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

I had that problem occasionally in college during long tempos on the pavement and track 10k's. I think it has something to do with muscle fatigue, and the surface you normally run on.

I'd do long training runs on the trails every day, and then I'd do a 10 mile tempo in peidmont park and my legs would loose coordination. One particular conference 10k i ran, at 5k my legs were feeling very uncoordinated and i was about to fall out the back.. this was odd because the pace was fine, but my legs were just wobbly... the pace ended up slowing down a bit, and i started feeling better and ended up running well...

My guess is that it has something to do with surfaces. I trained on dirt and gravel trails with heavy duty trainers, then I raced on hard surfaces with minimalist spikes. I also never did track workouts in spikes. I think the impact over longer distances on hard surfaces with minimalist footwear makes your muscles fatigue in a totally different way then atleast I was prepared for. It had nothing to do with lactic acid or lack of aerobic fitness since we all know how that feels.

If I had to do it again, I think I would train more on the track in minimalist spikes.. I always avoided that due to fear of injury and enjoying the feel of the lighter spikes on raceday... I might also do a few more runs on the road just for the pounding. I know thats what I avoided like the plague, but once or twice a week may actually help.

has anyone tried orthotics? my D.O suggested that I get some because I have some issues with my gait that could be causing the problem and hopefully fixed with orthotics.

Sarah - I would say that I have good days and bad days but I am quite certain that it has more to do with how well rested I am going into a run than whether or not egoscue is impacting things.

I know what you mean about feeling like you're at square one because that's how I feel sometimes. But then I remind myself that I am not at square one because I have ruled out so many different things. I no longer visit chiropractors, neurologists, orthopedists, PTs, massage therapists and other specialists because they have proven worthless with this condition. So I'm not exactly at the starting point. I was at the same point where I had a hard time convincing myself to spend 60-80 minutes per day on something that may or may not work. I've been doing it for several months now and still haven't seen the results, but I feel like I need to do it for a few months before I am in a position to say for sure that it did not help.

The only egoscue success story for something like this is 16X...at least that I know of. That is good enough for me, because I don't have any other treatment options at the moment.

I want to make sure you guys know that my success was with a osteopathic manipulative and it took 5 months and probably 10 visits. He ended up putting a heel lift in my "short side" and after some months it balanced the opposite side. Then I took it out.

What I did was log onto the free menus and did those over the months I was under this care - and still use some of the exercises. He said there was nothing wrong with doing exercises to balance my body, but he was not familiar with egoscue. I had a friend who is a massage teacher in Atlanta and she used egoscue with patients with great success.

Don't want you to think I had a true egoscue experience, with evaulation and all that,but my healing was at the hands of an osteopath.

My sister had pain in her right hip and did the exercises with me last summer and she was able to rebalance and the pain went away. She still does the free menus.

I am pulling for all of you. Let me know if I can help.

Having only been able to browse through the numerous pages of commments on this subject, I can't address everything I've read. However,as a former collegiate runner and now a PT, there are some general observations I have noticed about runners and related injuries. I apologize for the rambling, technical nature of the post but here goes...

Symptoms such as buckling of a leg, weakness in a leg, numbness, tingling usually suggest peripheral nerve involvment rather than a problem with the muscle itself. I would first rule out involvement with the lumbar spine before anything else since the L2 through S1 peripheral nerve roots innervate the majority of muscles in the legs. Running on flat surfaces, epecially harder surfaces such as cement or tracks will increase lumbar lordosis of the spine and anteriorly tilt the pelvis and put the intervertebral foramen in a more closed position, increasing the chance of impingement. Up-hill running usually decreases lumbar lordosis, opening the foramen. Normally your transverse abdominus muscle is responsible for providing stability for the spine so the spine does not take a pounding. Speaking from my own college days and some of the patients I 've seen, this muscle will often fatigue during long runs and longer races leading to more force being absorbed by the spine itself and possible impingement. Doing sit-ups, crunches, bridging does not target this muscle. Even with piriformis and sciatica issue, there may be a lumbar component. My guess is that it is very difficult to reproduce these symptoms for the Dr., PT, or whoever unless a person is in the middle of their long run or workout.

I would also clear the hip for possible impingement of the joint capsule, piriformis-sciatic nerve irritation, or hip abductor (glute med, TFL) weakness. There may be some merit to orthotics, leg length discrepancy, etc. but they would not be the first things I would consider. I would start at the lumbar spine and work down.

Hey thank you so much for your advice. Could you tell me what you think of my situation? I understand what you're saying about relieving symptoms when running uphill, but, I still get my left leg loss of muscle coordination even when running uphill. I NEVER have pain like Sarah and some of the other posters. The one thing that relieves my symptoms is running on a very uneven surface, like a rough trail. That makes me think (after looking into everything from the foot up and the back down over the last 5+ years) that the problem originates from my foot up. My foot is what is affected by the uneven surface. Yes, I have DEVELOPED problems up in my hip/pelvis, but I believe these to be a result of original foot issues. Is that possible? I have a large (gobstopper sized) accessory navicular on my left foot that has visibly deformed my left foot, compared to my right which had the accessory removed in college 9 years ago. My question for you is is it possible that the large accessory navicular that has put my foot into a state of chronic forced external rotation could cause the chronic foot and knee splay that the muscles of the hip are too weak to combat? Or, could the acc navic be pinching the post tib tendon? or nerve under there? I do get cramping, a sort of ratcheting sensation at both ends of the fibula at the knee and ankle joint when I get the loss of muscle coordination. Any advice or thoughts would be appreciated so much. Thank you!

It's hard to say whether the ankle problems came first or the other way around. Most therapist I know will treat the ankle,knee, and hip if there are any strength or stability deficits since they all affect each other.

Problems with the accessory navicular can cause problems with the post tib and nerve causing the ankle to buckle inward (loss of post tib eccentric control) during stance with a very flat foot. There are also other things that could be at fault and cause pain. The fibula at the distal end is meant to provide a bony block along the lateral side and limit the inward buckling. The common and superficial fibular nerves as well as the fibular muscles and tendons do run the course of the fibula hence the name. I do not know what to say beyond that.

While not the exact same thing, I have had some tarsal tunnel syndrome in my left ankle, which pronates heavily, causing tingling on the bottom of my foot. I never seemed to have this problem on trails (which are fairly uneven) I'm guessing partly because of the softer surface and having to constantly adjust to changes in surface elevation and path direction with lateral and vertical movements. I know the trails you run may be smoother and allow to run at speeds comparable to roads, so this may not be the case.

Runner PT - assuming it's the lumbar spine/transverse abdominus, what can be done to correct it? what part of the country do you work at?

Runner PT,

What happens if u find that there is joint impingement, or piriformis-sciatic nerve irritation? I've read that these can occur when the thigh is undergoing adduction. So what can people do at home on their own to sort out such complications?

What r the possible exercises u would recommend if the lumbar spine was involved?

If the problem was more with the nerve than with the muscles, what can we do about it?

I realise in most cases u would need to examine the patient first hand b4 giving any prescriptions, but some general examples might be helpful to us 'un-coordinated' sufferers here.

Thanks for your time.

I too have seem just about every one for this, even a few surgeons(misdiagnosed). So my first advice is not too give your money away.

I learned how important the glute med. is for running and so I worked hard on my bad leg. I learned the best thing for this, is to train in a area that allows for the type of running that challenges the bad leg the most. So the flat faster runs, help strengthen what ever needs to be strengthend the most. (its always worse after training on hills and making left turns on the track)

which brings me to my advice number two, don't ever train through the problem when it gets bad...I still struggle with this one even after causing a sports hernia on the other side after a 10 mile tempo.

I came back from that hernia operatin determined not to give up, even though the winter I had to stop on all my TM tempo runs and during a spring 8k had to limp the last 2 miles. I did one long progression run with success and entered a low key marathon and ran 2:21, only problems were in the first 12 miles. Two things that helped during the race...I started off slow (5:30's the first 5miles) then made sure my bad leg was on the high side of the road.

You would think I figured out the problem, but I haven't. Racing has gone bad, and tempo runs slower then my marathon pace have also gone bad. So my last bit of advice is probably to quit. My experiences lead me to believe its something that can be relieved....but never fixed. And that alone is going to limit your performance becuase its hard to stay mentally ready as you all know.

I felt bad after reading this c, floyd, but I am living proof that it can be "fixed".

update

today was my first day running, since that 3200 3 weeks ago:

ran a 2 mile tempo at 5:15 pace today on flat asphalt bike path and had no loss of coordination in my right leg (loss coordination would normally occur at 1.5 miles) yes, running a tempo probably isn't a very smart idea after taking 3 weeks off, but i wanted to test my leg to see if it was progressing- which it definitely is.

in the last three weeks i have been doing: hip flexor exercises daily, side leg lifts daily that target the glute med, lunges (only once in the last 3 weeks) with weights that target the glute max.

i'll update two weeks when I do a fast 5 mile tempo on a flat asphalt road.

I live in the Twin Cities. Without overstepping my jurisdiction, and, yes, not having examined anyone, here some problematic areas and subsequent exercises I often give patients. Again this if FYI.

Lumbar spine - This can vary a little bit depending whether it is an extension/rotational/closing problem or more a problem related to flexion. In addition if there is a bulging or herniated disc, this can dictate various exercises. If symptoms are worse with extension (symptoms worse with running on flat ground, improved with up-hill running), a simple exercise to promote flexion is double knee to chest while lying on back (4 x 30 sec). No matter the patient, strengthening is key as stretching alone won't be as successful. Most will benefit from transverse abdominus (TA) strengthening for stability. The easiest way I teach this to my patients is lying on their backs with knees bent. I instruct them to hallow their belly button and abdominal area just below towards their spine and hold for 5 seconds each. I tell them if they are doing it right, they should feel the muscle tighten just medially to the two points on the front of their hips (ASIS). This exerice can be progressed by increasing repetition (often up to 30 to 40+)in seated positions (gravity neutral), on hands and knees (against gravity), on theraballs (rotations while holding TA contracted), adding slow alternate arm and leg movements( on hands & knees,hips and trunk level so you could set a glass of water on) while TA is contracted. There are a lot of exercises to strengthen TA.

Hip- A lot of you are right that it is important to strength the glute med (GM) as research has shown a connection between weak hip abduction and such injuries as IT Band syndrome. GM can be hard to isolate as the hip flexor often substitutes for it if done incorrectly. One exercise I give a pt. is sidelying hip abd but it can be ineffective if form isn't proper. Pt is instructed to lie with hips facing wall, not opening to the ceiling, hip extended, toes pointed to the wall. Leg is raised towards the ceiling and back repeatedly. They have to watch for hips opening to the ceiling or the thigh flexing forward. How well they hold form determines number of reps. Pt should feel it in the side of their butt if it's done right. Also traction while hanging the leg off of a step stool while wearing a light ankle weight (5-10 pounds) for 1-2 minutes has helped some of my patients improve their symptoms.

Unless there is underlying pathology, problems with nerves are often addressed by working on joint stability and correcting arthokinematic problems (proper joint motion) due to muscle imbalances, capsular hypomobility.

I do manual therapy with many of these areas.

I will echo the sentiment to not give up on an injury and keep looking for answers. I ran the last two years of my college career with a swollen lateral knee. The first sports docs and PTs I saw said bursitis. Finally I went to Mayo, did an MRI, and they found what was at that point a 30% tear in my IT Band, a first for any patient they had ever seen.

Thanks for the replies Runner PT.

I feel like mine has a lot to do with my back. Although this problem started before injuring my back, I feel that my back injury made it much worse. It feels better now for the most part unless I have been standing for a long time. Sometimes, while running it will begin to tighten up on me and that causes problems with my legs. I think I fall in line with symptoms being worse during extension of my lumbar spine.

If anyone else wants to try this, I feel that the sprint workout I have been doing once a week is helping my coordination. I don't have any coordination problems while sprinting all out on my toes unless my legs are already extremely fatigued which hasn't been the case in awhile. I've been doing this for 7 or 8 weeks now and have noticed quite a bit of improvement. I also do 8x100m strides fairly quick (800-1500m pace) after my runs 3 or 4 times per week. I guess my distance stride is what is thrown off and out of balance, but my sprinting stride is more balanced, if that makes sense. I could barely complete a 4 mile tempo run on a fairly even trail 2 months ago, and that was with me grimacing the entire way trying to stay coordinated. Two weeks ago I finished a 6 mile tempo run without incident and woke up the next day feeling ok.

Just a suggestion for everyone. I've also been doing glute med. exercises by hanging my leg off a step and raising it as described earlier in this thread.

mlbfan - wow, what a huge improvement for you!

What surface do you run your strides on?

I know exactly what you mean about running on your toes feeling better, I guess the problem is that I am a midfoot striker when it comes to long distance.

I'm a mid-foot striker as well, so I still don't feel quite right when running on pavement or a bike path, but things seem to be improving. I do my strides mostly on the street in front of my house. It's not exactly the best place to do them, but I finish up my runs when I get home so I just do them there. Once a week I'll do them at the track as part of my warmup for my normal 4x200m work out all out. It still baffles me that I can sprint all out without any incident whatsoever, but I feel like it promotes proper muscle coordination as long as I focus on my form.

and are you doing your sprints on the track all the same direction? with the left leg inside?

Yeah, I sprint counter clockwise, but I warmup and cooldown clockwise on the track. I never gave it much thought about whether or not the intensity of sprinting vs. jogging in a certain direction has differing effects. I might try alternating my sprints to see how I respond.

bump

have been making progress-

my right leg has a funny feeling now when i am not running, but i have not lost coordination.

ran a 3 mile tempo in 16:35 with a little tightness in bad leg in the first mile, but loosened up along the way and never lost coordination.

still doing hip hikers, lunges, and leg press biweekly but added a new exercise- using the eliptical trainer for 15 minutes on a steep setting and moderate resistance, making sure you stand up straight- i HIGHLY recommend trying it out, i feel it targets the glute max and quad where i need it

also i am running a clockwise mile on the the track twice a week, picking it up on the curves.

how is everyone else doing?