The Next Time Your Hip Hurts

From the New York Times Magazine.....

What He’s Been Pedaling

By DANIEL COYLE
Published: July 16, 2006
“That’s the one,” Floyd Landis said, his index finger tapping rapidly on a glossy page. “That’s what I want.” It was a lovely June evening in Murrieta, a small city in Southern California, and it was 10 days before the start of the Tour de France, the most prestigious and grueling of all cycling races. Landis, one of America’s hopefuls in the race now that Lance Armstrong has retired from the sport, was sitting on his patio, eating a piece of Greek-style pizza and shopping for a new hip.

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Jonathan de Villiers for The New York Times
Landis in his Strasbourg hotel room two days before the start of the Tour de France, demonstrating the time-trial position that he calls the Praying Mantis.

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Top, Landis's initial fracture. Middle, the screws that fixed the fracture. Above, with blood cut off by the fracture, the ball of the hip, normally round and smooth, has become worn and necrotic.
Actually, he was not shopping so much as hunting. As Landis looked through the pages, his lean 5-foot-10, 150-pound body shifted hungrily, his muscles flickering beneath his tan Harley-Davidson T-shirt and blue jeans. His gaze was sharp and intense; his reddish hair stuck out in spots, as if it were electrified.

Landis, who is 30, slid the booklet, an annual report from a joint-replacement manufacturer, across the table toward Brent Kay, his doctor. Together they gazed at the silvery ball-and-cup assembly identified as the Durom hip system.

“Nice, huh?” Landis said, and it was hard to argue. In the oversize photograph, the Durom was a glistening, precision-milled orb. It resembled a Henry Moore sculpture or perhaps an expensive set of drawer pulls.

“Sure, it might look good,” Kay said, drolly setting himself up for the inevitable bike-shop bon mot. “But do they make it in titanium?”

“They’d better!” Landis’s face beamed with a fierce smile, his voice rising with mock indignation. “I wouldn’t want anything to slow me down!”

Landis was being funny here, and like most of his humor, this joke works because it cuts two ways. First, it’s funny because in almost every situation in his life, Landis is slow. He walks with a limp. He sits as often as possible and cannot cross his right leg over his left. He takes elevators instead of stairs, valet-parks at the shopping mall and sometimes has difficulty sleeping. Running is out of the question. Like many of the 216,000 Americans who will receive hip replacements this year, his life is defined by chronic, debilitating pain.

Second, it’s funny because there exists a singular situation — which is to say, when he is on a bike — in which Landis is extremely fast and strong. He is so fast and strong, in fact, that this year he has won three world-class races and, as of July 7, was among the leaders in this year’s Tour de France, which ends July 23 in Paris.

But perhaps the funniest part is that Landis has been successful at keeping his hip condition a secret from teammates, rivals and the media for 20 months, confiding it only to a small handful of doctors and close friends. This maneuver has involved what Landis, who was raised as a Mennonite in Lancaster County, Pa., calls “a few adaptations.”

“I always have to get on my bike putting my right leg over first,” Landis told me. “If I tried to get on the other way” — tilting his pelvis against his damaged hip — “I’d be lying on the pavement. Then people would be standing around wondering what the hell’s wrong with that guy?”

Landis’s right hip — his original, in the car-mechanic parlance of the joint-replacement field — is afflicted with osteonecrosis, or bone death, a degenerative condition caused by lack of blood supply. (The condition, which forced Bo Jackson, the star football and baseball player, to get a hip replacement in 1992, is also called avascular necrosis.) Essentially, the ball of Landis’s hip has withered and collapsed, resulting in bone that his doctors liken to a chunk of rotten wood, a sunbaked desert and a half-melted scoop of ice cream.

The Tour de France’s status as the world’s most physiologically demanding event is largely unquestioned. The riders cover 2,272 miles at an average speed of 25 miles per hour, roughly the equivalent of running a marathon almost every day for almost three weeks. In the Pyrenees and the Alps, they climb a vertical distance equal to three Mount Everests. They take in up to 10,000 calories per day, the equivalent of 17 Big Macs, elevating their metabolic rates to a level that, according to a Dutch study, is exceeded by only four species on earth. All of which transforms Landis into the embodiment of an intriguing question: Is it possible for someone with a ruined hip to win the Tour de France?

Kay, who has worked closely with Landis for four years, and Dr. David Chao, Landis’s orthopedic surgeon, are in the best position to address that question. When asked, they swiftly list a few factors that work in Landis’s favor: the hip will be replaced, so it cannot be damaged any further; cycling is a nonimpact sport (that is, it doesn’t place weight on the damaged hip); Landis possesses a high pain tolerance and an unusually strong work ethic.

When pressed further, however, clinical rationality gives way to hapless shrugging. “This is uncharted territory,” says Kay, who runs the Ouch Sports Medical Center in Temecula, Calif. “I expect that people will freak out a little when they hear about this; they’ll say it’s dangerous to let him compete. Well, before they say that, they need to know Floyd. The only way to stop him would be to literally chain him to his bed, and even that probably wouldn’t do it.”

Chao, who serves as team physician for the San Diego Chargers, says that he sees “a lot of injuries, a lot of guys playing with pain. But if I were a betting man, and you showed me Landis’s X-rays, I would bet my house that he could not be competitive in the Tour de France. This is the hip of a guy who, if he were just a weekend warrior, would have problems with everyday living. But to be a top athlete? Where a 1 percent performance loss is a big deal? No way.”

As for Landis, he responds to the question in his customary fashion, which is to question it. “Well, I’m doing it, so it must be possible,” he said, his face flashing into the sharp, faintly incredulous expression he often gets when he talks about his hip. “All the doctors have ever been able to tell me is that I should get a replacement when the pain gets to be too much. O.K., that sounds fine, but how much is too much? Can anybody tell me that? How much is too much?”

andis jokes about his hip a lot. As Kay puts it, he’s a one-man comedy show. During my visit last month, the Floyd show consisted mostly of vivid, darkly funny monologues, most of which spring from his hourly epiphanies.

“I got it!” Landis said. “When this is over, I’ll have the surgeons give me my old hip, and I’ll sell it on eBay. I’ll mount it on a trophy.” He pantomimed lying on a stretcher, talking to an invisible surgeon. “Excuse me, could I please get a to-go bag?”

“I need a cane!” he blurted out another time. “I’m going to show up at the tour with a cane, diamond tipped. Or maybe I should just go straight to the wheelchair. Motorized, with rims. Now that would be classic: drive up to the start, get out of my wheelchair and get on the bike! Yes!”

Yet when Landis was asked what his hip feels like, he fell silent. “It hurts a lot,” he said after a while. “Mostly, it stops me from doing things.”

How much? What’s it feel like?

Landis squinted. He rubbed his hand over his face.

“It just hurts,” he said finally. “Some days are worse; some are better.”

Part of his ineloquence is job-related. Bike racers, like test pilots, don’t like to talk about crashes or pain. Least of all Landis, whose distaste for excuses is well known in the professional ranks. As he concisely puts it, “You’re either good enough to win or you’re not, period.”

Fortunately, a survey begun in 2005 by the Osteonecrosis/Avascular Necrosis Support Group International Association offers a measure of insight. Respondents wrote that their pain was like “sharp stabs,” “crunching bone,” “labor pains,” “electrical shock” and “grinding your bare feet into hot broken glass and jagged shards of metal.” Another respondent invoked the labors of Sisyphus; still another wrote: “You lose everything even yourself in the pain. It consumes everything.”

Landis is better at describing a different sort of ache: the uncertainty of deciding when and how to swap out a painful-but-still-usable body part. In one of our first conversations, which took place after he revealed his condition to me in mid-May, Landis spoke about the process. “It’s so hard, deciding which way to go,” he said. “Some days I just wish the thing would collapse just so it would get resolved one way or the other. It’s too stressful, not knowing what’s going to happen. It’s a big weird gray area, and I’m tired of it.”

Landis officially arrived in that gray area on Nov. 19, 2004, after he came to Kay complaining of deep hip pain. “Just the fact that he admitted he was in pain meant in my mind that this was serious,” Kay recalls. “I saw the X-ray and felt sick to my stomach.”

It wasn’t a complete surprise. Landis and Kay had been dealing with this hip since January 2003, when Landis fractured it in a crash. But since July of that year, the story line had been his gutty, two-surgery comeback to help his U.S. Postal Service teammate Armstrong win the 2003 Tour de France. Seemingly fully recovered, Landis had followed it up with a breakout 2004 season that saw him join the top ranks of the sport. But that story ended with the radiologist’s blunt report: advanced osteonecrosis, 25 to 50 percent femoral head collapse, with superimposed osteoarthritis. It was a textbook case: cut off from the blood supply, the femoral head was withering into a cauliflower-shaped knob that was already grating away at the remaining cartilage.

Landis’s situation was complicated by the fact that he had just left U.S. Postal to sign a three-year, $700,000 contract to lead the rival Phonak team. Worse, his new team had just been hit with a series of doping scandals — among the riders fingered was his fellow American Tyler Hamilton — which endangered the team’s spot in professional cycling’s ProTour. “Those were very, very dark days,” Landis’s wife, Amber, told me. “Floyd was all over the place mentally.”

Landis explained: “I finally had everything the way I wanted it, and then suddenly it was all going to go away — my team, my health, my career, everything. I got paralyzed by the whole situation. So I just told myself that it was going to be all right and blocked everything else out.”

He began researching his options. (“Floyd spent three straight days at the computer,” Amber recalled. “I don’t think he slept.”) Kay posted pseudonymous queries on cycling Internet forums, trying to locate professional cyclists who had successfully returned to competition after a hip replacement. (He found none.) Landis studied medical literature and haunted chat rooms and after a few days came to a decision. He would approach his hip as an experiment. He would ride on it for one or two years, then get a new one.

“Odds were, a replacement would work O.K. and take away the pain, which would be a huge thing,” Landis says. “But it’s still an unknown as far as performance goes. I basically decided to treat the hip like an old car — if it still works, you may as well run it into the ground.”

He also decided to tell only his coach, his trainer, his agent, his financial adviser and a few other close friends, swearing them all to secrecy. “I was worried about people finding out and somebody stopping me from riding,” Landis says. “In retrospect, I probably should have been more open. But I didn’t want anybody thinking I was damaged goods. And I had this idea that if I could just keep riding, everything would be O.K.”

Just before Thanksgiving in 2004, three days after the initial diagnosis was confirmed, Landis underwent a medieval-sounding palliative procedure called decompression, in which his hip was drilled with a dozen or so small holes that relieve pressure and help renew blood flow. Leaving the hospital on crutches, Landis employed a decoy, placing a large splint on his healthy right ankle. When asked about his limp, Landis said that he had tripped on some stairs, nothing serious. A few days later, the experiment officially began as Landis flew to Europe to meet his new team and to begin preparation for the 2005 season.

When Landis saw the Swiss doctor in the white lab coat, his heart sank. It was 10 days after his decompression surgery, and Landis was standing in an exam room near the Phonak corporate headquarters outside Zurich, wearing only his underwear.

At first, Landis hadn’t been worried about passing the physical. In his experience, the exams were perfunctory at best, designed to fulfill the “physically able to perform” boilerplate contained in every rider’s contract. But Phonak, as it turned out, was relatively new to the cycling game and eager to display their Swiss thoroughness and efficiency. All riders, it was announced, would be receiving full orthopedic examinations. “When I heard that, I figured I was screwed,” Landis recalls. “I’d be packing my bags, looking for another job.”

The Swiss doctor began by eyeing Landis’s posture and announcing that his right leg appeared to be five millimeters shorter than his left. (The difference, because of the collapse, is actually on the order of 15 millimeters.) Then, as Landis lay back on the exam table, the doctor began to pry and rotate his legs. Landis did the only thing he could think of: he stiffened his good left leg so that it came close to matching his right.

To Landis’s disbelief, he passed. “What was that guy thinking?” Landis told me, almost offended at his good fortune. “At that point, I couldn’t walk up stairs without a handrail!”

Temporarily rescued, Landis spent the rest of the winter as he would spend much of the 2005 season: pretending not to hurt. Unable to press hard on the top of the pedal stroke with his right leg, he pedaled harder with his left. To ride his time-trial bike, which required a hunched aerodynamic posture, Landis was forced to ride on the nose of his saddle, a near-proctological position that drew amusement from his fellow riders but which, because it created a wider angle between his trunk and his femur, permitted his hip to work. “Everything’s a compromise,” he says. “You get one pain or you get the other pain. No way around it.”

He adapted in other ways, acquiring a shoulder-rolling, stiff-legged walk to disguise what a trained eye might identify as an externally rotated antalgic gait. Landis was assisted in his subterfuge not only by his offbeat reputation but also by cycling’s social structure. As a rule, professional riders live and train apart from one another, gathering only at races and occasional training camps. Phonak, like most ProTour teams, consists of 25 riders, an ever-changing handful of whom are chosen by coaches to compete in each event. At races, when Landis’s teammates noticed his walk, they saw it only as an invitation to tease him about his rap-star strut. “I’m not quite as cool as they think I am,” Landis says archly.

His friends came up with codes. In phone calls, his coach, Robbie Ventura, referred to Landis’s hip as “the finger.” Another friend would ask Landis how “his bad back” was doing. As the season wore on, the secret held.

“I was kind of amazed at first that nobody noticed,” Landis says. “But then I realized that it’s such a weird thing, that you’ve really got to look for it. Everybody’s ready to look to see if you’ve got a cough or if you’re two pounds overweight, but they’d never look for this.”

Landis’s most useful adaptation, however, came in the form of an idea. It was planted in his head by Kay, who, as fate would have it, suffered osteonecrosis of the shoulder from a college car accident and had gone on to complete six Ironman triathlons. Kay’s idea was that it might be possible, through repetition, to wear a useful groove in the bone and cartilage of his damaged joint. “Floyd really liked the groove idea,” Kay says. “He never wanted to look at the hip or any X-rays or even talk about the clinical part of things, but he kind of fixated on that idea.”

Landis explains: “When the hip does something weird and it hurts, I always imagine that it’s cutting a better path in the joint. I’m probably fooling myself, but I may as well imagine something good is happening, since it definitely doesn’t help to think that it’s getting worse.”

The secret also supplied psychological fuel. During races, Landis cataloged riders and their favorite excuses. “Every time I heard somebody talk about how bad their stomach ached, I thought, That guy will be easy to beat when I get in shape,” Landis says. “And that works pretty well, because sooner or later, everybody makes an excuse.”

To outward appearances, Landis’s 2005 season fell below expectations. He finished 3rd at the Tour de Georgia, 11th at the Dauphiné Libéré and a hard-fought 9th in the Tour de France behind Armstrong. The true results, however, could be found in another number. According to his estimates, Landis rode 250 days for 5 hours per day at a cadence of 90 revolutions per minute. Which means that the damaged femoral head moved 6.7 million times back and forth along a narrow track within the cup of the hip joint.

n my second day with Landis, we traveled with Kay to Chao’s San Diego office for Landis’s pretour cortisone shot in his hip. (Cortisone, a non-performance-enhancing hormone with a variety of anti-inflammatory and other beneficial effects, is a banned substance. Landis’s condition, however, which his doctors have selectively described as “bursitis,” has allowed his team to obtain a therapeutic use exemption from the Union Cycliste Internationale, cycling’s governing body.)

After administering the shot, Chao gathered us at a conference table cluttered with a hardware-store jumble of ersatz bones and hip-replacement samples, testament to an expanding industry fueled by two trends — an aging, active generation and an increase in obesity. By 2030, hip replacements in the United States are expected to increase 174 percent, to 572,000 a year, according to a 2006 study by Exponent, a Philadelphia technology research firm. Artificial-knee implants are expected to increase 673 percent, to 3.48 million, over the same period, combining to create a rise in demand so abrupt that some wonder whether there will be enough qualified doctors to perform the required implants and the inevitable reimplants, called revisions.

The explanation for this increase lies partly with an ever-younger population of joint-replacement patients, some of whose arthritic conditions are accelerated by running and other impact sports, and partly with better technology. New, more durable plastics, along with improved metals and ceramics, promise to lengthen the 10-year life span of current replacements. These developments are not lost on the $4.3 billion joint-replacement industry, which has begun to develop niche products, like a knee designed specifically for women, and has also enlisted celebrities like Jack Nicklaus and Angela Lansbury to market directly to patients. In a similar fashion, Landis plans to raise the profile of osteonecrosis and hip-replacement issues through the charitable organization he intends to start during this year’s tour, tentatively called the Floyd Landis Foundation.

Conversation eventually turned back to the groove theory, specifically to whether this groove might actually exist. Chao, a brisk and cheerful surgeon who trained at Harvard and Northwestern, smiled knowingly and reached for Landis’s X-ray. As we leaned in, Chao pointed to a cloudy, half-moon-shaped blur on the rim of the femoral head, just beneath the pelvis. It was 1.5 centimeters long and a centimeter deep; it looked like a tiny pearlescent goblet.

“There’s your groove,” Chao said, tapping the film with a pen. “It’s soft, and the pelvis is pushing down on it. It’s a dent.” Landis looked at the X-ray intently, faintly pleased at this revelation but distinctly unsurprised.

When I ask him about it later, Landis said: “It was good to see, but it also makes sense to me. There’s a lot of friction, a lot of pressure. Logically, that pressure has to go somewhere.”

Geographically, Farmersville, PA., is situated in central Lancaster County, close to New Holland and Paradise. Spiritually, it is located close to 17th-century Europe, from which the Mennonites emigrated in order to escape persecution and follow the mandate set out in II Corinthians 6:17: “Come out from them and be separate.” As a young man, Landis obeyed the dictum, but not quite in the way his parents would have preferred. “That boy put us through the mill growing up,” Floyd’s mother, Arlene Landis, told me. “Just doing the normal thing, that’s boring to Floyd.”

By Lancaster County standards, however, the Landises were middle of the road. Floyd, his four sisters and his brother enjoyed the comparative luxury of being able to listen to the radio, attend public high school and ride in cars. And yet, to the young Landis, being Mennonite seemed to involve an unusual number of rules: no dancing, no television, no uncovered heads for women and no mingling with the unrighteous. “It wasn’t all the rules that got me, so much as the fact that they didn’t seem logical to me,” Landis says. “We weren’t allowed to wear shorts in gym class. Does God really care if somebody wears shorts or not?”

In Lancaster County, Mennonite children who test limits are said to “stretch” their parents. For Paul and Arlene Landis, the elastic started to fray when Floyd bought a mountain bike at age 15. At first, he used it to travel to remote fishing holes. Soon Landis was entering races, some of which took place on Sunday, a day when vigorous exercise was expressly forbidden. Landis kept riding, dominating regional races and then, at 17, winning the Junior National Mountain Bike Championship. Pressure was building, from both sides. “They basically told me I was going to hell if I kept racing my bike,” Landis says. “I love my parents, and they’re good people, but that didn’t make any sense to me. So I knew I had to get out, and the bike was the way.”

Two years later, he moved to California, having never tasted alcohol or caffeine or seen a motion picture. With the help of mountain-biking pals, Landis soon enacted a kind of Mennonite Pygmalion, receiving an education about music, movies, TV and dating. Landis returned the favor by supplying a few lessons of his own. “He did monstrous workouts no one else could do,” says Will Geoghegan, a former teammate on the Chevy Trucks mountain-bike team. “He sought out the pain and embraced it. Floyd worked so hard that we all had to decide about him — either he had a screw loose or he had a calculated plan to get what he wanted.”

In fact, Landis had a plan, an eight-year training regimen that he had drawn up with the help of his coach at the time, Arnie Baker. Some years called for Landis to log 24,000 miles, or about once around the globe. The level of training diminished Landis’s performance in races, but he was focused on more long-term goals.

In 1999, Landis switched over to road racing and three years later was signed by U.S. Postal, which at the time ranked as the sport’s version of the Yankees. Landis was quickly drawn into the orbit of Lance Armstrong, who was impressed by the newcomer’s unconventional sensibility and his toughness. The two trained together often as Landis grew into one of Armstrong’s top support riders and perhaps his closest friend on the team — at least until 2004, when Landis’s outstanding season drew offers from other teams, and he decided to leave U.S. Postal for Phonak. From there, the friendship deteriorated fast. Armstrong considered Landis’s move traitorous, while Landis considered Armstrong unreasonable, pointing out that Phonak had doubled Postal’s contract offer. The two spent most of 2005 in an occasionally spiteful feud, partly fueled by the fact that with his hip in such bad shape, Landis felt he had little to lose.

“There aren’t many guys in the peloton” — the main pack of riders in a road bicycle race — “who are willing to tell Lance to go screw himself,” says David Zabriskie, a top American who rides for the Danish CSC team. “Floyd just didn’t care.”




It was late afternoon, and Landis was reclining in the front seat of Kay’s Lincoln LS, the seat slid all the way back for comfort. We were on our way to the mountains north of San Diego to see the spot where Landis crashed in 2003. At the moment, however, Landis’s mind seemed focused on the future: specifically, on how the disclosure of his hip problem might play out at the Tour de France.

Historically, the spectacle of the injured rider who refuses to quit ranks as one of the tour’s most reliable sources of gloire, starting with Honoré Barthélémy (broken shoulder, dislocated wrist and eye injury, 1920), Eddy Merckx (broken jaw, 1975), Pascal Simon (broken shoulder blade, 1983). But Landis had a hunch that his disclosure might inspire a less worshipful reaction, at least among his rivals. “I better bring the X-rays, because some of them aren’t going to believe it,” he said, going on to recount the memorable drama at the 2003 tour, when Hamilton, riding for CSC, was forced to display X-rays of his cracked collarbone to quell intimations of fakery. “Most of the guys, though, will just not care. Which is fine with me — why should they?”

While Landis’s disclosure might surprise his rivals, his performance most likely won’t. The 2006 season — season No. 2 of his experiment — has so far been a resounding success. More interestingly, Landis is not sure why. “The hip doesn’t hurt any less,” he said. “It doesn’t feel all that different. I’m just going faster now.”

This past winter, Landis returned to Murrieta looking forward to his first surgery-free off-season in three years. He spent six weeks off the bike, underwent ultrasound therapy, trained a bit less than usual and watched in surprise as his power numbers ticked upward. (Power, the key measure of a cyclist’s ability, is measured by sensors mounted to the pedal cranks or wheel hub.) In 2005, Landis could maximally produce 900 watts for five seconds. By this spring, he could push 1,250 watts, a 39 percent boost.

His year started brilliantly. In February, he won the Tour of California. In March, he won Paris-Nice, and in April he won the Tour de Georgia. All told, it amounted to more than 1,900 miles of world-class competition. Landis was so dominant that until a below-average performance in early June’s Dauphiné Libéré, some in the media speculated that he might be doping, a rumor that entertains Landis to no end. Though not quite as much as the reports that some rivals have begun to copy his uniquely painful position on the time-trial bike. “Maybe they should break their hip, and it would work better for them,” Landis told me with a smile.

Kay attributes the improvement to a combination of increased rest, lack of stress and the fact that the joint seems to have stabilized. “It’s encouraging,” he said guardedly. “Something bad could still happen — some soft bone could break loose, maybe. But basically, it seems like he’s been able to remodel the joint and make it functional.”

I suggested to Landis that given this new stability, he might put off the hip replacement another year. As he suggested, run it into the ground. “No, no, no,” Landis said. “This hip gets used up, an athletic career gets used up. At some point, things are done, and this thing is almost there. Plus, Amber would kill me.”

Landis plans to schedule his hip replacement surgery for a few weeks after the Tour de France, to give himself maximum time to train for the following year’s race. While Landis’s position with Phonak appears secure for the near future (he has an option on his contract through 2007), the level of his post-operation performance is an open question. “We’re completely in unknown territory,” said Chao, pointing out that when Bo Jackson briefly returned to baseball after his hip replacement, Jackson, formerly one of the league’s fastest players, slowed noticeably. “In baseball, you can lose speed and still perform, but that might be harder in cycling,” Chao went on. “On the other hand, the thing going for us is that Floyd’s sport is not impact-loading like baseball or football, so the replacement won’t loosen. And also of course that he’s Floyd.”

We left the thronging highway and drove into the hills, gliding through a classic Southern California landscape of avocado trees, Hearst-like mansions and large, impeccably clean sandstone boulders. After 15 minutes we made it halfway up a steep incline, and the car stopped at the intersection of Calle Vista Lejos and Sunset Terrace. Landis climbed out, moving in his usual strut. “I hit right here,” he said, pointing to a spot in the center of the road. He walked us through the crash: his decision to turn right instead of going straight, his front wheel skidding out, his body slamming the ground, his 30-foot skid, his abject crawl off the road.

Then he showed the reason why: a thin, barely visible sheen of dark pebbles exactly the color of asphalt. The pebbles apparently came from an adjacent hillside. It was a fluke of topography, a happenstance of pressure, time and wind. Landis picked up some of the pebbles and shook them in his fist like tiny dice.

Later, back at his house, Landis would finally open up a little about the pain. He would say: “Everybody thinks you can overcome pain if you want to enough, and let me tell you, you can’t. This isn’t some Jean-Claude Van Damme movie, where somebody can get shot in the leg and keep going. There’s pain that makes me stop, makes everybody stop.”

He would keep talking, his voice growing softer. “My parents would look at everything that I’ve gone through and say that all this is God’s plan, which makes it sound like a good thing. But I can’t do it, because I have to work with what’s true. Things end. We’re all going to die. But until that happens, there’s really a lot you can do. Especially if you realize this is your last opportunity.”

But for now, standing on a sunny road in the middle of nowhere, Landis was looking for something lighter to say. Which he found. He should buy a plot of land next to the crash site, he said, then build a giant house and erect a lemonade stand to sell T-shirts with a big stylized picture of his hip bone on them.

“I should really do that,” he said, smiling as he limped and strutted back toward the car. “That would be perfect!”


Daniel Coyle, who has written for Play, the Times sports magazine, is the author of “Lance Armstrong’s War.”