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

Frustrated, I have been reading and contributing some to this thread since it first began. The symptoms that people have did not exactly match my problems, but are very close. I have had problems with my stride, hip, and lower back for over 25 years. Finally I had to stop running a year ago and decided after every other therapy failed to ask a Doctor to check to see if I have a labral tear (learned about it first here). I did and had surgery July 25. It has been a huge success so far. I got rid of the crutches after a few days, was up to 7 miles on the elliptical 3 weeks post surgery, at 4 weeks I ran one mile every other day, at 5 weeks I bumped it up to 3 miles, Today is 6 weeks post surgery and I did 5 miles. I had a tear repaired and something that the doctor wrote down as synovial impingement, which I can't find any reference to online. I think I wore a groove in some tissue that also got built up and he fixed that by debriding it. A lot of people have FAI impingment due to the bone. I feared I had that, because my hip just never seemed to fit in the socket correctly. Due to this, my leg seemed to adjust over the years to get out of pain and keep me running as best as it could: the knee and femur rotated in to a knock- kneed position and my tibia and foot rotated out in the opposite direction and running was awkward, but I kept at it. Although, I am running slow now, my leg seems to line up so much better and my femur seems to fit properly in the hip and feels stable and strong. I feel great. I wish I knew more about what the synovial impingement was exactly, all that I know is that it is great to be fixed.

Surgery is scheduled for Sept. 19th...hope to be able to post some good news soon afterwards! The sports med doctor is still not totally convinced of a labral tear but the improvement in running after the cortizone shot was the best indicator that "something was going on in the hip." And nothing else...no barrage (over years) of various tests on the brain, spine, legs, foot...even a stint with PT...yielded any solution. And even then it took two trips to the sports med before getting the cortizone shot on the third trip. Cautiously optimistic!

Bumping.Still having the same problems: medial hamstring tight all the time, and weakness/soreness quickly spreads to medial calf and hamstrings after a mile or two, typically. When it's really bad, my shin and quads start to go too, and my foot splays out in front of me with my femur externally rotated, and my foot pronating strongly (likely as a result of the leg rotation). I also have groin pain on the opposite side, that seems to scale according to how bad my lack of coordination is. I pulled my adductor on that side two years ago, and my PT thinks that it's flaring up because the left side has to compensate for my lack of coordination on my right side. I was switched to a new PT regimen after it was pretty clear that the hamstring strength stuff wasn't making a big difference. This new regimen is mostly SI joint mobilization stuff. It seemed like it was getting better after I'd started that, although I'd taken several days off after my coordination problems flared up a few weeks ago. I also got an MR-Arthrogram and a local injection of lidocane (short acting numbing agent, like they'd use at the dentist's office). I was told to run after the procedure and see how it went, which I did. I ran 7.5mi with several "bursts" of fast running in the middle, and even some sprinting. I felt somewhat better: even though it was the furthest and fastest I'd ran since I started having problems in the spring, I didn't have any coordination problems or weakness. There was still some tightness in my medial hamstring near the back of the knee, but I did not get the characteristic "locking up" feeling in my calf and hamstring. I had run the night before the injection too, so I was expecting problems if it didn't do anything. Most days this summer, if I ran two days in a row, I'd start having issues. Three in a row was a virtual guarantee of problems. Took the day after the injection off so I could do a "fresh" test of what I'd done on the injection day. Ran two days after, same course and with surges, etc. Felt decent, but a bit off-balance compared with the day I had the lidocane. Ran the next day, felt worse: some tightness spreading into calf and hamstrings in general. Took a day off, then ran three miles, and problems were just as bad as ever: calf, hamstring, and even thigh a bit. During this, I was doing my new PT stuff the whole time. So that's obviously not helping. I'm not 100% convinced the injection helped, because I might've just gotten lucky and had a "good" day on the day I had the injection. But I got a call about the MRI today and the radiologist saw a tear in the labrum. The hip doc hasn't taken a look at it, so I don't know much about where, how bad, etc. Remember, this is the doctor that indicated that many people have asymptomatic labral tears, but I'm hoping that, seeing as he has seen a LOT of hip labrum tears in his time, he'll be able to tell whether this is a "normal" tear or whether it could be responsible for my issues. I've done some research, and most studies on the presence of labral tears in asymptomatic people either use plain MRIs on athletes from sports like hockey, which have a LOT more hip twisting than running does (not to mention that plain MRIs can't reliably detect labral tears), or use dissections with cadavers (which are often 70, 80, or 90 years old, and have all sorts of cartilage issues). So needless to say, I'm suspicious that a 22-year old would have an asymptomatic labral tear. So anyways, I'd like an update on anyone who's gone down the labral tear road. It sounds like only one or two posters have actually gone ahead with the surgery, and mostly haven't updated the thread about their progress and whether their symptoms have been resolved. I'll hopefully meet with the doc and look over the MRI in the next week or so. From what I've read, it sounds like my two options now are 1) cortisone injection and/or 2) surgery. I guess I'd like to give the cortisone a shot (bad pun...) to see if I get longer-lasting relief. Like I said, the lidocane wears off in ~8 hours, so I only got one chance to get out and run on it. If I get a cortisone shot and can do 2 or 3 days in a row without issues, then the labral tear is 100% the cause. But I'm suspicious because I don't have ANY of the classic symptoms: no referred pain in the groin, no pain on internal rotation or hip flexion, no painful clicking (though my right hip does "pop" a lot, like a knuckle would, if I get up/rotate my hip after having sat down for a while). I did some reading tonight on iliac and popliteal artery entrapment, and it sounds like that might be a possibility too, albeit a far-fetched one (although at this point, everything is far-fetched: a labral tear with no hip pain?). I also found one medical source that DID mention a loss of coordination associated with labral tears (in all of my reading this is the only thing I've found regarding loss of coordination associated with labral tears).http://nucre.com/Artigos%20-%20Quadril/Labral%20Tears,%20Extra-articular%20Injuries.pdf

The thickness of the labrum and its morphology may slightly vary, but it is from 2 to 3 mm thick, and extends 2 to 3 mm past the acetabular socket. Neuroreceptors have been identified and may provide propioception to the hip joint [4]. This may explain the decrease in propioception and pain with labral tears.

Could this be the answer? Maybe, but some of the artery entrapment stuff I was reading sounded convincing too. Weakness, lack of power, etc. But it was mostly in cyclists, and was usually (though not always) centered around the quads, not mostly the calves and hamstrings.

Thoughts? Updates? There are a lot of threads on labral tears here on letsrun, but most of those people had the "classic" symptoms: referred groin pain, clicking, grinding, etc. Every so often I get a vague "pinch" or tightness in my TFL just sitting around, but that's maybe once a week or so. Other than that, NOTHING near the hip joint.

This injury is a complete nightmare if you are a serious runner. It is true that many people have some sort of damage to their labrum over the course of their life and some show symptoms while others are fine. It makes it very confusing to decide whether or not surgery is the right option for you.

The first thing I will tell you RIGHT now is to stop seeing a physical therapist. You need to find out for certain if this is an issue that PT can actually fix; you can do all the PT in the world but if you have a true biomechanical problem inside of the hip joint that cannot heal itself it's not going to matter and you are going to be mentally drained as the months pass by.

I had EVERY symptom you are describing in your case. It can come and go quickly; each day varies on a pain scale and sometimes you have a fluke day where you are able to get in a run. I think the injection helped you temporarily but that's exactly what it's supposed to do. It won't last more than 24/48 hours. If you are anything like me you probably had vague symptoms the past few years and was able to ignore them for the most part because you were still able to get in runs and they were only intermittent.

I saw about 6 very good orthopaedic doctors in NYS the summer that I was forced to stop running because I literally could not control my leg. Most doctors were either convinced I simply had "tight muscles" and was "imbalanced" or that I was compensating because I had poor form. I knew it was a load of sh*t; don't ever doubt your own instincts about your body. You know it better than any other doctor out there.

I will tell you right now I had NO pain inside of my hip joints. Only one leg had symptoms. The only pain I had or discomfort was on long car rides or sitting in class the outside of my butt might get crampy or feel like there was a knot in it. I had no clicking, no groin pain, and most ROM movements did not give me bad pain.

But it didn't change the fact I was 9 months deep into physical therapy and basically going NO where fast. I finally did research about femoral acetabular impingement and labral tears and then researched surgeons. I found a surgeon I could TRUST. That's the main issue. I wanted someone who was competent enough to evaluate me but would only suggest surgery if it was my last option. The guy I found in the end was phenomenal. He was honest about what all of my options were and told me exactly what he would do as a competitive athlete. The guy I saw is a team physician for the NFL, NBA, and NHL so I know when he operates on an athlete he has their best goals in mind. I am 26 and had to have bilateral hip surgery for both impingement and labral tears that were grade 3 (that = bad). The impingement is what caused them. I had two forms of impingement and it was ugly. Oddly, the impingement did not show up that well on x-ray but with a CT scan it lit up like a Christmas tree.

To cut this short, I am now back to running and I have NEVER felt healthier. Even just walking to my mailbox at the end of my driveway feels different. I had no idea how much discomfort and tightness I actually had but because it was such a gradual onset I thought it was normal and I was not in pain. It's amazing even how the day after surgery you can tell the difference.

If you want to talk about surgeons (and even if it's just for a consult/opinion) let me know because I have some good contacts. I think it's important to not push surgery but know that there are good doctors out there who can help you and you have a chance to be healthy again. Don't give up. I went through everything you mentioned and probably a bit more.

I'm getting another injection in my disc today. It didn't do anything last time. But I'm not running after I get it today, and I'm not running tomorrow. I'm racing Friday. If it helps me for even one race, I'll be ecstatic. Last race I went through 5k in 15:28 and finished the 8k in 26:29. I had to stop/walk/stretch the last 2 miles.

Where is the bulged disc? Between the L4/5-S1? And have you tried actual physical therapy for the "disc bulge" or only the injections?

I'm also at the point where I really suspect this whole issue to be more due to FAI or something rather than just a "weak glute medius." I remember finding SOME initial relief with the strengthening of the glutes, etc., but it definitely wasn't completely healed.

Lately, tempo runs have become almost impossible. I think the hallmark of this problem is the inability to complete a tempo run. I can do shorter stuff, sure, tempo? Forget it.

What SUCKS is that I live in Canada -- and Newfoundland at that. I had to give up (just this week) being coached by a phenomenal coach online -- I just couldn't complete the workouts properly anymore.

Anyways, the significance of where I live is that there is a FULL YEAR'S wait to get into a orthopaedic specialist, and only THEY can book an MRI appt., which is another damn year's wait!! I got an X-ray done on Monday, and my chiro is going to go over it with me tomorrow in the case that I have some bone issue going on in there.

I have been having the same problems for the last two years. Not a lot of pain, and most of the time none at all. Symptoms all down my leg, into my big toe, and increased pronation. I just got back from my orthopedic doctor and found out I have a labral tear and a bony build-up, potential cam impingement. I believe TDF had very similar symptoms, so his surgery going so well has given me a lot of hope that the tear is the cause of the problem, and it can be fixed.

My doctor and I have decided to forgo the cortizone shot. Since I don't have a lot of the traditional pain, the shot may not actually do anything. I am going to go to a gait specialist in the area at a sports med clinic, then most likely go under the knife.

lizard king wrote:

I have been having the same problems for the last two years. Not a lot of pain, and most of the time none at all. Symptoms all down my leg, into my big toe, and increased pronation. I just got back from my orthopedic doctor and found out I have a labral tear and a bony build-up, potential cam impingement. I believe TDF had very similar symptoms, so his surgery going so well has given me a lot of hope that the tear is the cause of the problem, and it can be fixed.

My doctor and I have decided to forgo the cortizone shot. Since I don't have a lot of the traditional pain, the shot may not actually do anything. I am going to go to a gait specialist in the area at a sports med clinic, then most likely go under the knife.

Well aren't we all just a lucky bunch

In the meantime, what's everyone doing for cross training? I find if I do a few days back to back of elliptical, I feel MUCH better when I finally go out to run. It's as if a lot of mileage really inflames the acetabulum of the hip

I walk a lot, which still really bothers my leg. I've just started lifting weights (TRX and kettlebell stuff). I've tried to keep running throughout this whole ordeal, but motivation has been tough. My run last night was actually pretty good from a mental stand point. It was nice knowing what was most likely wrong with my leg. Most of the time before I would go for a run I would hope that the problem would have magically healed over night. Now I know that's not going to happen so I can just go out there and run. I am going to keep lifting and running up until surgery, hopefully that will speed the recovery.

Well it's just what I was afraid of. I have not seen the MRI myself, but the radiologist's report says the imaging shows "tearing of the anterior aspect of the right superior acetabular labrum with additional tearing and fraying of the anterior portion of the labrum." But the hip doc I'm seeing is not at all convinced my issues are from a labral tear. Despite the fact that I had the best and furthest run in the past 4 months the day of the lidocane injection, and despite the fact that I had my second-best and second-furthest run the next run after that.

So he wants me to do another month of physical therapy. Gosh I bet it'll really help this time...fifth time's the charm right?

In all seriousness though, I think my best course of action right now is to find a new doctor. Can anyone recommend someone in the midwest? I've stayed in-state (MN) until now, but by now I'm more than willing to travel. I have the MR-Arthrogram (showing a tear!), I've done the physical therapy gauntlet, I at least want a doctor who will sit down and actually show me the MRI itself and explain why the labral tear is not why I am having these issues (which have caused labral tears in others). I've only spoken with my current doc once, for about 5min at the initial appointment. Everything else has been shuttled to and from him via his army of secretaries and assistants, which I'm pretty unhappy about. I'll browse through all 44 pages of this thread again to see if I can find anyone in MN/ND/SD/IA/IL or even further away, but suggestions from those of you who have "been there, done that" are greatly appreciated.

Not sure if Michigan is close enough, but you may want to check out Dr. Jon K. Sekiya at the University of Michigan Sports Med Clinic in Ann Arbor, MI. He was very cautious and really followed the steps suggested on this board; an evaluation, a cortisone injection in the hip to see if running improved, and then the MRI Arthrogram, which didn't show much. He even suggested we get a second opinion. The deciding factor was that the hip injection made a difference. He too was and is not convinced that the labral tear could cause the "loss of leg coordination" issue - no pain symptoms really throws doctors off. Surgery was on Sept. 19. A follow up visit 8 days later and the next follow up will be on Oct. 27. Hope to be able to add a success story like some of those posted on this board!

4078jcrs wrote:

Not sure if Michigan is close enough, but you may want to check out Dr. Jon K. Sekiya at the University of Michigan Sports Med Clinic in Ann Arbor, MI. He was very cautious and really followed the steps suggested on this board; an evaluation, a cortisone injection in the hip to see if running improved, and then the MRI Arthrogram, which didn't show much. He even suggested we get a second opinion. The deciding factor was that the hip injection made a difference. He too was and is not convinced that the labral tear could cause the "loss of leg coordination" issue - no pain symptoms really throws doctors off. Surgery was on Sept. 19. A follow up visit 8 days later and the next follow up will be on Oct. 27. Hope to be able to add a success story like some of those posted on this board!

It is definitely hard to describe to doctors just how disconcerting your symptoms are, especially when there is no acute pain that you can pinpoint in order to help narrow down the problem. It makes it difficult for a doctor to decide what the best course of action is because ANY surgery is invasive and obviously one wants to invoid it under most circumstances.

My best advice to those who have been struggling with these symptoms for months is to get the appropriate imaging and multiple opinions. Before I was properly diagnosed I had several x-rays, several MRIs, an SI joint injection, an injection into the hip joint itself, and also an MRA. The only thing that indicated I had a problem was the MRA -- it showed "signs" of a labral tear but my ortho was still suspicious that was what was causing all of my symptoms. I had no chronic history of hip pain or groin pain. I had no clicking or popping.

I referred myself to a 2nd orthopaedic in NYC. What was able to make a difference was the fact he used a special MRI machine (it was not the usual MR Arthrogram with the dye). The MRI machine they use is not found in most clinics; I forget the major difference but I think had higher resolution. My surgeon explained that up to 60% of the time labral tears do not show up on MRAs, and even if they do the image can be very blurry due to the dye contrast and quality of the imaging.

The 2nd type of imaging I had was a CT scan. He was suspicious because under x-ray they were not able to see any form of impingement. There were signs of impingement (I had a mark in my femur that looked like the hip was hitting it). But it wasn't enough to make a diagnosis. The CT scan however showed the impingement on all levels. its' a 3D image (unlike the 2D x-ray) and you can see exactly where your problem is. Depending on the program they use to analyze your bone they can also show you how your deformity (cam or pincer) developed overtime and how it may continue to develop as you age. This way you can decide if surgery is the course of action you want to take, if you want to wait and do physical therapy, and also what you might be facing if you decide to take more conservative options.

In reply to 4078jcrs, I was a very similar case in comparison to you. I had no pain symptoms, groin pain, or clicking/popping. I also was able to run with minor muscle dysfunction for about 3 years before my leg finally sh*t the bed and even then I did not have a lot of hip pain. But once my doctor was able to scope my hip this is what he found:

Bilateral cam AND pincer impingement with excessive cam lesion on the right hip

Bilateral grade 3 labral tear in Each hip. Grade 3 is bad.

Loose bodies in each hip (this means there was damaged tissue/cartilage and pieces were floating around within the joint).

Synovitis (I required a synovectomy).

For someone who had little hip pain this was pretty extensive damage. My surgeon has done over 2,000 FAI/Labral repairs (as of last January) and he explained that for the level of damage I had he was extremely surprised I was not in more pain. He operates on a lot of professional athletes and told me that any of the cases that were even comparable to mine had patients complaining of a level of 7-9 on a pain scale and they had noticeable limps and were unable to compete in their sport.

He explained that although there is not a clear medical explanation, some athletes are able to compete at a high level despite the amount of damage because there is not a high degree of vascularity or innervation within the hip joint. He's found that certain individual's are able to find ways to block out the pain and discomfort to the point they can adjust to it almost as if it were normal. They are finally forced to seek help once the hip becomes completely dysfunctional.

I hope this might be able to give some people more confidence in terms of understanding their pain, or lack of pain and symptoms. Don't ever feel like you are crazy or that "nothing" is wrong with you. Imaging does not always tell the truth. It's a matter of finding the right physician to help you.

I got acupuncture and cupping done. It also did not work. Next thing to check for me is labral tear I guess.

Went to a mechanics specialist. He says I should focus on my form more when I run. He thinks when I get tired that my form changes and causes me to stress my hamstring area making it go out of control. He also thinks it may be a strength issue.

Well today we were doing a progression/tempo run. My leg started giving out around 6.5 miles of a 10 miler. I usually try different techniques to see if I can stop it from giving out. Today I tried really short strides and it didnt work. Then i tried high knees to stretch the hamstring. Didnt work. Then for some reason I did like a high knee with my right leg(leg that goes out) and made it come all the way across my body. I kept doing that and it allowed me to hold the pace without the giving out feeling. I did this for the whole last 3 miles, which were 5:22, 5:18, 5:08. 56:11 for the 10 miler. Thats the fastest I've gone since last cross country season when I didnt have the loss of coordination problem. Earlier this year I had to stop 2-3 times on these runs because it got so bad.

When you did the "high knee with my right leg... and made it come all the way across my body", was that while you were running? If so, what do you mean by coming accross your body? I can see doing that as a drill, but not while running.

Thanks.

I hate to bump with bad news, but here I am...

Since the last post, I've seen the doctor again. Because my main problem is loss of coordination, not the hip pain that comes on the day after I do a hard run where I lose coordination, he's hesitant about the surgery, as am I. We decided to try another hip injection, this time with both lidocane and cortisone, which I got about two weeks ago. The day of the shot, I went out and ran, feeling pretty good. I had some lingering hamstring soreness and a bit of calf tightness, but my coordination felt good, and I did 5mi with several "bursts" in the middle and a hard 800 at the end. Notably, my leg felt BETTER during the faster running, which is pretty much the opposite of what usually happens (I can fake it for a while going slow, but if I go fast my leg craps out). I was encouraged by that result. Later that day I went on a 3mi walk at a brisk pace, something else I haven't been able to do, and that went excellent. I felt almost 100% on it.

The radiologist told me there'd be a delay between when the lidocane wore off (6 hours or so) and when the cortisone started to work (2-5 days), so I shouldn't be surprised if things got worse before they got better. And that's what happened--the next day, I ran and felt good for 20min or so, then started to feel a bit "off" with a bit of bad coordination and hamstring/calf tightness. Each day after it got progressively worse until I was about back to square one, feeling about the same as I've felt all summer. I also did long walks on the subsequent days, and those got progressively worse too, but not as bad as the runs.

But the problem is that the cortisone never kicked in, so I'm left having to hedge my bets on the results of one day and one shot. The cortisone DID seem to reduce/eliminate the hip pain I had AFTER running hard and losing coordination, but again, that's (at least for now) secondary to the actual loss of coordination.

The one thing I have not tried this time around, and the one thing that worked temporarily the last time I had this problem (one year ago) was an extended break from running. Last time it was forced on by a stress fracture in my pelvis, which was probably caused by my coordination problem throwing off my stride. So what it looks like I'll do now is take 8 weeks off from running. I won't do anything at all for the first two weeks, and then I'll try to find a pool to aquajog in the next six weeks, since that's what I did last year. I'm telling myself that it's not "giving up," but that's sure what it feels like. After the 8-week break, I'll try to start up running again. If I'm still having problems, I'll probably schedule surgery.

I do have a hunch that the labral tear IS the problem, and that the lidocane worked because it numbed the proprioceptive nerves in the labrum and the cortisone (being an anti-inflammatory) did not. Regardless of that hunch, I had one of the top labral tear/FAI doctors in the Midwest tell me he can't guarantee that the surgery will have any effect on my coordination problems. And considering that, I don't think it's fair to jump into surgery without trying EVERYTHING else, including an extended break from running. Even though I'm fully aware that, if the labral tear IS the root cause, time off will not help (since most of the labrum is avascular and thus cannot heal). Especially considering this worked for a while the last time around.

So I don't suppose I'll be posting updates any time soon. I'll check back with this thread and try to answer any questions people have though. Anyways, good luck to everyone else.

I've been dealing with this problem for about two years now. Like many people on here I can randomly get in good workouts or even a solid week here and there.

I've also tried everything, and pretty much have given up on running as of right now, I just go through the motions and if its a bad day for the leg thats all I get in that day.

I'm really looking into the impingement theory and planning on suggesting it to my Dr. next time I can meet with him.

TDF, what is your story lately, are things still going good? and neliah2507, what about you man?

I'm working with a great Dr. right now Chris Larson in Edina, Minnesota (team doctor for minnesota vikings) anyone looking for someone to see with this problem might want to look into seeing Chris.

Also, enough with physical therapy, after reading this whole thread it just goes to show you that these PTs can come up with endless theories about your problem, you could literally keep trying a new approach with PT for 10 years and still not get better! I really don't think its the answer for any of us who have had this problem longterm

Dr. Larson in MN? No kidding. That's who I was seeing. What's he told you about your injury? I'd be very interested to hear. Have you gotten an MR-Arthrogram?

Also, brief update from me...4 weeks off as of Friday. Might start some aquajogging in a week or two, and probably some strength and lifting at 6 weeks. Can't really tell if there's been much improvement, since I've avoided running/walking long distances. But I can't really tell a side-to-side difference when I walk around the house like I could when I was trying to run. And I don't have any right side hip pain anymore either.