They are the cr√®me de la cr√®me of the best Alpine ski-racing team that the U.S. has ever produced, but every one of them must be classified, quite literally, as being among the walking wounded of sport. Had their wounds occurred not so many years ago, they'd be limping along among the also-rans and the never-starteds of world-class skiing. Their number includes the best American male ski racer of all time, Phil Mahre, who has won two straight overall World Cup titles and leads the standings again this year. Their company also includes the second-best male U.S. ski racer, Phil's twin, Steve, who won a gold medal in the 1982 Fédération Internationale de Ski world championship giant slalom and finished third in the overall World Cup totals last year. Other members of the club are Tamara McKinney, currently second in the overall women's World Cup competition, Christin Cooper (two silver medals and a bronze in the 1982 FIS worlds) and Cindy Nelson (a silver at the '82 worlds), not to mention most of the rest of the U.S. women racers.
All of these skiers have been so badly hurt at one time or another in the past five years that orthopedic surgeon J. Richard Steadman is able to say with authority, "If injuries of the type these kids have suffered had happened in the 1950s to people like Stein Eriksen or Toni Sailer, they would have been out of top-level ski racing for life."
No one knows better than Steadman what has been required to put injured U.S. skiers back on the slopes. Since 1976, when he became the chief physician of the U.S. Ski Team, Steadman has treated, through surgery and/or rehabilitative exercise, no fewer than 63 serious injuries suffered by 31 members of the team. They have been, in effect, reborn on his operating table. As Hank Tauber, who brought Steadman aboard when he was director of the team, says, "His success record is absolutely unprecedented. When he's in Europe, people from other teams ask his advice on the hill. They all know who he is. And, believe me, he knows he's good, too. He told Steve Mahre after his last knee surgery, 'Now I've really put a gold-medal knee together for you.' Dick meant it and, more important, Steve believed it."
Steadman's reputation in his profession is also first-class. He's known for his knee surgery and for his ability to correct the most ruinous fractures with open reduction surgery, which reinforces bad breaks with metal plates and screws. And his prescription of immediate, controlled physical exercise following even the most traumatic surgery, once thought to be radical, is now commonly considered a key to quick recovery. Dr. Robert Kerlan, founder of Los Angeles' Southwestern Orthopedic Medical Group, who has treated many famous athletes himself, says, "I consider Steadman definitely in the top group of surgeons in the U.S. His pioneering in immediate post-operative rehabilitation has been extremely important to highly skilled athletes whose livelihood might depend on the quickest possible recovery."
February 21, 1983
Most physicians who reach the top of their profession tend to practice in major population centers. Not Steadman. He is tucked away in remote South Lake Tahoe, Calif. (pop. 20,681). The place is more than an hour by car from Reno, the nearest city of any size. Says Steadman, "Living in Tahoe sets up a natural screening mechanism that brings in what you might call really dedicated patients, because coming here is difficult."
It wasn't all that easy for Steadman to get there himself. He spent most of his boyhood in Sherman, Texas and wound up moving around and about—to Berlin, for example, in the late 1940s—after his mother was remarried to an Air Force man. Steadman finished high school in the little town of Fairborn, Ohio, where he starred at football, basketball and golf, as well as at scholarship. He'd known for years that he wanted to be a doctor, largely because of the influence of two M.D. uncles who greatly impressed him. At graduation he found himself with a choice of three vastly dissimilar colleges: Harvard, the University of Michigan and Texas A&M. He chose Aggieland.
Why? Bear Bryant. Says Steadman, "I had met Coach Bryant when he was on a recruiting sweep through Ohio. I really wasn't a very good player, but he made me feel great. I was indoctrinated for two years in the atmosphere that Bryant created: 'Suck it up and hit 'em hard.' It made the rest of my life different."
Steadman, 6'3" and 220 pounds, was a 195-pound tackle at A&M, and in those days Bryant staged one-on-one "challenges" between his marginal players to see who would make the traveling squad. Steadman managed to fight his way onto the 36-man squad as a sophomore. But Bryant-type football took its toll: Steadman was nailed with a D in a course in comparative anatomy, a grade that could have kept him out of medical school. He agonized over the conflict between football and medicine, stayed on the team through spring practice in his sophomore year and was told by Bryant that he would certainly be playing a lot the following fall.
"That was a terrific team," Steadman recalls. "We were picked to be No. 1. I had a terrible time making up my mind. I spent the whole summer agonizing, then I wrote Coach Bryant a letter in August and said that I just was not willing to risk my career as a doctor. I quit the team. Well, he wrote back and he said that he respected my decision. He said that he hoped maybe someday I would take care of him when I got to be a doctor."
After medical school in Dallas, Steadman interned at Charity Hospital in New Orleans, was drafted for Army service in Germany—where he got hooked on skiing—and then returned to New Orleans for a four-year residency in orthopedics, which he finished in 1970. At a professional conference in Colorado he had met an orthopedist named Paul Fry, a vibrant redhead who had a practice near Lake Tahoe. Fry invited Steadman to visit California, they liked each other, and they agreed to practice as partners. That was the genesis of an orthopedic clinic that today has five doctors. Steadman lives two miles from the clinic in a splendid glass-fronted house on the shores of the lake with his wife, Gay, a talented expressionist painter. Weather permitting, he rides to his office—and to his operations—on a bike. Of practicing orthopedics in the far reaches of the Sierra Nevada, he says, "There was tremendous activity from the start when there were only the two of us. We practically had a night-and-day practice with all the injuries from the ski areas."
The first couple of years, Fry and Steadman dealt mainly with broken bones on an emergency basis. Today, Steadman says, "We all tend to specialize in different kinds of orthopedics. My own practice is 80 to 85 percent involved with knees. I do from eight to 12 knee operations every week. I've narrowed my practice enormously. I wouldn't do an appendectomy at this point. I don't regret narrowing my specialties, not at all. I'm able to maintain a high educational level in the areas I've chosen. Most of what I've learned about athletic injuries isn't from medical school, it's from experience."
Obviously, no single source has offered more in terms of high-grade experience than the U.S. team. As Steadman says ruefully, "We have had the opportunity—fortunately or unfortunately—to do a lot of work on the knees, ankles and legs of first-class athletes. Skiing produces more joint injuries than almost any sport but—possibly—football. When you're skiing at a high speed at the absolute edge of your control, as these kids are, you get hurt when you fall."
Have U.S. skiers suffered more serious injuries than those on other national teams? After a pause, Steadman says, "No, I don't think our ratio is much higher. However, we might have suffered more injuries to our best people. Also, because we have less depth than other teams, we probably have more pressure to recycle people, to get them back out there sooner and in better shape."
The "recycling" of American ski racers has become Steadman's major professional preoccupation—although obviously the vast majority of all the knee operations he performs are done on far more ordinary mortals. "The growth of our clinic's practice is a direct result of the fitness boom," he says. "Most of the people I operate on are undergoing corrective surgery by choice, not necessity. They like to jog or play tennis or participate in some active recreational sport, and they have decided that rather than adjust an active life-style to fit a bad knee, they will repair the knee to fit the life-style."
Of course, the repair of injuries to World Cup-level ski racers isn't a mere matter of life-style but of livelihood. Being sidelined costs money—tens or even hundreds of thousands of dollars for each skier.
Steadman's most celebrated piece of surgical recycling was his work on Phil Mahre's shattered left ankle. The injury was freakish in the extreme. Mahre skied into a giant-slalom gate during a World Cup race on the Lake Placid Olympic course late in February 1979. There was nothing spectacular about the accident, but he was in extreme pain; when he was taken to a local hospital for X rays, doctors and technicians were surprised by what they saw. Bones were shattered and broken as if they had undergone tremendous impact. Three days later, after Phil had been flown to California, Steadman cut the ankle open, and he could scarcely keep from exclaiming at the mess he found. Because Phil had elected to have a spinal anesthetic and was awake on the operating table, Steadman saved his expletives for later. The operation itself, which was the subject of much media attention during the 1980 Olympics, mainly involved placing an intricate and super-strong fixation device in the joint that included seven screws and a metal plate.
Steadman had warned Mahre that it was most unlikely that he would be back skiing at world-class level in less than 11 months. Nevertheless, the day after surgery the doctor had him doing exercises involving his good ankle, all other parts of his body and the freshly repaired ankle. Phil then moved into Steadman's home, which is open to all injured ski-team people. By the time he returned to his home in Yakima, Wash, two weeks later, Mahre was able to ride a stationary bike for 30 minutes, using both legs. Eight weeks after the operation, Phil had recovered 80% of flexibility in the shattered ankle. Five months after the operation he was skiing. Three months later, on Dec. 8, 1979, at the first World Cup event of the season, he finished 14th in the giant slalom, 29th in the downhill and got a first-place in the combined. And in February of '80 he won a silver medal in the Olympic slalom, a bit more than 11 months after his ankle was pulverized.
Nearly as amazing was the rehabilitation performance of Steve Mahre last year. Because of his fervent commitment to the joys of motorcycle riding, his knee injuries pre-date his world-class skiing days. In December, 1981, as the World Cup season began in France, both of Steve's knees kicked up, causing him trouble on turns. When Steve came back to the U.S. at Christmas, Steadman did arthroscopic surgery on both knees, taking out cartilage, and adjusting synovial plica, the bands of thickened tissue that line the joint behind the kneecaps—this despite the fact that the FIS world championships were less than five weeks away. "I knew he had a capacity for excellent recovery," says Steadman, "so I wasn't too concerned that he would be ready." Steve was very ready, winning that historic FIS gold, the first ever for an American male.
That wasn't the last of Steve's knee problems. Steadman recalls with a smile, "About three weeks after he won the medal he was back in the States and he was playing basketball when his left knee locked. He flew to Tahoe, and I did another arthroscopy. He stayed with me two days doing exercise, then went back to Europe. I guess it was maybe 10 days after I had operated when someone said to me, 'Hey, did you hear that Steve won a race today in Czechoslovakia?' That was the biggest surprise I've ever had with these kids."
Over the years, Steadman has had plenty of opportunities to be surprised by various members of the U.S. team. For the record: Nelson, 27, has had three knee operations—two arthroscopic, one open—plus surgery on a fracture and ligaments of her left ankle, yet she had her best season in 1982 with a silver in the FIS downhill. Cooper badly broke an ankle skiing in South America in 1978, and required surgery by Steadman; she was back scoring in the Top 10 within 10 weeks. Last season she got those three FIS medals and finished third in the overall World Cup standings. She was coming on strong again this year when, on Jan. 28 at Les Diablerets, Switzerland, she severely injured her left knee and broke her tibia in a freakish way—so badly that Steadman had to graft a bit of bone from her hip to it. Last week, immediately after the operation, the doctor had her using a passive-motion machine to bend and straighten her knee, and two days later she was hobbling about on crutches, her recovery speeded by the use of a trans-cutaneous muscle stimulator, a little black box that sends small electric charges through four electrodes attached to the muscles of her thigh. Cooper is out for the season but, typical of Steadman's patients, is planning to compete again next year. McKinney dislocated a kneecap in 1981, an injury Steadman treated without surgery; she won the World Cup giant-slalom title that year. Holly Flanders, who finished a very impressive second in World Cup downhill racing for 1982, had both kneecaps rearranged and some cartilage removed last spring.
To keep the record straight, it should be pointed out that though Steadman is the No. 1 ski team doctor, there are others. Steadman administers a program in which a pool of about 30 other orthopedic physicians is available so that, whenever the team is on the road, there will always be at least one American doctor on hand. These physicians are volunteers and, like Steadman, pay their own travel expenses, which are tax deductible as contributions to the team.
Steadman is now planning to start an organization called the Sport Performance Orthopedic Research and Training Foundation. (The acronym is S.P.O.R.T, what else?) Among other things, Steadman would like to see S.P.O.R.T. develop a brace that would prevent, or at least reduce, the number of knee injuries in skiing. "Maybe we could come up with something that ski racers would be required to wear, like the helmet in the downhill," he says hopefully.
At 45, Steadman is at the top of his profession, yet he's a relatively modest man. "You have to make it clear that I haven't done this by myself," he says. "There are orthopedic surgeons everywhere in the country, and we share with each other any new techniques or ideas we come across. There's terrific interplay in the profession and I benefit from it all the time." However, not everything can be shared because not everything can be graphically explained. As Steadman says, "Quick mobilization is a great way to get people back on their feet, but there's a thin line between doing too much too soon and doing exactly the right amount of exercise to accelerate the rehabilitative process. There's as much art as there is science in it."
And to the U.S. Ski Team, Steadman is the master artist.