Dancing is more than just a hobby or passion for 22-year-old Reagan McDaniel. It's her life's calling. When she entered the Bachelor of Fine Arts program at Jacksonville University in Florida as a dance major, Reagan felt like she was on her way to the life she had dreamed about. 

But after finishing a challenging dance routine during the fall recital of her freshman year, Reagan felt a sharp ache in her left hip. She stretched, and it felt better the next day. However, when the pain kept returning sharper and lasting longer, Reagan got the nagging sensation that something was wrong.

"I continued to dance on it for months," says Reagan. "I know a lot of dancers have chronic pain. I thought this hip pain might just be something I would have to learn to live with."

After five months of progressive pain, Reagan finally mentioned it to her mother, who works in the medical field. Her mom, who previously underwent surgery for a hip labral tear, recognized the signs and made an appointment for Reagan with a sports medicine and orthopedic specialist at Mayo Clinic in Florida, where she works.

Crushing news 

Reagan met with Dr. Luke Spencer Gardner, an orthopedic surgeon specializing in hip surgery. As Reagan's mom suspected, an MRI revealed a torn hip labrum, the cartilage lining the hip joint socket. 

Dr. Spencer Gardner explained that Reagan had femoroacetabular impingement (FAI). FAI occurs when the ball-and-socket of the hip joint don't fit together properly, and the hip bones rub together. In Reagan's case, a bony protrusion on the ball caused the misalignment. It's not uncommon for extra bone to develop during natural growth and development, but when it pinches the labrum, it can lead to tearing. Repetitive or twisting motions, like those used in dancing, are also a contributing factor and can make tearing more likely.

"I remember getting the news that I had been dreading," says Reagan. "I was so upset. But my mom assured me that Dr. Spencer Gardner would take good care of me, and sure enough, he did."

Hip preservation surgery times 2 

Reagan tried physical therapy to reduce the pain, but between her dance schedule and the severity of her tear, she was not making good progress. Dr. Spencer Gardner suggested hip preservation surgery to fix Reagan's structural hip injuries and eliminate her pain so she could get back to dancing. Hip preservation also has added long-term benefits by helping prevent early onset osteoarthritis and delaying the need for hip replacement.

In November of her sophomore year, Reagan underwent a hip arthroscopy and labral repair. Dr. Spencer Gardner fixed the tear and shaved down the bone spur, operating through small incisions using a tiny camera called an arthroscope and specialized instruments. 

The minimally invasive surgery was an outpatient procedure, and Reagan went home the same day with no complications. The expected recovery time for the procedure is typically six months. 

But less than two months later, Reagan once again experienced the nagging feeling that something was wrong. This time, the pain was in her right hip.

"I had just started my spring semester and was still using a crutch to recover from the first surgery, when I felt the same kind of pain," says Reagan. "I told myself that my hip was just sore from overcompensating during my recovery, but soon I was back in front of Dr. Spencer Gardner and getting another MRI." 

Imaging showed a similar labral tear and smaller FAI in her right hip. At the end of January, less than eight weeks after her first surgery, Dr. Spencer Gardner performed a second hip preservation surgery (arthroscopy and labral repair) on Reagan's other hip.

"I remember being in that hospital the second time and wondering whether I was ever going to dance the same way I had before," says Reagan. "Then I locked in and made the decision that I wanted to be back dancing by six months from my first surgery."

The road back to dancing 

Physical therapy was critical to Reagan's recovery. The physical therapists at Mayo Clinic guided and supported Reagan as she pushed to regain her strength and restore flexibility. Four months after the second surgery, Reagan started easing back into dance.

"I was worried I might get injured again, but I know my body well enough to know when to start," says Reagan. "I began with marking, a dance term for performing movements on a much smaller scale to mentally rehearse and then working yourself up to bigger and bigger movements."

Reagan spent time learning choreography and teaching at several local studios. She worked hard to make up for all the dance training she missed. Somewhere along the way, she found herself drawn to hip-hop.

"While I was not fully back by the six-month mark, I was doing hip-hop at that point," says Reagan. "Hip-hop doesn't require as much leg lifting and floorwork as other dance styles, so it was easy to start with it. But I realized how much I loved it."

Dancing toward a bright future 

Reagan is forever thankful to her entire team at Mayo Clinic. The nurses helped calm Reagan when she was nervous about anesthesia. The physical therapists pushed her and supported her quick recovery. Dr. Spencer Gardner gave Reagan back the gift of dancing.

After college graduation, Reagan has plans to move to Los Angeles, where she will be pursuing a career in professional dancing.

"I'm finally back to where I was before my surgeries," says Reagan. "I may not be as flexible as I used to be, but I have the same strength and movement quality I had before. And my passion for dancing is stronger than ever."

Related post:

• Mayo Clinic in Florida expands shoulder arthroplasty with robotics, scaling capability across sites

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Over two years ago, a devastating hip condition and a misdiagnosis threatened to sideline a young high school basketball player for good. But thanks to advanced medical expertise and innovation at Mayo Clinic, the 16-year-old prep star in North Carolina is back in the game — stronger, more determined and inspiring others with his comeback story.

Jason Howland has his story.

Watch: Mayo Clinic restores hoop dreams for teen athlete

Journalists: Broadcast-quality video (2:44) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Watch him on the court, and it’s clear that 16-year-old Roman Solheim loves playing basketball.

"I love the competitive nature, just competing and having fun with my guys," he says.

A 6-6 high school sophomore in Greensboro, North Carolina, Roman has high hopes for the future. "I want to go to a D1 school, preferably a high major, and become an engineer," he says.

But three years ago, those hoop dreams were nearly deflated by a subtle hitch in his step.

"We couldn't figure out anything because he, being Roman, didn't say too much. He didn't really complain about it," says Kristie Solheim, Roman's mother.

"I was just limping, not moving the same way that I usually do," Roman says.

"He went through some therapy, and he started playing again, but his limping was more pronounced at that point. And then it started to be painful," says Brent Solheim, Roman's father.

Roman's doctors diagnosed him with avascular necrosis, a lack of blood supply to the bone. "There's not a good treatment for it. He has to stop playing all sports to preserve his hip as long as possible, and he's looking at a hip replacement in 10 years," Brent says.

"It's crazy. It just wrecked my world, basically," Roman says.

"We said, 'We're going to get a second opinion at Mayo.' And that's what we did," Brent says.

A multidisciplinary team of experts at Mayo Clinic in Rochester, Minnesota, quickly determined the true cause of Roman's limp and hip pain.

"They said I had chondroblastoma, which is a benign bone tumor on my femoral head," Roman says.

"The tumor was inside his femoral head, the ball in the socket joint. It is a rare tumor, but especially for younger patients with open growth plates, it's something that we see commonly here," says Dr. Emmanouil Grigoriou, a Mayo Clinic hip preservation surgeon.

Dr. Grigoriou performed the surgery to remove Roman's tumor. "We were able to surgically and safely dislocate the hip so we can actually take the ball out of the socket, so we can see exactly the tumor, remove it in its entirety, and then put in extra bone — just to let it and help it heal — and then put everything back in place," he says.

A key component of surgical planning and the procedure itself was a 3D-printed replica of Roman's ball-and-socket joint created by the Anatomic Modeling Unit at Mayo Clinic.

"The green is Roman's tumor, and this is a model of his very specific hip with his very specific tumor," says Dr. Grigoriou as he displays the replica of Roman's femoral head.

Two years after the tumor was removed, Roman is back on the court and better than ever. "I can jump a lot higher now," Roman says.

"It was amazing to see him back on the court after, you know, being told he couldn't play again," Brent says.

"We're very proud. He's been through a lot. He's very brave," Kristie says.

"Anything is possible. I came from being told I would never play again to playing at a very high level," Roman says. "You can do way more than what you think."

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Tommy John surgery is not just for baseball pitchers. Ask Kylie Donat of Bemidji, Minnesota.

Kylie is an 18-year-old high school swimmer, track and field athlete, and wrestler. She has been wrestling since 2021, the first year that girls' wrestling was a sanctioned high school sport in Minnesota. By 2023, Kylie was favored to win her weight class at the state championship.

Then came the practice that changed everything.

In January 2023, her wrestling partner threw her down on the mat. Kylie tried to catch herself, but her left elbow bent awkwardly, and she heard popping sounds. A week later, she used the Heimlich technique on a teammate who was choking on her food. The maneuver worked, fortunately, but it made Kylie's injury – to her medial ulnar collateral ligament – worse.

"It was a complete rupture, as bad as it could be," says Christopher Camp, M.D., a Mayo Clinic orthopedic surgeon who had a virtual appointment with Kylie in March 2023.

Despite the injury, Kylie was eager to return for her senior season and compete in the state championship. Dr. Camp put Kylie on a standard short course of nonoperative treatment consisting of rest and physical therapy to give the ligament time to heal and stabilize on its own. But it didn't stabilize, so surgery was the next step.

A week later, Dr. Camp performed the ligament reconstruction using the anatomic technique, a new approach he developed at Mayo Clinic. This procedure builds on Tommy John ligament reconstruction surgery, which was first performed on baseball pitcher Tommy John in 1974.

The injury is most common in baseball players, but it can affect athletes in other throwing sports such as softball and javelin. Wrestlers and gymnasts may sustain traumatic versions of the injury.

During surgery, Dr. Camp repaired Kylie's ligament, gave her a new one (taking a tendon from elsewhere in her body to form a new ligament) and added an InternalBrace (2-millimeter-wide suture tape) for stability.

"It's designed to recreate the normal anatomy of the ligament," Dr. Camp says. "It uses newer fixation and anchor devices that are smaller and stronger, and it increases the contact area between the graft and bone to create a larger surface area for healing."

Kylie went home the same day and began to focus on her recovery.

Once Kylie got her splint off and was fitted for a brace, she began her rehab in earnest. She did a lot of stretching so her injured arm could move like the other one. Once she got full movement back, she started building the muscles in her entire body and around the elbow, including the shoulder, bicep, tricep and forearm.

"Knowing that I had lost that opportunity (to compete) due to an injury, I was ready to get back out there," Kylie says. "I knew it would take a lot of work."

Kylie's mother, Sara Donat, says her daughter was determined, but knew she couldn't rush her recovery. Once Kylie was cleared to do pushups and work more of her muscles during physical therapy, she started to have hope. She added swimming to her regimen, which she knew would be good for her elbow and overall athletic shape. In October 2023, she wrestled for the Minnesota Storm in Iowa.

"After that, I was like, 'Wow! I'm really ready to wrestle,'" Kylie says.

Traditionally, the recovery from this type of surgery is a year or longer for a throwing athlete. For a wrestler, recovery is usually nine to 12 months. Kylie got back to wrestling in five months.

"She did a great job on her rehab and physical therapy," Dr. Camp says. "She was extremely motivated and worked hard. We had a very clear goal – wrestling – so she could compete in the state tournament."

In March 2024, Kylie fulfilled her promise to herself by winning her weight class at the state wrestling tournament. Her elbow didn't cause any problems.

"It was the best feeling," she says.

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Normally, hearing about a senior with hip problems would not be very surprising. But the senior you're about to meet is a senior in high school. Thanks to Mayo Clinic, this young woman has a bright future that's all teed up.

There's nothing like the sound of a solidly struck drive. Growing up in a golf family, it's a sound that Maddy Trapnell has heard a lot of. But it was a different sound that she says had her worried about her golfing future. "It would clunk, like, over and over again."

That "clunking," as she puts it, was coming from Maddy's hip. Like golf, hip problems run in her family. Maddy says her symptoms started when she was 14. Then, in the fall of 2022, her junior year of high school, she says her symptoms got worse. "My coaches started taking me out of tournaments because, like, I refused to stop. But they took me out because it's like, 'You're in pain. You need to stop.'"

Watch Golfer's future back on course following hip surgery

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After seeing a few local doctors, Maddy came to Mayo Clinic, where she met with orthopedic surgeon, Dr. Emmanouil Grigoriou. "So Maddy's case is unique because she had pathology both inside her hip joint, as well as outside the hip joint around the hip with how her bones were formed."

Understandably, Maddy says she was worried about her future. "Like, I was just worried, like, what's my senior year going to look like? Like, am I going to be able to play? Is this pain ever going to go away?"

Dr. Grigoriou explains why was able to get back on the course so quickly. "We're able to do both procedures in the same setting, which is very, very important for the patients and allows them to return back to what they love, faster. We're able to do both the hip arthroscopy and the periacetabular osteotomy; the same setting on the same day with a single anesthesia event, a single recovery, a single rehabilitation — one and done."

Less than six months after surgery and just weeks before her senior season was due to start, Maddy was cleared to start playing again. Maddy says it took a little while to get back into the swing of things. "I started being very consistent again and started having fun again. And yeah, I was excited. It was great."

And a senior season that was once in jeopardy, ended with a top-10 finish at the state tournament. Recently, Maddy was back at Mayo to have three screws, the last reminder of her surgery, removed.

While uncertain about her competitive golfing future, Maddy says she has her eye on college and something else that runs in the family. "What’s next is I'm planning to attend the University of North Dakota for mechanical and aerospace engineering. I love airplanes. I love flying. I love looking at them. I think they're fascinating. And so, I just want to do something that I know I'm going to enjoy and I'm passionate about."

Just like her golf game.

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When people retire, they often plan to spend more time with their grandkids, or on activities like volunteering, gardening, traveling and hobbies. Christine Brown came up with something far more epic.

After thinking about what she and her husband, Tom, enjoyed doing together, she proposed that they spend the next five years hiking the 2,190 miles of the Appalachian Trail (AT). Stretching from Springer Mountain, Georgia, to Katahdin, Maine, it's the longest hiking-only trail in the world.

Tom's response was, "Absolutely!"

Retirement challenge: Tackling the Appalachian Trail

So in 2018, the La Crosse, Wisconsin, couple laced up their boots, hoisted their backpacks, grabbed their hiking sticks and headed north from the trail's southernmost point. Their five-year plan called for hiking the Appalachian Trail in 400- to 550-mile segments. That schedule meant 12 to 18 miles per day over rough terrain, up and down mountains through all kinds of weather, from sweltering heat to snow and sleet. According to the Browns, that breaks down to 30,000 to 40,000 steps a day.

"It's a physical challenge, but it's also a mental challenge," says Tom. "Some days, you see quite a few hikers; on other days, you're completely alone. Some days, the hiking is challenging, and some days you're walking down a small town's Main Street. You meet people of all backgrounds and ages on the AT. The hikers become a community and are always willing to help each other."

Even before the start of their epic trek, Tom, 63, had been experiencing pain in his right knee brought on by years of work at his excavating and snowplowing business. He'd undergone hyaluronate injections to relieve the pain and help the joint move more smoothly. Those treatments meant the pain wasn't enough to delay or trim back their plan.

Then came May 2022.

A slippery stone leads to surgery

Christine, whose trail name is Beanbuster, and Tom, whose trail name is Traverse, were hiking the Appalachian Trail as it wove through the Green Mountains of Vermont. It was a drizzly day. They were climbing up a mountain, and the stones underfoot were slippery. A stone shifted, and Tom felt something stretch and pop: the Achilles tendon in his right leg.

The couple worked their way to a hotel, began icing the tendon and contacted James Mannion, M.D., Tom's Family Medicine physician in La Crosse, for advice on caring for the injury. The Browns decided to head home and a few days later, Tom's Achilles tendon ruptured. Repairing the tendon now took precedence over his aching, arthritic knee.

To address this critical injury, which turned out to be particularly complicated, Tom reached out to Charles Nolte, D.O., his long-time orthopedics specialist, who practices at Mayo Clinic Health System in La Crosse and Onalaska, Wisconsin.

"This wasn't just an Achilles rupture," Dr. Nolte says. "Tom had a completely calcified tendon, probably due to an earlier injury. We had to perform a complex reconstruction of the tendon, which involved cutting out much of it, then reconnecting it."

Dr. Nolte says they weren't sure if the tendon would heal, much less heal well enough for Tom to return to the trail. Dr. Nolte told Tom it would be a slow recovery. But Tom tackled his rehabilitation and recovery with the same can-do spirit as he tackled the trail with Christine.

"At one point, there was no guarantee if the surgery would hold, if I'd have a drop foot or get my range of motion back," he says. "The physical therapists knew I wanted to be back on the AT by May 2023, so they set up a program that focused on strength, range of motion and stretching the tendon. They kept me on track and didn't let me get ahead of my healing."

Time to address chronic pain

After six months of recovery from the Achilles rupture, it was time to start phase two of Tom's plan to get back to the trail: a total replacement of his right knee.

"Tom had dealt with his arthritic right knee for years and undergone nonoperative treatments to relieve the pain," says Dr. Nolte. "We planned to do a total knee replacement during his off-season from the trail, but then the Achilles rupture happened."

In February, Dr. Nolte performed a robotic-assisted total knee replacement of Tom's right knee.

"The robot takes a really good, successful procedure and makes it better," says Dr. Nolte. "The accuracy of cuts and component alignment are close to perfect, which reduces pain and speeds recovery."

Dr. Nolte adds that after completing about 300 robotic-assisted total knee replacements, he's seen a considerable difference in the postoperative recovery phase, with patients getting back more quickly to what they love to do.

Once again after surgery, Tom went into aggressive rehabilitation mode, following the plan of his physical therapists, and buying an exercise bike to continue building strength and range of motion at home. His goal was to be back on the Appalachian Trail by early May.

"I want to thank Dr. Nolte and my physical therapists, for all they did to help me reach my goals," Tom says. "They were amazing."

Dr. Nolte also credits Tom with doing the hard work to get better.

"Tom's a highly motivated patient. He did physical therapy before and after both surgeries, and followed his recovery plans," says Dr. Nolte. "Christine is a real go-getter, and he wanted to make sure he could keep up with her."

Postcards to the hometown care team

On May 5, almost one year to the day since his Achilles injury and less than three months since his knee replacement, Tom and Christine were back hiking a grueling 400-mile segment of the Appalachian Trail, including summiting 6,288-foot-high Mount Washington in New Hampshire's White Mountains during a snow and sleet storm.

"We had two weeks of nice weather," says Christine, "followed by five-and-a-half weeks of rain."

Despite the weather and continual up-and-down mountain climbing, Christine noticed a difference in Tom.

"He had been in pain for a long time with that knee. Pain is insidious, and affects you physically and mentally," she says. "It was great having my cheerful, good-humored husband back."

Throughout their 2023 trek of the trail, Christine sent postcards to Dr. Nolte. He shared the cards with his team members, who took pride and satisfaction in Tom's accomplishments. While the scenes on the cards varied, the message was always the same: "Dear Dr. Frankenstein-Nolte. Your surgery was such a success that you've created a monster. My husband sees a mountain, wants to climb it and makes me go with him. I'm cold and tired. Make him stop. Christine."

Christine will get her wish in June 2024 when she and Tom reach Katahdin, Maine, and officially complete the last 170-mile segment of their epic trek. To mark making it to the trail's end, they're planning to fly family members to Bar Harbor, Maine, for a grand finale celebration of their great adventure on the Appalachian Trail.

This article first published on the Mayo Clinic Health System blog.

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Jennifer Budd's biggest accomplishment is also her biggest heartbreak.

Jen, an MRI scanning technician at Mayo Clinic in Florida, started running in 2009 to get into shape and to reduce stress.

Soon, running progressed into a passion, not just for her but also for her family. By 2013, she had completed eight half-marathons. But she'd also had two knee surgeries — an ACL surgery and a meniscus repair.

The surgeries didn't slow her down — at least not initially. She actually was thinking bigger.  

She had watched her husband complete a marathon and wanted to try it herself. In 2014, she accomplished that goal.

"There is something cathartic about running. The simplicity helps to clear my mind," Jen says. "I also like the commitment it takes to run a marathon — following the training schedule, putting in the time, and then meeting up with thousands of other runners and crossing the finish line together."

Eventually, knee pain caught up to her, however, and she couldn't continue running.

"My knee pain steadily increased until 2020, when I had to wave the white flag," Jen says. "My activity level was greatly reduced due to the pain in my knee, and I knew it was time."

That's when she met with Cedric Ortiguera, M.D., an orthopedic surgeon at Mayo Clinic in Florida.

Reclaiming her passion for running

Jen was no stranger to Mayo Clinic. She calls herself fully "Mayo-nized." She was born at Mayo Clinic in Rochester and next year will celebrate 25 years of working at Mayo Clinic in Florida.

During Jen's appointment, Dr. Ortiguera recommended that she undergo surgery to replace her patella-femoral joint, also known as a partial knee replacement.

Jen agreed to the surgery after talking through her goals.

"Dr. Ortiguera is amazing. He is incredibly kind and patient. He listened to me and knew what I wanted to achieve after surgery," Jen says. "I knew that without the surgery, I would have never been able to continue being active, and my quality of life would not have been the same."

 There was work to do after the surgery.  

"The recovery process was humbling," Jen recalls.

She treated recovery like a full-time job and began physical therapy right away.

"I got to know my physical therapy team well. They were so knowledgeable and gave me the right tools to help me regain muscle strength," Jen says. "It was fun celebrating milestones with them —– making a complete revolution on the bike, walking up stairs, bending my knee past 90 degrees."

Her commitment to physical therapy paid off when Dr. Ortiguera gave her the green light to start running again. She laced up her shoes and started training for her first post-surgery race — the New York City Marathon.

Not slowing down

About a year later, Jen returned to see Dr. Ortiguera for a follow-up appointment.

"My favorite moment was when he asked what activities I had been doing," she says. "I told him I had been using my Peloton bike, doing strength training, and I ran the New York City Marathon.

"He was genuinely happy for me," Jen says. "I felt like I had crossed the finish line again."

Since that visit, Jen has completed three more marathons, and she doesn't plan to slow down anytime soon.

"My goal is to run the six major world marathons — New York City, Berlin, London, Chicago, Tokyo and Boston," she says.

With New York City, London and Berlin crossed off her list, that leaves only three.

"I am running the Chicago Marathon in October and have already applied to run the Tokyo Marathon. I am still chasing the Boston Marathon qualifying time," Jen says. "Running with my husband and sons has been such an amazing experience. I have never crossed a finish line without crying tears of pride."

And she says she can't thank Mayo Clinic and Dr. Ortiguera enough for fixing her up and getting her back on track to pursue her passion. 

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Wayne Clark grew up on a horse farm in New Paltz, New York. In seventh grade, he started cross-country running and Nordic skiing. Sports defined his life. He was good at them and loved being active.

Then came the pain in both hips – something that would shift his plans for his life.

The pain got worse over time, especially during the running season. He saw several doctors.

He was diagnosed with hip dysplasia, a deformity in the curved part of the pelvis that forms the socket of the hip joint. Doctors told Wayne, then in ninth grade, that he needed to stop running immediately. He could still ski, however.

He says this news was hard to hear for someone whose identity was wrapped up in sports. Reluctantly, he quit running for his sports teams and switched to dryland training of roller skiing, cycling and hiking. He logged 400 to 500 hours a year while training solo most of the time.

"I was in pretty severe pain, but I would push through it," Wayne says. "I found out that ice was always beneficial."

In 2009, Wayne won a Division I scholarship to cross-country ski for the University of Wisconsin—Green Bay. He majored in history and minored in coaching and education. In his junior year, he began coaching younger athletes in the community. He enjoyed this work, even though he could feel it in his hips. After races, he'd sit in snowbanks in below-zero temperatures to ease the pain.

When that pain became unbearable, Wayne came to Mayo Clinic and saw Rafael Sierra, M.D., an orthopedic surgeon. Dr. Sierra performed a periacetabular osteotomy (PAO) on both of Wayne's hips – the first the in fall of 2012 and the second a few months later. Dr. Sierra cut the bones around the acetabulum and realigned Wayne's hip joints to improve the loads on the joints. Mayo Clinic has been performing this procedure since 1992.

"This is a big operation and only half of the patients are able to get back to the previous level of activity with one PAO," Dr. Sierra says.

After surgery, Wayne made Dr. Sierra a promise. Wayne yearned to be active again and told the surgeon he would be his first double-PAO patient to complete a marathon.

Before he could think about running again, Wayne had to let his body recover. He went from training 20 hours a week and competing at a DI level to an abrupt stop. After the second surgery, he had to learn how to walk again.

"I had to deal with depression," Wayne says. "I was so used to training hard. Now I was having to start all over. It was tough mentally."

But Wayne persevered and eventually resumed his sports. He moved to Boulder, Colorado, in 2014 and did backcountry skiing, cycling, running and adventuring. Three years ago, he moved to Telluride, Colorado, where he teaches and coaches at the high school. He began eyeing ultramarathon-length races.

In retrospect, Wayne figures that Dr. Sierra probably had other PAO patients complete a marathon after surgery. But he may be Dr. Sierra's first PAO patient to complete a 40-mile race with a 7,000-foot vertical gain in the mountains of Colorado.

Wayne did that at the 2022 Grand Traverse Triple Crown, a three-race series between Crested Butte, Colorado, and Aspen, Colorado. The ski mountaineering segment in April took him 11 hours, 10 minutes. He completed the other two segments on Labor Day weekend. The running leg, from Crested Butte to Aspen, was a 40-mile race with 7,000 feet of vertical gain. That took him 9 hours, 15 minutes.

"After running the farthest distance of my life the day before (in the running leg), I was pretty worked," Wayne says. "The bike leg became one of the toughest days."

The final leg – on mountain bikes from Aspen to Crested Butte – took 6 hours, 39 minutes, with 8,700 feet vertical gain.

After the race, Wayne was resting and hanging out with his parents, who had come to watch the race. Then he got a huge surprise: He had placed third, with a combined time of 27 hours, 3 minutes.

"The fact that he was able to reach such a high level of activity with two PAOs is remarkable," Dr. Sierra says.

Wayne says his medical journey amid his athletic pursuits changed his outlook on life.

"If can endure the mental side of it, my body can respond," Wayne says. "It's hard to explain how emotional the run was. I was on top of this knoll when I stopped for a few minutes to take it in. For years, I had been told that this was something I'd never be able to do."

A few months ago, Wayne, now 32, wrote Dr. Sierra and mentioned his future goals: a 50-miler and a 100-miler.

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Edward Markle was desperate.

Despite receiving nerve blocks from his doctors, Edward says the pain from two herniated discs had become excruciating and unrelenting. He could not sit or walk without pain. He slept on the floor, two hours a night. He was increasingly worried about the future.

"It shut my quality of life down to almost zero," he says. "I couldn't move. I could not get out. I could not find a way to hide from the pain. There was no position to get into to get even a minute's worth of relief. There was no light at the end of the tunnel."

Looking for help

Edward began to search in earnest for a solution. One night, at 2 a.m., he went online and typed: "Best back surgery in the United States." Mayo Clinic popped up first.

The next day, he called Mayo Clinic in Rochester, Minnesota, from his home in Pass Christian, Mississippi, about 25 miles from Gulfport-Biloxi. He reached out to a doctor who had treated him for an unrelated matter years earlier. Eventually he connected with the Mayo Clinic Spine Center. To his surprise, the person on the line said she had an opening for an initial appointment the following week.

"She asked if I was able to make the appointment in such a short time frame," Edward recalls. "I believe she could tell I was frantic and in distress. I said, 'I will be there.'"

Days later, Edward, 72, and his wife were on a plane to Rochester. He met with a physician assistant at the Mayo Clinic Spine Center for an initial assessment, and it became clear that he needed surgery. Within the hour, Edward was talking to Brett Freedman, M.D., an orthopedic spine surgeon. Dr. Freedman examined Edward and reviewed his medical records, CT scans and X-rays.

This wasn't Edward's first back injury. Thirty years earlier, he had hurt his back, but it healed without surgery. This time, the pain from an injury in September 2022 was significantly different.

The right timing

Dr. Freedman set up more tests for Edward and determined that Edward needed surgery as soon as possible. Because of an unusual last-minute cancellation, Dr. Freedman’s surgery schedule had an opening the next day. Edward took the spot.

During the disc decompression surgery, Dr. Freedman removed part of Edward's herniated discs and bone pushing on his nerve, which was causing pain.

A herniated disc that causes symptoms is the most common reason people seek out spine surgeons and surgery, Dr. Freedman says.

"We remove only the things you don’t need," Dr. Freedman says. "When we’re done, you have a stable spine, and in six weeks, a stable and healed spine. Mr. Markle's problem was a 100% pinched nerve, and he got 100% clinical benefit."

The surgery went well. Edward, a lawyer and engineer by training, was amazed. While in the recovery area, he did not have pain radiating down his right leg or in the surgical site. He had no significant complications.

The next morning, he did something he had not been able to do for two months — walk up two flights of stairs with no pain.

A few days later, Edward walked out of Mayo Clinic and headed home.

"It was an amazing outcome," Edward says. "I call it a miracle. Mayo and Dr. Freedman saved my life."

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Jeff Helfrich, 41, began running in 5^th grade. He competed from grade school through high school in Illinois and was good enough to walk onto the track and cross-country teams at Harvard University, an NCAA Division I school.

Then came the summer of 2002, an injury, and what became a 20-year search for relief.

Running man

The summer before his senior year, Helfrich was in excellent shape. He had already qualified for the 2003 Boston Marathon. While running a downhill half-marathon in Colorado, he felt extreme pain in his right calf. He thought he just pulled a muscle. He rested and eventually returned to training camp for cross-country.

“I was only able to run one cross-country race that fall when the pain returned,” Helfrich says. “So I rehabbed for most of the season.”

That winter, Helfrich ran indoor track and posted his fastest time in the 5K. That spring, he skipped spring track so he could work on his senior thesis and run the Boston Marathon. He trained solo and completed Boston in 2:46, placing 117th overall.

After graduating, Helfrich moved to Denver for work. He ran for fun and trained for the occasional marathon.

His calf pain flared up periodically, forcing him to stop running for a few months. He tried rehab and massage, but just when he thought he was in the clear, the pain came back. Sometimes his left leg hurt, more often it was the right. Over time, the pain-free periods seemed to get shorter, the recovery periods longer.

No definitive answers

In 2008, Helfrich moved to Dallas for a new job. Over the next few years, he saw various specialists around the country. He underwent MRIs and bone scans. He got cortisone shots, received physical therapy and tried stretching routines. He also received platelet-rich plasma therapy.

One physician suspected chronic exertional compartment syndrome, an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes disability in the affected muscles. The doctor encouraged him to undergo pressure tests for the condition.

Pressure tests -- which involved sticking needles into Helfrich’s calves – showed Helfrich had borderline high results, but they were inconsistent with earlier cases of the syndrome.

“He offered surgery but needed to see what was going on once he got in there,” Helfrich says. “He didn’t have a prognosis. I passed on the surgery.“

On his own, Helfrich continued to research chronic exertional compartment syndrome. He learned about popliteal artery entrapment syndrome, or a pain or cramping in the calf that happens during exercise and goes away during rest. This condition can mimic or coexist with chronic exertional compartment syndrome.

Stealing a run

Eventually, Helfrich decided his running career was over. He switched to biking and rowing. Once in a rare while, he "stole" a run, but it was never consistent.

“I resigned myself to the fact that if I couldn’t run like I once did, I would do what I could and let sleeping dogs lie,” he says. “I remain firmly in that camp today.”

Mayo connection

Helfrich kept up with the scientific literature on his condition. He noticed that more people were finding relief with botulinum toxin (aka Botox). In 2021, he contacted Jonathan Finnoff, D.O., chief medical officer of the U.S. Olympic and Paralympic Committee and former medical director of Mayo Clinic Orthopedics and Sports Medicine in Minneapolis.

Dr. Finnoff recommended Jacob Sellon, M.D., a physiatrist and co-director of Mayo Clinic Orthopedics and Sports Medicine in Rochester, Minn. Helfrich came to Mayo and consulted with Dr. Sellon and vascular surgeon Jill Colglazier, M.D.

Sellon says that Helfrich’s case was unusual as his symptoms did not fit well with the typical symptoms of chronic exertional compartment syndrome, which commonly affects the front our outside part of the leg. Helfrich’s symptoms fit better with popliteal artery entrapment syndrome, though his test results suggested he might have both conditions. Helfrich and his physicians discussed surgery, a traditional treatment for these conditions, but ultimately they decided on botulinum toxin injections.

“The mechanism is not entirely clear, but the thinking is that the toxin is relaxing the muscle around the blood vessels that are entrapped, which allows better blood flow,” Dr. Sellon says.

In July 2021, Dr. Sellon gave Helfrich the injection under ultrasound guidance. Ultrasound guidance allowed Dr. Sellon to target the muscles that appeared to be constricting his popliteal arteries, while avoiding injury to nearby nerves and blood vessels. The effects of the toxin lasts about three months.

In recent years, botulinum toxin injections have been show to help both syndromes, though the duration varies and the injections are considered experimental by most insurance companies, Dr. Sellon says.

Helfrich resumed running. In August 2022, he ran in a 200-mile relay race, the Ragnar Northwest Passage, an eight-year tradition with his buddies. Helfrich completed 11 miles over three legs without problems.

“We actually won the race,” he says. “There was no way I could have done that before Botox.”

Unfortunately, Helfrich’s pain has returned. He knew that this was a possibility and that he might need additional injections. He is planning to get a second round this month near his home in Dallas.

“I don't think I'll ever do the surgery as my prime running days are behind me,” Helfrich says. “The pain and rehab of doing two calves and missing out on other activities during the downtime just doesn't seem worth it. So anything the Botox can give me is a gift.”

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Always active, Lisa Luskey-Lestrud of Kensett, Iowa, played volleyball and softball in high school and worked physical jobs requiring hours of standing and heavy lifting. By the time she was 47, her aching knees reminded her daily of the toll that wear, injuries and having rheumatoid arthritis were taking on her ability to remain active.

After going through noninvasive treatments — physical therapy and injections — Lisa was walking with a stiff leg and more than ready to undergo total knee replacement to relieve the pain. That's when she connected with Michael Eckstrom, M.D., an orthopedic surgeon in Albert Lea and Austin, Minnesota.

"Knee replacements are typically performed due to sever arthritic pain that doesn't respond to more conservative treatment. But we're seeing these surgeries being performed in an increasingly younger population," says Dr. Eckstrom. "In these patients, severe arthritis is frequently brought on by trauma to the joint.

"At some point, it comes down to pain versus quality of life. The pain affects their quality of life and keeps them from doing what they want to do, whether it's just daily activities, playing golf or riding a bike."

One drawback is that younger patients will more than likely need another joint replacement in 15–20 years. "It's a mechanical piece of equipment that can and does wear out," Dr. Eckstrom says. "How fast that happens depends on patients' weight, if they participate in a lot of sports or engage in high-impact activities, like running."

Dr. Eckstrom says when a patient has reached the point of needing a total joint replacement, he explains the potential outcomes, then leaves the decision to his patients. "Most opt for reducing pain and improving the quality of lives," he adds.

That's the decision Lisa came to, as well, despite her young age. Her first total knee replacement was performed traditionally on the knee she had injured playing softball. The surgery provided the pain relief, stability and greater mobility she was seeking.

Five years later, orthopedic surgery technology had advanced considerably. Dr. Eckstrom performed surgery on her other knee assisted by a robotic arm.

"The precision of robot-assisted surgery provides better alignment and balance because the weight of the body is more accurately centered through the middle of the knee. It may even prolong the life of the device," says Dr. Eckstrom. "It takes out the guesswork, and I think it makes me a better, more consistent surgeon. Robot-assisted surgery definitely takes total joint replacement to the next level."

Lisa agrees. In January, at age 52, she underwent her second total knee replacement. "I definitely noticed a difference, even right after surgery," she says. "I was moving around better and went home the same day."

Her husband, Scott, and son, Ryder, took care of her, but as Lisa says, "They didn't baby me. After the first couple of days, I was managing pretty much on my own. But I firmly believe in using the ice machine to keep down swelling and pain."

A bout of COVID-19 slowed her recovery, but she's back doing her physical therapy exercises to regain strength and flexibility. One result is that, with the arrival of warmer weather, Lisa began walking more, along with her miniature schnauzers, Mylo and Axel.

Scott also bought a new motorcycle, and she practiced getting on and off.

"My goal was to be able to swing my leg over the seat. It was hard at first, but now I can do it. We're really enjoying riding again," she says.

Once again, Lisa's life is active, with motorcycle riding, serving on Kensett's 150th anniversary celebration, camping and even exploring a new job. She loves creating crafts made from found objects like driftwood, china plates and colorful beads. A circle of crafting friends is saving up money from sales to vacation together. She's busy, but that's just how she likes it. And now she can enjoy life pain-free.

This article first appeared on the Mayo Clinic Health System blog.

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