Loss of coordination in leg - Official runner's dystonia / focal dystonia discussion thread

mlbfan24,

MORTON'S TOE!!!

Your earlier post from a page or so ago said you were frustrated and nearly ready to give up. Well wait! Try this first. I just saw someone who said I have Morton's Toe on my left foot (the one that loses muscle coordination). (This is NOT "Morton's Neuroma". You can google it; two different things.) Anyway, look at the bottom of both feet bare in the mirror. As a runner, the most callused/padded toes of your foot should be the ball of each big toe, which you use to push off of. On my left foot, the ball of my second toe is much more prominent, larger, and callused. It was explained to me that my second longer toe is taking the majority of the pressure from each foot plant, but it is an inherently smaller/weaker joint not intended to do this. The weakness causes my foot to supinate and splay, along with my knee. I don't hit the ground first with my powerful big toe, I hit it with my 2nd toe and roll out. The person I saw suggested adding a simple metatarsal pad the size of a quarter to my insert just where the ball of the big toe is.

Granted, I get excited every time I see someone I think has "the answer" about my problem. I go down that road every time, and maybe I'll be posting here again in a week and say I got my hopes up again for no reason. But, have to say that I have been problem free on my easy mileage runs (including flat bike-path and road runs that usually cause problems) since last Saturday. Not that long for a true test, yes, I realize that. And, admittedly, even with the insert, I still had the problem in my track workout this week. BUT, all the imbalances and weaknesses that Foomiler and others talked about are still there in my legs of course. If I correct my foot plant, it will still take strengthening and stretching work to get my legs balanced again. However, hopefully this is it and I won't be making things worse on my regular runs if I'm correctly my foot plant. It could be the power of suggestion but if I take the insert out to compare how running feels each way, I do feel that bony area on the ball of the second toe on my left foot hitting the ground distinctly, and I don't feel it on the right. Also, with the insert in, it is DEFINITELY easier to get up on my toes and feel my calf firing properly.

In hindsight, I think this could be why when I put in the right insert into my left leg to force pronation back in August, it worked for a while because it forced me to put more pressure on the big toe, until I squished down the insert.

Also, I would like to comment that Foomiler and others have valid comments about muscle weaknesses and imbalances, but I've always felt that they are EFFECTS not CAUSES. Why did we all start having these weaknesses and imbalances? SomeTHING had to initially get that ball rolling to make our bodies become that way... I had another person watch me run and he noticed right off my pelvic tilt, but commented that my foot plants were uneven and different on each side, so that the rolling of the feet was probably CAUSING the pelvic tilt...

It's worth a try, so if you do, let me know how it works...

Miss Osage County-

I do have Morton's Toe on both feet. About a month after I first began losing coordination, I bruised the bottom of my metatarsal under my left big toe while running a 3k on the track in spikes. I started landing on the outside of my foot more, which perhaps contributed even greater to my problems. I'm not sure though. Anyways, thanks for the suggestion. I will definitely look into it.

Also, do you lose coordination in your calf while riding a stationary bike? I have been on the bike at the gym the past couple of days due to a deep cut under one of my toes, and noticed a problem that I had a few years ago when I was last relegated to a stationary bike. I lose coordination in my right calf and have to focus to maintain form, or adjust the resistance and slow my cadence a bit til it feels better. This problem only seems to happen on a bike or elliptical trainer, and is independent of my other running problems, but it reminded me of your calf problem. As soon as I stop it goes away and I have no further symptoms. Even when I am running, I have foot splay in my right leg. It's baffling to me because my right leg is much better off than my left leg while running.

maybe the weakness is causing mortons toe.look at my post on shin splints and achellis tendon problem.when these muscles in your hip become weak it will change your foot plant.Foot splay is clear to me about a weak glute max on the right.i broke the top of my foot and got tarsal tunnel because of a weak glute max.When your glute max is weak your foot will land extremly hard almost like a peg leg.plus when you push off you will have to shorten your stride.

Well, Morton's Toe is a structural defect, if you will, that you are born with. It is rather common in the general population (I think around 10%?) so it is not so much a defect as it is a variance in one's foot. The 2nd metatarsal is structurally longer than the 1st one in Morton's Toe.

mlbfan24,

I will try the stationary bike and see how my calf reacts. After all this time I feel silly that I didn't think to see how my leg/foot would react to other activities besides running! That is such a good idea! I can keep discouragement at bay a lot better when I have new things or ideas to try regarding my injury. So, this hopefully will help me stay optimistic for a bit longer because it will fill in another piece of the puzzle with some new information... thank you! I suppose we're all sort of in a stage of self-experimentation regarding this bizarre injury. Hopefully the collective will be able to figure it out one day...

This is disheartening to say but I think I am hanging up the running shoes and my college running carreer. This problem is such a mysterious pain in the ass. Mentally it is far more taxing than physically. I have run mid 14's for the 5k and went out today and did a mile and a half time trial and could only run 7 flat with tons of discomfort. I think I might become a road biker or something lol. Maybe the next Lance without EPO.

After several failed physical therapy attempts I went to a guy who I feel really knows his stuff. He specializes in running and he first put me on a treadmill and analyzed my running form. After seeing that my right leg crossed over my mid-line and my left hamstring contracted while my right hamstring did nothing he looked for a cause by testing the strength of various muscles. He did the usual tests that I have experienced from other PTs and found that there definately was a lot of weakness and dysfuntion on my right side, but instead of just giving me excercises, he looked for a cause. after digging deep into my muscles he found that my right hamstring had a tear in it that had a lot of scar tissue. the tear, he said, probably happened years ago, (I think when I played hockey), but the problem was that it did not heal correctly and the scar tissue was causing my hamstring to not fire correctly. After a mere 5 painful minutes of horrific pain while he worked on releasing the scar tissue, I noticed immediate differences in the strength of my leg. I went back for two more visits where he worked on my legs more and gave me some stability drills and form drills to work on. I have been on two runs since resuming running and I'm not 100%(it's going to take a while to get used to running with two legs again) but I feel a huge improvement.

That's great to hear hillrunner8! Definitely keep us updated on your progress. I feel that your doctor may be on the right track by looking at the hamstring as a possible cause.

I know the further I run, when my leg begins to seize up, it is during the forward swing phase that I lose control. I'm pretty sure the hamstrings and glute max help decelerate the leg during the forward swing phase, so if the hamstrings is tightening or seizing up, perhaps correcting this will solve the problem.

Although, with the amount of time many of us have dealt with this, there are most likely other problem areas that have arisen, such as a tight IT band or TFL, a weak rectus femoris and psoas, etc.

Has your doctor checked to see if you have a posterior pelvic tilt on your right side? This could help explain the weakness in your quad/psoas if you have that, and could also explain tightness in your hamstring which can lead to tearing in the muscle. I know in my case, I have a posterior tilt on my left (bad) side, and an anterior tilt on my right side.

Hillrunner, I had the same problem occur in my left leg and it turned out to be a complication from plantar faciaitis believe it or not. I'm glad you're improving,

mlbfan24,

I've been thinking a lot about breaking down in the swing phase since you mentioned it in your last post. Granted, this is just an excerpt from an Ohio podiatrist's website, not necessary the international guru of all running injuries, but I think he explains the importance of the swing phase and the muscles involved well, so I'll post part of it, and provide a link to the entire webpage.

http://www.runlabdro.com/lectures/power.html

A lot of the information is in line with what folks have posted already, but I like the how he explains the relation of the muscle weaknesses we've been talking about specifically TO the swing phase...

"The Power Stroke in Running"

When you ask runners what is the most important biomechanical event in running, the biomechanical event which is responsible for generating the power for forward running, they usually tell you is has something to do with the leg that is on the ground. A good answer but a wrong one. Runners, when they train, concentrate on the leg that is on the ground. Runners believe that is where the action is. When runners lift weights they work on building up the calves, building up the Quads, thinking that they are the key to faster running; not so. That is, simply stated, the power stroke in running, the primary forward driving force in running, is accomplished by the pulling action of the swing phase leg. The swing phase leg, the non weight bearing leg, is responsible for generating a pull on the runners center of gravity. This advancing center of gravity acts on the leg that is in contact with the ground, using the foot locked onto the immobile ground as a lever to generate rearward thrust, which drives the body forward. Therefore, the power for maintaining forward velocity (pace), the acceleration for speeding up (kicking) and the rate at which you run (cadence), is initiated and controlled by the non weight bearing leg while it swings through the air. So if you wish to run faster or if you wish to be able to hold your pace longer before fatigue slows you down, you have to strengthen, condition and imprint your swing phase muscles. The muscles that are responsible for the Power Stroke, the swing phase, are your hip flexors, Psoas Major, Psoas Minor, Iliacus and your inner thigh muscles. These muscles are the last group of muscles to get into shape and are the first group of muscles to de-train when we stop working out....

...When we fatigue in a race, it is not the leg on the ground that is slowing down, it is the hip flexors and inner thigh muscles that are fatiguing. As our ability to maintain the rate, pace or cadence that we are racing at becomes more difficult, the hip flexors and inner thigh muscles demand more blood and oxygen than the body can supply....

...Our hip flexors are the Psoas Major, Psoas Minor and Iliacus muscles. These muscles lie deep on our lower abdomen, attached to our vertebral bones running over the inner surface of our pelvis, finally attaching to the inside of our upper thigh bones. These muscles in conjunction with our groin muscles, when contracting, pull our thigh towards our chest in effect lifting the knee...

this is great to hear, i hope this is a solution, or at least part of the solution

I sincerely believe that the hamstring is the culprit to this problem. I have a video where I lose coordination (sorry for the terrible quality, I had to compress it to a practical size)

http://media.putfile.com/compressed

or

http://video.google.com/videoplay?docid=-2737910492450352108&hl=en

Assuming that you can view this file, there are a couple things to look for:

1) I am the kid in the gold and navy blue jersey running in 2nd place. My loss of coordination occurs in my right leg, and throughout the video you may notice differences between how my left and right leg function.

2) The first time around, I am on lap 7 of a 3200. The leg problem is beginning to kick in, but has not taken full effect. You may notice my stride is awkward and that I am beginning to compensate a little bit.

3) On the second time around, lap 8, the problem become more obvious. My right hamstring begins to stop firing normally and I compensate with other muscles to bring my right foot up from the ground. Towards the end of the clip as I head down the backstretch, you may notice that my right foot begins to point out, and to the right, as my hamstring pulls it up. This probably means that I am trying to compensate by rotating my foot outward, in order to use other hamstring muscles to bring my foot up.

4) While am I preoccupied with bring my right foot up from the ground, I still have to quickly drive my knee forward to complete the stride. However, since I am not bringing my foot up high enough, my stride cycle is broken and I have a very choppy and limited stride as a result

pause at 1:08.your spine has a lot of curve and your hip is dropping terribly.that is a clear sign of a weak glute med muscle.remember the glute med weakness will show up when for example if your left leg is on the ground with all of your weight on it see what your right hip is doing.it should be held leval or higher.yours drops a lot.I HOPE THIS HELPS.

I just found this on Runner's World.

http://forums.runnersworld.com/eve/forums/a/tpc/f/678106477/m/2961076732

The first post sounds exactly like all of our symptoms. Some other posts mention compartment symdrom. (I'm pretty sure our injury is NOT compartment syndrom - I've had the surgery and it did not help)

The final post mentions something about a nerve entrapment at the fibular head. The person had no previous pain, just loss of control. She had surgery to release it.

Has anyone been tested for nerve entrapment in this region? I've had numerous nerve conduction tests but none specially at this location.

Maybe something to consider...

I had that emg test done as well, it did show some nerve problems. So I had operations for peroneal nerve entrapment and compartment syndrome. they didn't work. It's turning out this problem is pretty common, so that makes me believe its muscular.

Wow, the OP of the thread definitely seems to have what many of us have.

I was kind of surprised the one poster that mentioned compartment syndrome said they did not experience any pain, because it was my understanding that compartment syndrome is always painful.

Like you, I got a nerve EMG conduction test through a neurologist. They pretty much stuck needles all the way down my leg and into my foot and said with total confidence that I did not have any pinched nerve...they said the test even rules out a nerve problem with my back. I don't know, I've always been skeptical of all these tests and I think the only way anyone will ever diagnose this problem is by having us run on the treadmill.

Hey everyone,I'm going to quote what Miss Osage County wrote (thank you for posting this!), because it really got me thinking, and I think I may have stumbled onto something positive here. I can't say for sure quite yet, because my body is way out of balance and it will take me a long time to sort things out, but I am encouraged and hopeful at this point. For reference, I ran 6 miles yesterday on a flat bike path with a couple friends faster than me, and we ran it in 33:50, which at this point, is roughly 10-15 seconds per mile slower than my 10k pace. So, this was faster than a traditional tempo run for me, and what was really encouraging for me is we were 16:35 for the first 3 miles. Usually when I go out too hard, I'm doomed to succumb to coordination loss and severe tightness in my quad, adductors, and hamstrings. I had minimal muscle tightness and no sense of being on the brink of coordination loss during this run. There were a few instances where my left knee buckled slightly, but that was it. This post will end up being quite long. I'll try to sort out my thoughts on this as best as I can, since I'm not exactly a phsyiologist.

Based on this info, I have realized, while running (and perhaps walking), my left leg drags as I run. More specifically, it drags while my right leg is on the ground and my left is swinging forward. I believe my hip flexors, and more specifically my psoas, iliacus, and my adductors have become passive during running.

I believe this set off a whole slew of compesatory movements in my running gait. What I believe is going on is the following:

- My rectus femoris is acting as the primary hip flexor in driving my leg forward. I believe this is why it is more pronounced in my left leg as opposed to my right, and also why it gradually gets tighter and shuts down.

- My hamstrings are taking on more of a role of pushing off in order to run faster paces, and they are not receiving help from my adductors, which eventually leads to tightness and cramping in them as well.

- Because my hip flexors are passive and extremely weak, rather than flexing at the hip during forward knee drive, I am flexing and extending at the knee as my leg prepares to land. This puts more strain on my rectus femoris as well as my hamstrings, further accentuating the cramping, fatigue and coordination loss. My right leg does not extend at the knee as I land. I found this very interesting.

Try standing on your good leg and drive your bad leg forward using only your hip to flex the hip and knee. Do not extend your knee with your quad as your foot comes down. If your condition is similar to mine, you should not feel any tightness in your quad while doing this. Now drive your leg forward but extend your knee a little as you land. You will probably feel your quad flex and tighten. I believe this is one of the major problems in coordination loss.

- My adductors in my left leg are passive and dysfunctional while running. This places more strain on my abductors and quad in order to move my leg through the swing phase. I believe this also causes the external rotation in my leg while running.

I have practiced using my adductors while standing on my good leg and keeping my bad leg straight as I cycle it through the swing phase, and I feel a lot of weakness in my hip flexors and weakness and severe tightness in my adductors. Roughly 3 years ago I pulled one of my adductors, and because I tried to run through the injury, I believe this may have contributed to changing my running style to accomodate the adductor pull, thus eliminating my adductor's job by shutting the muscles down.

The information in this section explains it very well. To give a real life example, I have noticed an increase in my ability to pick up the pace at the end of a run by focusing on running in this manner. Usually when I try to do so, my legs tighten up severely and I quickly lose coordination. Sometimes it is still very difficult to do because I am wired to run differently now, but in general, I feel much smoother by focusing on these muscles.

Another point of interest is I feel my glutes working much more effectively while running. I am not even trying to recruit them while I run. It seems to just happen by focusing on properly driving my leg forward. I am also more aware of where my imbalances are. My left adductors, hip flexors, and abductors are weak, but my right abductors feel way too tight. More specifically, my right TFL and gluteus medius feel way too tight.

If I try to push through any coordination loss during running, my rectis femorus, hamstrings, and adductors begin to tighten up severely. The other night at the gym, I attached a cable to my foot and put some resistance on it. I then tried to slowly cycle my leg through the running phase by using only my hip to raise my knee. My right leg responded very well, but I could not raise my left leg anywhere near as high as my right.

So to wrap things up, focus on using your main hip flexors while bring your leg forward during the swing phase of running. Make sure you are not flexing your knee with your quads while doing so. It is very easy to do so as your hip fatigues. Eliminate extension in your knee during landing. This will get rid of overstriding and take a lot of strain off of the hamstring muscles. And finally, focus on recruiting your adductors while driving your hip forward. This is the hardest thing for me to do as I run. My leg is used to being externally rotated as I run, which stretches my adductors as I run instead of letting them do their job of driving my leg forward.

Practice cycling your leg through the swing phase while standing on one leg. It is much easier to get a feel for it this way as opposed to implementing it while running. There are so many things to consciously think about while this is occurring and it is nearly impossible to do so right from the start during running.

Anyways, I know this is really long, and I probably did not explain it as well as I would have liked, but I really hope this will be a step in the right direction for everyone who is suffering from this frustrating situation. I will keep everyone updated on how my progress goes.

i agree.the only thing i added was glute med on the left.i need it to help with rotation.

Thanks for sharing all that mlbfan24. It really helps. I'll try to explain some more of my symptoms/thoughts.

I posted excerpts from the podiatrist's article, but not the entirety. He ends by saying the best way to improve your running is to have "groins of steel", adductor strength.

My earlier post I said you got me thinking about the swing phase, and I felt that it was hamstring as well, that was the culprit. However, upon further reflection, your most recent post, and further assessment while running (yes, I'm guilty of constantly changing/evolving my opinion as I, like all of us, try to sort this out), I feel my hamstring APPEARED to be the culprit because it was overloaded from the lack of work the adductors were SUPPOSED to be doing.

For example: I had an 8mi tempo run at 6:10/mi pace scheduled. Because of traveling, I was doing a 2mi loop through a residential neighborhood, with some grassy lawns I could run on to get off the even surface of the road, which is usually a sure way to bring on the loss of muscle coordination. The first mile of the loop was uphill, and the second downhill. I got through 5mi and then noticed the problem kicking in. Up through that point, my splits were: 6:32 uphill (miscalculated pace on unfamiliar route), 5:52 downhill, 6:13 uphill, 5:47 downhill, 6:08 uphill. I was able to continue to maintain my pace by controlling the left leg that was losing muscle coordination, though it is always very mentally challenging and physically demanding to do this, as frustration builds and other muscles are grossly compensating... but, I wanted to see what would happen if I pushed and pushed... So, the left leg is feeling very tight and will hardly bend at the knee and I am sort of swinging that left hip to pull/swing the leg through, while my knee feels as though it's degree of flexion is not changing at all through the entire stride. Mile 6 downhill is 5:47 again, despite problem; mile 7 is 6:09, still on pace from previous uphill mile, BUT by mile 8 downhill, my leg is totally SHOT. It feels as though it is entirely loose in my left hip socket, sort of dangling out from my midline with no control from the rest of me. My left foot is striking very far from the midline, nearly 18in from my body, and is overstriding out, as though it's reaching out to push a clutch or something (picture driving, that sort of body to foot relation). There is nothing holding my leg in to my body properly. Also, my leg is collapsing as it strikes the ground. Picture this: straighten your arm and make a fist, pushing that fist into a couch cushion, and just as you hit the cushion, quickly bend your elbow and let your arm just collapse. That is what my leg felt like. So, I ended up running 6:07. (Took a 5mi jog and then was able to run a single 5:30mi no problems. This is always bizarre to me, how minimal rest always allows me to resume running. Probably couldn't have done anything much longer, but I was seemingly symptom-free for that last effort. Anyone else experience this?)

Check out these images of the adductors:

http://www.fotosearch.com/LIF127/3d704007/

http://www.fotosearch.com/LIF127/3d704003/

I really feel like these muscles were the main culprit--- these muscles that pull my leg in, "add"ing it back to the midline of the body (ADDuctors). I don't doubt that I have issues with tightness on the opposing side, and that I have other muscles in both legs that are weak, but I got very good advice from my former director of sports medicine/current ultramarathoner that still practices sports medicine. Ask yourself, "What is keeping you from running?" Well, what was keeping me from running my workout that day, every day really? Is it the tight psoas on the right?? The weak glut on the right? No. It was my left leg entirely giving out on me. All problems need to be addressed yes, but identifying which are causes and which are effects is no easy task. At this point, I think it is my adductors that are unable to continue functioning at higher/more intense paces and other muscles compensating for them, eventually give out too until my leg is jello-y. Adductor strength must be addressed.

thanks for that info miss osage county, really got me thinking. That is a dead on description of the problem, I tried racing through this and it caused me to tear my groin (sports hernia) on the good side.