the doctor. "Dr. Kraus may be a controversial figure to people who are very orthodox in their practice of orthopedic medicine," he says. "I don't think that he has fallen behind in his understanding and recognition of new developments in the field. His philosophy is that there is never any need to rush into surgery, that it should be done pretty much as a last resort after optimum benefits have been derived from other forms of treatment and therapy."

Kraus, whose offices are on Manhattan's East Side, has treated high-powered celebrities over the years, including Arthur Godfrey, Lowell Thomas and Katharine Hepburn. He also treats "doormen and cleaning ladies, bellhops and cab drivers, if they need me." Kraus' longtime rock-climbing friend, New York attorney James P. McCarthy, recalls a day in the 1950s when the doctor's calendar of appointments indicated that one "Mrs. A. Khan" was waiting in his office. McCarthy says, "It turned out to be Mrs. Ali Khan, who was then Rita Hayworth. But Hans never went to the movies in those days, and I'm not sure he knew whom he had treated until someone told him later."

Kraus' patients have also included thousands of athletes, most of them of the recreational, weekend variety. The best-known sports figure was probably skier Billy Kidd. After Kidd won America's first gold medal in the FIS world championships, in 1970, he appeared on the cover of LIFE and presented Kraus with an autographed copy of the magazine with the inscription "Thanks for putting me here."

Despite his expertise in sports medicine, Kraus has never been a physician for a major league team in the U.S. "I think that being a team doctor involves an automatic conflict of interest," he says. "What is good for the team isn't necessarily good for the athlete. You want to make him well, but the coach wants him back playing—and the athlete himself might want himself back playing—when he should not do it."

Kraus has always viewed mass spectator sports with disdain, convinced that they lead millions to spend their lives in a state of inactivity. His preference is for individual participation sports—the more demanding and dangerous, the better. Indeed, it was his own involvement in mountain climbing and a nightmarish accident he had as a 16-year-old daredevil in the Alps that gave Kraus the impetus for a career in medicine.

"I was always crazy about sports and did everything under the sun," he says. "My main sport when I was 13 or 14 came to be rock climbing. My friends and I knew nothing and we had no equipment worthy of the name, and yet, for some reason, I didn't get killed doing it. By the time I was 16, I was actually leading climbs. I took a friend of mine up a 12,000-foot mountain one day. We were putting up a first ascent on the face, and before the first ridge my friend fell. We had no pitons. We had no equipment. It was an unpardonable thing. I tried to hold the rope to keep him from falling. I had gripped the rope as tight as I could, but, of course, I couldn't stop him. The rope ripped and burned through my hands as he fell. My palms and fingers were denuded of their skin. They were stripped to the fascia. In some places the tendons showed.

"I climbed down to where he lay. He was still warm, but there was no heartbeat, there was no breathing. He had been killed. It was the first time I had seen a dead person and it changed me forever. I could do nothing for him. I continued on down toward the hut where other friends would be. It was a terrible trip. I fell into a crevasse, and I saved myself from dropping deep into the glacier only because I spread my arms to bridge the chasm.

"My hands were in terrible shape, bleeding heavily and growing stiffer. The local doctor said I should be very happy to be alive, that I was incredibly lucky, but he also said I would never be able to move my fingers again. He predicted I would be equipped with stiffened claws because of what the rope had done to my hands. He bound them in bandages and said that was all that could be done. However, I began to soak my hands in hot water twice a day—each time I changed the bandages. And as I soaked them, I moved the fingers. Slowly at first, painfully, they moved. But they did move. I kept it up. By some instinct, the idea of movement instead of immobilization worked for me. My hands were never quite perfect again, but I could move my fingers very well and I became adept at surgery. And, of course, I have climbed for all of my life, which requires strong and limber fingers."

Once he recovered the use of his hands, Kraus found that his life had changed. "My father was in the shipping business and had expected me to do the same," he says. "I had, too. But after seeing the death of my friend, I decided that a life spent just working for money was wrong. I told my father that I had decided to study medicine. He wasn't pleased. He said, 'Do it on your own. I won't help you.' Out of sheer stubbornness, I went ahead on my own. I went to night school for 10 months and I worked during the day, and I took 18 examinations and on all of them I got A's. It was then that my father relented and helped me to go to medical school."

Kraus was born in 1905 in Trieste, then part of Austria-Hungary, where the family's tutor in English and Italian was an impoverished writer named James Joyce. When World War I broke out, the Kraus family moved to Zurich—and so did Joyce. Once again he was hired to tutor the Kraus children. "He was fascinating, a tine teacher, although he would surely turn around in his grave if he heard me speak now." says Kraus in his strong Austrian accent. "When we knew him, he was gathering material for Ulysses in a notebook, writing down things that he saw: a trolley car rolling past, a man crossing his legs, vignettes of many things. He once said to me that writing prose is like composing music. I was only a boy and I said to him. 'How can that be? You can't make chords with prose. How is it like music?' And he said. 'Supposing in Chapter I you have a man with a kidney disease, and then in Chapter 3 you have that man eating a kidney, and then in Chapter 6 that same man is kicked in his kidney—that, my boy, is how you make a chord with writing.' I was 11 or 12, and I understood that very well. Joyce was a terrific teacher. Sessions with him were very unstructured, and very beautiful. I loved the hours with him."

After medical school at the University of Vienna, Kraus was a resident intern for a short time, until he was put in charge of fracture emergencies in the surgical department of the university hospital. He dealt with sprains (torn ligaments) and strains (torn muscles) as well as fractures. Everything was treated by immobilizing it—using soft wrappings for minor strains, splints or plaster casts for more severe injuries. In the ease of a sprained knee, it was common to encase most of the leg in a plaster tube. "Today people ask, 'When can I play my sport again?' " Kraus says. "In those days, athletes would ask, 'Can I ever play again?' Often an injury, with weeks of debilitating immobilization, meant a man's career was over. We knew of no other choice of treatment in those days."

An old friend changed all that. He was Heinz Kowalski, who had been raised in a family of circus acrobats and who had become a highly regarded coach—indeed, he was president of the Austrian Sports Teachers Association—as well as the owner of a gymnasium where Kraus, a recreational boxer and jujitsu practitioner, often worked out. Kraus recalls. "One day it occurred to me that although Kowalski sent many injured patients to me at the hospital, he had never sent anyone with a strain or any ligament injuries. 'Why don't you send me them?' I asked him. He said, 'No, you would only put them in plaster or in splints. You doctors don't know what you are doing."

"I pursued this, telling him that we doctors believed that the only way to heal such injuries was a long rest from movement. But he reminded me that he came from a circus family, and that if a circus performer suffered a sprain or a strain, he would be out of work. If he didn't perform, he didn't eat, so there was no practical way to use immobilization."

Kowalski then told Kraus that in the circus, injured performers used a technique that kept them working despite the most severe sprains or strains. They would soak a towel in alcohol, wrap it around the injured area, then expose the towel to a steady cloud of live steam. This would produce a kind of numbness in the painful area and the performer could begin to move the limb. This treatment would be undergone several times a day, and usually, after a day or two, the injured performer would be back at full strength and mobility.

"I was fascinated by this," says Kraus. "It almost fell into the area of folk medicine, yet it made a lot of sense, and I resolved to try it as soon as I could." A short time later, two skiers were admitted to the hospital, each with a badly sprained ankle. Kraus told them about the Kowalski treatment, and they insisted he experiment with it on them. The result was amazing: "In only three days they had full range of their ankles and they were back skiing soon."

But the application of alcohol compresses-cum-clouds of steam was cumbersome, and Kraus began to experiment with other, more efficient, chemicals—mixtures of ether and acetone with alcohol, for example—to produce numbness. At last he hit upon ethyl chloride, which had long been used by physicians as a local skin anesthetic to reduce pain when lancing boils and making small incisions. The numbness is produced by freezing the skin: indeed, the use of too much ethyl chloride results in frostbite.

The first patient Kraus treated was a veterinarian with two canes who came limping in on an excruciatingly painful sprained ankle. Kraus sprayed ethyl chloride on the ankle, then had the vet move it. The pain ebbed. Kraus sprayed the ankle again, then had his patient exercise further until he said he felt reasonably comfortable. The veterinarian returned three times in the next week for treatment, and declared that his ankle felt fine. Kraus released him. telling him to come back in a month for a checkup. When the vet returned, the ankle was in perfect shape and the man was beaming. "You've got a good thing," he told Kraus. "You know, I've started using it on horses and dogs. I shave the sprained leg and spray it with ethyl chloride. It works exceptionally well: almost all the animals run off after the treatment."

Kraus immediately began treating other patients with ethyl chloride. "I tried it on everything from appendicitis to concussion," he says with a chuckle. In 1932, he gave a paper on the use of ethyl chloride spray before the Academy of Physicians in Vienna. "I was just a young kid," he recalls. "They could have laughed me out of town, but they were very understanding." A correspondent for the American Medical Association heard the presentation, and an abstract of Kraus' paper was later printed in the AMA's Journal. And Kraus was assigned to teach on the use of ethyl chloride and early exercise in injury treatment at the Vienna Medical School.

Eventually, Kraus coined the acronym MECE to describe his treatment, in contrast to the more commonly used technique he calls RICE. "I can't name a dozen doctors using my treatment," he says. "Most people will use the RICE treatment, which stands for 'rest, ice, compression and elevation.' MECE stands for 'movement, ethyl chloride and elevation.' "

There are, of course, limitations to MECE therapy. "Obviously you can't treat a major ligament tear or a fracture requiring immobilization with ethyl chloride spray," Kraus says. "On the other hand, you don't have to worry about using it, because it's self-limiting and will cause no trouble; it will remove pain from strains and sprains so you can move them, but not from major ligament tears or major fractures. Thus, there is no danger from excessive movement that would worsen the injury, such as might occur if novocaine is used as the pain-numbing agent." However, Kraus warns that people must not try the treatment on themselves without first consulting a doctor.

When Kraus describes the way his MECE treatment works, it sounds little short of miraculous: "Let's say you're a jogger who has a sprained knee and you have come to me for treatment. I first find out where your pain is most severe. If it is in the medial collateral ligament of the knee, I spray the area with ethyl chloride, and then have you bend and extend the knee two or three times. If you still have pain, I'll ask you to show me where. The pain usually shifts from the more acutely damaged area to a less damaged area, because limitation of motion has concealed it until now. The idea is to follow the pain with the spray. I then spray this area, and have you bend and extend the knee several times, rest briefly, then move the knee again. If there is no pain, you walk out. Of course, we must find the true cause of the injury, but a minor sprain will respond to ethyl chloride spray and gentle exercise of the affected part with immediate recovery."

No one knows precisely why ethyl chloride, a surface anesthetic, produces such a deep beneficial effect. One theory is that pain originating in one area of the sensory motor chain leads through a series of links to reflex muscle spasms and the involuntary locking of joints, and that the elimination of pain at any point in the chain breaks the entire linkage of pain, relaxing the affected muscles and joints. How ethyl chloride spray breaks the pain chain when combined with motion isn't precisely known, either, but, as Kraus says, "the important thing is, it does."

Once MECE became known, Kraus was overrun with patients, many of them athletes. From 1931 to 1938, he served as official surgeon to the Austrian Sports Teachers Association and to several Austrian Olympic teams. He became an espouser of therapeutic exercise and of physical fitness as a cultural boon whose benefits could extend far beyond elite athletes. "As an intern, I had gotten a diploma as an exercise teacher," Kraus says. "I helped train the Austrian Olympic hockey team and many skaters; Vienna was the capital of ice skating then. We discovered that you had to be in very good shape to compete in athletics. We also learned that systematic exercise was necessary to good health in general. Vienna was the center of this fitness movement many, many years ago. It has only recently dawned in the United States."

Nonetheless, Kraus revised and widened his concepts of orthopedics because of American influences, most notably that of a U.S. runner and coach named Harold Anson Bruce, who had been hired as a track and field coach by the Austrian Olympic Committee. "Harold Bruce introduced me to the world of track and to many forms of treatment for sports injuries," says Kraus. "When I came to America, he was the man who put me in touch with sports people whom I treated and made friends with."

Kraus first visited the U.S. in 1934, spending much of his time studying the techniques used to treat fractures at Columbia-Presbyterian Medical Center in New York City. "I was enormously impressed," he says. "These Americans were so far ahead of us in their surgical practices. I was bowled over by their brilliance. I decided then that I would come to America and get more involved."

He returned to Austria in the mid-'30s, and then departed permanently in 1938 after the Anschluss. He served for many years on the staff of Columbia-Presbyterian and has also been affiliated with two other New York City hospitals, Bellevue and Metropolitan. And he has been an associate professor of physical medicine and rehabilitation at New York University's College of Medicine.

In the early 1940s, Kraus and a colleague at the Posture Clinic at Columbia-Presbyterian, Dr. Sonja Weber, designed a set of minimum-fitness tests to measure the muscular strength and flexibility of those visiting the clinic. This was the famed Kraus-Weber test, six simple exercises that were designed, as Kraus explains, "to determine only the minimum levels of muscular fitness, not the optimum levels. The tests determine whether or not the individual has sufficient strength and flexibility in the parts of his body upon which demands are made in normal daily living." The original tests involved 4,264 American children, who were compared with 2,870 kids tested in Austria, Italy and Switzerland. The findings were devastating: No less than 57.9% of the American youngsters failed one or more of the tests, while only 8.7% of the Europeans did so. A total of 44.3% of the U.S. kids failed the flexibility test, compared with 7.8% of the Europeans, and 35.7% of the Americans flunked one or more of the five strength tests, as opposed to a mere 1.1% of the Europeans.

There was almost no official interest in such tests in those days, and Kraus spent thousands of dollars of his own money to underwrite the study. But after the results were revealed to the President in 1955, an alarmed Ike established the President's Council on Youth (now the Council on Physical Fitness and Sports), which successfully focused attention on the fact that this health-conscious nation was, in fact, producing a generation of weaklings. As Kraus said at a White House luncheon back then: "We're paying the price of progress. The older generation was tougher because it had to undergo adequate physical activity in the normal routine of living. We have no wish to change the standard of living by trying to do away with the automobile and television. But we must make sure that we make up for this loss of physical activity. In other words, let's take the sting out of the benefits."

Fittingly, last year Kraus was given the Distinguished Service Award of the President's Council. Yet, despite the fact that more than a quarter of a century has passed since the first report stunned President Eisenhower, Kraus is still banging the same drum, insisting that the level of U.S. fitness may not be high enough to meet the demands of normal life in the 1980s—particularly, normal life among Americans who want to participate in sports on a regular basis.

In his new book, Kraus presents another series of very simple (one critic calls them simplistic) tests, designed to measure muscular strength and flexibility, plus the likelihood of injury in athletic activity. Kraus writes ominously, "If you fail even one of them, you're a prime candidate for injury. What do you do then? Instead of playing sports, start the conditioning program indicated for each test.... [Then, when you are able to pass all seven tests,] you can start to play sports. If by chance you can't pass those tests but have been playing sports without injury, don't think I'm wrong calling you a candidate for injury. You're playing on borrowed time, and you're likely to end up in the doctor's office."

Kraus' preachments and theories in this book deal almost exclusively with muscles. He composes a veritable symphony of fitness when he writes, "Your muscles allow you to move and express your thoughts. Your use of your muscles affects your metabolism.... An athlete in training can consume up to 6,000 calories a day without gaining weight. Vigorous exercise relaxes both your muscles and your mind. Fifteen minutes of exercise that causes the heart to beat 100 to 120 times a minute has been shown to have measurably greater tranquilizing effect than 400 milligrams of meprobamate, the generic name for Miltown and Equanil...."

Kraus warns that the muscles are easily—and adversely—affected by the frustrations and (perhaps worst of all) the mechanization of modern life. "As a result of the constant assault of irritations and the inability to work them off in the course of daily living," Kraus writes, "many people lead the lives of caged animals. Their muscles become more and more stiff and tight because they don't work off the accumulated tension."

Kraus categorizes four different kinds of pain that occur in muscles. "If you appreciate the difference," he says, "you can treat the pain appropriately. I cannot stress this enough because muscle pain is often baffling to both athlete and physician." (Dr. Nagler, for instance, points out that 80% to 90% of all back problems are not caused by any pathology, but are of muscular origin.)

The four kinds of muscular pain defined by Kraus are:

1) Pain from muscle spasm. This follows a severe strain or sprain, or a fracture. A spasm of the muscle triggers a vicious chain of pain and contraction, pain and contraction, which can continue for days. The chain can be broken by ethyl chloride spray, ice massage or, when dealing with a spasm in the back, a hot pack. Then the muscle can be exercised with a gentle limbering motion. Oral pain-killers or tranquilizers do very little to relieve the pain of muscle spasms.

2) Pain from muscle tension. This occurs when a muscle remains contracted beyond the momentary need to perform a task. This sets up a constant, nagging pain, often in the neck, back or head. A so-called "tension headache" is an example of this type of pain. Tranquilizers alleviate it, but to avoid long-term use of tranquilizers, exercise of the muscles involved must be performed.

3) Pain from muscle deficiency. Weak or stiff muscles cause this by not carrying their load. For example, weak abdominal muscles often cause pain in the lower back muscles. Or an athlete with a stiff or weak quadriceps muscle may experience intense knee pain. This kind of pain can be dealt with only through therapeutic exercises designed specifically to correct the deficiency involved.

4) Pain from triggerpoints. For the layman-athlete this could be the most significant revelation in Kraus' book. "The most neglected of all causes of muscle pain, triggerpoints are small hard nodules in muscle that literally trigger pain and spasm," he writes. "They have been biopsied and shown to be areas of degenerated muscle tissue." This phenomenon has been known since the late 19th century. Max Lange, a German orthopedic surgeon, did the classic work describing the distribution, origin and pathology of triggerpoints in 1931, and many researchers have since studied them. Yet, Kraus says, "Most physicians are completely unaware of the existence of triggerpoints and their significance."

The commonest cause of tennis elbow, according to Kraus, is triggerpoints that develop from the repeated shocks to forearm muscles caused by a faulty racket swing. Because triggerpoints usually occur at a point where a muscle is attached to a tendon or a bone, they are also probably to blame for a majority of sore arms and shoulders suffered by baseball pitchers, Kraus believes. Runner's knee is frequently caused by triggerpoints, as are various pains in the neck, calves, back and the occipital region of the head. In fact, President Kennedy's back problem was caused in part by triggerpoints.

Nevertheless, says Kraus, triggerpoint therapy has been slow gaining acceptance. Says Kraus, "Back in 1931 when Lange published his book on the subject, he predicted that 20 years would pass before the medical profession recognized their significance. He was an optimist. Even today few standard medical works discuss them." Kraus points out that Taber's Cyclopedic Medical Dictionary, 12th edition, 1970, a standard reference book, doesn't mention triggerpoints. There is, however, an entry in Taber's, defining tennis elbow as "an obscure, insidious, distressing complaint," for which treatment is as follows: "In mild cases, immobilization by a splint or adhesive strapping, supplemented by heat or diathermy. In long continued cases, surgical intervention may be indicated."

Dr. Nagler doesn't share Kraus' pessimism about the progress of triggerpoint therapy. "I would not agree with him that few doctors are using it," he says. "I would say triggerpoints have widespread acceptance. One reason the treatment isn't practiced more is that it's a lot of work for the physician. It's easier to send the patient to X-ray and other labs than to search for triggerpoints."

The treatment of triggerpoints involves a relatively simple, though tedious and, for the patient, uncomfortable, technique—something Kraus calls "mechanical destruction." Once the triggerpoint is located through methodical manual probing by the physician—followed at each successful probe by the patient's wincing—it can then be destroyed through injection and needling with a hypodermic syringe filled with lidocaine, an anesthetic. (Should a patient be sensitive to lidocaine, then a saline solution matching the salt content of the blood is substituted.) The needle is moved in a circle; as the sore spots are touched, lidocaine is injected. The combination of needling and injection eventually breaks up the triggerpoint. Three to four days after the injection, Kraus applies electric muscle stimulation and ethyl chloride spray, and then directs the patient in gentle exercise of the affected muscle.

Kraus points out that triggerpoints are more commonly found in people with an endocrine imbalance, such as women in menopause, or those suffering from hypothyroidism or Addison's disease. However, he warns that triggerpoints often occur in athletes in top condition—and Kraus himself is no exception.

All his life, Kraus has been an expert rock and mountain climber, a nimble and powerful man in superb physical condition. Yet he, too, has been a triggerpoint victim. "Once while mountain climbing I had to chin myself with one hand over an overhang in order to avoid a terrible fall," he says. "As I pulled myself up, I felt something tear in my right shoulder. It hurt. However, I not only climbed farther that day, but for the following three weeks as well. Eventually I knew from the pain that a triggerpoint had developed in the shoulder blade muscle. I tried pressure, heat, cold and electrotherapy. None of these methods worked. Then I had the triggerpoint needled and injected. That eliminated it."

For a long time Kraus has been, as he puts it, "a very active consumer of orthopedic medicine." His injuries over his vigorous years of participation in a variety of tough, risk-filled sports—ranging from motorcycling and rock climbing to downhill skiing and boxing—have been frequent and sometimes painful. Besides stripping the skin off his hands, he fractured his right wrist and a finger in the mountain accident in 1921. Three years later he broke a tooth and tore the biceps of his left arm in a motorcycle accident. A short time later he cracked the fifth metatarsal of his left foot when he was skipping rope and snagged a toe in a crack in the floor. He fractured an ankle skiing at Big Bromley in Vermont in the early 1940s and badly reinjured his left arm while glissading down a snowfield in the Tetons, also in the 1940s. He suffered three deep gashes in his scalp, a huge hematoma in his back and countless contusions in a 60-foot fall down a rock face in the Shawangunk Mountains of upstate New York in 1959. Over so many years of falls and shocks, and a lot of jogging, he has all but wrecked his knees. Suffering from a chronic deterioration of the cartilage in back of the kneecaps and a breakdown of the cushion of fibrocartilage in the joints, he was forced last year to have both knees operated on—"a general housecleaning," as he puts it. Despite Kraus' criticism that unnecessary surgery is often performed on injuries that could be treated by less traumatic means, he's enormously grateful for the surgical breakthroughs that have allowed a man of his age to recover from such a potentially debilitating condition. In his case an arthroscope was used, a tubelike device inserted into the knee joint to clean out fluid and debris that had accumulated over decades of blows and injuries. "If it hadn't been for that technique, I would have been laid up for a long, long time," he says. "My knees might have survived the kind of major surgery that used to be necessary in such cases, but the time of immobility for a man of my age would have made it very difficult to get in condition again."

After knee surgery, Kraus was back cross-country skiing within 10 days. He was also back in the Shawangunks, among the best climbing areas in the world. Kraus is one of the grand old lords of climbing in that region, having done something like 50 or 60 first ascents in the region since he began going there with his old friend, Fritz Wiessner, now 81, who is acknowledged as the discoverer of the Shawangunks as a climbing area in the late 1930s.

Kraus has a weekend house in upstate New York, scarcely a rope's length from the Shawangunks. He is slightly limited on the faces he can ascend these days, not so much because of his knees, but because of the ancient injury to his hands. He is now unable to grip anything firmly between his right thumb and forefinger. Still, almost every weekend he makes ascents that would wither the soul of those unaccustomed to the risks that climbers of Kraus' skill take for granted.

Kraus has been associated with skiing in the U.S. for 40 years or more—and still is. He was elected to the Ski Hall of Fame in 1974, largely because of his longtime reputation as "The Ski Doctor," an appellation earned for his services to Billy Kidd and other members of the U.S. ski team and for his years as an official advisory physician of the National Ski Patrol. In 1959 he married a ski racer—Madi Springer-Miller, 26 years his junior and a member of the 1958 U.S. ski team. They have two daughters, one still in college, the other in her first year at veterinary school. Kraus still thinks nothing of an eight-mile trek on cross-country skis, although he now rarely does any downhill skiing. Injuries are part of the reason, but he also considers such skiing to be a lazy man's sport in these days of chair lifts and gondolas—a sport he dismisses as "yo-yo skiing."

His views on American sport in general in the 1980s have been influenced by his own involvement as a ruggedly individualistic participant. He is particularly critical of those who huddle before television sets to watch football, and he is downright scornful of the game itself. He says, "Our age is a viewing age. People don't do, they view, and that isn't basically healthy. They are vicarious livers, people sitting around waiting to see an accident—and football is happy to oblige. Football makes injury unavoidable. Players are coached to inflict injury. A young man shouldn't be afraid of injury. Men should be exposed to danger, they should be exposed to injury. But certain injury—no, that isn't good, particularly at an early age, as high school football players are. To experience danger and to overcome it—that is a good, healthy, educational experience. To simply sit around and view danger and view injury—that isn't good."

And what of the so-called fitness boom? Hasn't this made a noticeable difference in the condition of the American population? Up to a point, Kraus admits, though he's still skeptical: "The run-of-the-mill person still considers himself a sportsman if he watches TV games, guzzles beer and munches pretzels. It's true that middle-aged people are doing more for themselves than before. There are joggers everywhere—but they're still a tiny minority of Americans. There are still no meaningful programs in the schools to produce concentrated physical conditioning for children. Still, things are better than they were."

PHOTOLANE STEWARTIn a demonstration, Kraus shows how he uses ethyl chloride to numb an injured area, after which rehabilitation can begin.PHOTOLANE STEWARTA stroll up the Shawangunks, rugged mountains that the 75-year-old Kraus has climbed for 40 years.PHOTOLANE STEWARTWith his wife, Madi, a 1958 U.S. ski team member, the energetic Kraus enjoys a moment of repose.PHOTOLANE STEWARTJoyce taught Kraus how kidneys can make chords.