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

Miss Osage County,

How is the insert working for you now? I'm thinking about creating my own makeshift insert to accomplish essentially the same thing. I feel like my left calf and lower hamstring are cramping and losing coordination now, along with my lower quad still feeling very weak, and I think it has something to do with landing on the outside of my left foot. Before these coordination issues arose, I landed evenly on my foot during running.

An excellent website on the role and function of the gluteal muscles:

http://www.easyvigour.net.nz/fitness/h_gluteus_maxintro.htm

MLB fan,

I too use to land fairly flat on both feet. Coinciding with my loss of muscle coordination, I now supinate on the left foot. I don't run a day without my insert and it is treating me well. So, I say yes, try it! My foot still tips out, but not nearly as bad, and like I mentioned earlier, I rarely get the loss of muscle coordination problem cropping up anymore on regular mileage runs, only workouts still occassionally. And, even that has improved as I can now run 8miles continuously at tempo pace without a problem. I could barely do 1-3 miles last year.

Thank you for sharing the gluteals link. I too think they are extremely important. I can engage my gluts a lot more easily now when I run and my hips are SO much looser, thanks to all the active isolated stretching with a rope. Night and day difference. I've also eliminated a lot of the tightness in my foot due to the stretches for the lower leg. So, I've improved the hips at the top and the feet at the bottom, and so now I can tell that when I get the loss of coordination problem, it coincides with tightness on the lateral aspect of my knee, at the fibula. So, that is the latest thing I'm investigating for an answer. One by one I'm trying to rule things out. I can tell from the rope stretching that my psoas and quads are incredibly tight. I think the key might be there, that those tight muscles are inhibiting proper articulation of my knee joint... I feel that or the back are the next to look into to rule out. I had this guy Jerry Hesch look at my back, and he thought it was a nonissue for my problem. (You can google Jerry Hesch and his "Hesch Method" for identifying SI joint problems:

http://www.heschmethod.com/interview.shtml

.) He's supposed to be some sort of expert, and he checked my SI and back and said what he found wouldn't cause my loss of muscle coordination, in his opinion, of course. I'm still not convinced though, because when I had an ART guy working on my back, it seemed to help a lot...

I'm piecing things together, and I think both the shoe insert to correct the supination and the rope stretching to open up leg muscles and allow them to function properly are two keys. Those both help tremendously, but the problem is not gone. So, the next part of my plan to figure this injury out is that I am going to increase the rope stretches for the quad to see if that helps reduce the knee flareups that coincide with the loss of coordination. Also, I'll give the ART guy another try for working on my back because maybe there is some sort of pinched nerve (ie: the peroneal on the lateral side of the knee) that is causing the loss of coordination.

What have you been trying for your leg?

For the last month, I've been following a strengthening routine that focuses on the glutes and hamstrings, similar to HSKid's program.

2-3 times per week, I've been doing the following routine:

Leg press - single leg, 3 sets of 15 reps

Seated hamstring curls - single leg, 3 sets of 10-15 reps

Life Fitness glute machine - single leg, 3 sets of 10-15 reps

I definitely feel like it is helping. Yesterday I ran a moderately paced 10 miler on a flat surface. The problem kicked in around 7 miles, but the symptoms were much fainter than ever before, it wasn't nearly the nuisance that it was in the past and I felt like I could run through it. I ran on the grass for a few seconds to get rid of the symptoms and it did not come back for the rest of the run.

Hopefully another month of this weight training will take care of it for good.

From my reading of the previous 2 pages, I think the quads r a real issue w many of us.

I believe that much of this has to do w running technique/style.

Ask yourself this question: do u consciously/unconsciously reach forward w your lower leg when u run? If u do, chances r that u will land ahead of your centre of gravity, making yr quads, knee, shin, ankle, foot take most of the landing load. Over time this can cause a severe shortening of the muscles in this area, and in extreme cases, shin and metatarsal fractures. This is worse if u land heel first, leading possibly to chronic achilles problems. U may also get an acquired short leg, hence creating even more problems w coordination.

Do u try to 'lift your knees' as u try to run faster? This is what I see many coaches tell their charges to do, teaching them that higher knee lift will make for better running. Hence the high knees drill. This may not be a real problem on its own, but most runners will contract their rectus femoris, iliopsoas, adductors in order to lift their knees, not to mention pushing off as hard as possible rearward to produce a more powerful forward and upward hip drive.All to attain the magical 'knee lift' that will satisfy their coaches' demand.

This leads to overstriding and landing ahead of the body's centre of mass, again overloading the quads/lower leg, making them do the work of stabilising AND mobilising the body. There is also a great braking force generated against the forward landing leg and this will send shock waves directly into yr hip joint, imposing a shearing force on yr hip muscles, particularly the iliopsoas/SI joint/pubis area. Over time your groin/lower abs will tighten up severely and may eventually tear up under great running effort.

Once u over-rely on yr quads for knee lift and shock absorption, they get real stronger than the hamstrings and may eventually shorten. This pulls down yr pelvic girdle from the front and so u have an anterior hip tilt, which in turn inhibits yr glutes from firing, leading to hamstring overloading for hip stabilisation and extension. This causes the hamstring to become very vulnerable to strain/pulls.

Inhibited glute med is not able to pull yr hip rearward and so yr lower back comes into play as compensation. This in time leads to lower back strain.

And u can see that all of the problems can be traced back to misconceptions and execution of running technique. It also doesn't help that most training shoes on the market r heavily cushioned, possess higher platform and high heeled, which encourages greater-than-normal push-off, careless foot landing, heel-striking, overpronation, over-reliance on hip flexors for forward knee drive/lifts.

All the work in the world of strengthening the gluteus medius, hamstrings, back, etc, of using podiatric aid and stretching out tight areas will amount to naught if u go on running in a destructive style.

We've already discussed the uses minimalist footwear and barefoot running, but u might still be running wrongly due to years pent in the built-up heavy shoes. I realise that there r many schools of thought on technique floating in the info world out there, but on a personal note I would recommend using a more 'pulling up' rather than 'pushing off' focus when running. Activate yr hamstrings for this purpose. Also pull yr foot backwards as if u r trying to slide the ground rearward, rather than trying to 'toe off' by pushing up from yr forefoot and by contracting yr calves. Forget trying to 'open up' yr stride to run faster, and forget the 'knee lift'. Emphasise high cadence, and the stride length/knee lift will take care of itself.

This will activate the hip flexors/quads/groin more synergistically rather than as prime movers when yr hip moves forward. In this way they will not be overworked, and yr hip will rotate more freely, almost like a wheel. U will also land yr foot below yr centre of mass and prevent overloading the lower leg/hip joints.

I can guarantee u that without a reconstruction of yr running technique, all that therapy will count for nothing. Don't go for short term gain; be farsighted in yr treatment.

my bad leg fatigues faster when riding a stationary bike, running on a eliptical trainer, or walking up large flights of stairs, but never to the point where i lose coordination- this isn't just a running thing- i think it's weak hamstrings causing the quads to work extra

i also have video of a race where my leg goes bad-

From what i noticed, when my leg starts to go bad, the hamstring (of my bad leg) will not contract as much as my good leg, and the kickback on my bad leg maybe goes 3/4 of the way back as my good leg. during the forward drive of the bad leg, my knee only goes up half as far as my good leg.

i'll try to post this video on youtube at some point, but i have to change to speed to slow motion so that you can see the difference

hskid,

From the symptoms u described, I see that yr bad leg is at this point shorter than yr other leg, and that the full length lift hasn't really solved the problem.

Your symptoms r fairly common, even among non runners (so in yr case I would say u r right abt it not necessarily a running thing). Besides poor running technique, other possible causes include always standing on the same leg, always using the same leg as 'pivot' when playing ball/racquet games, subconciously tensing that same side of yr body when standing or seated, too much track work, etc. Yr bad leg fatigues faster when u climb stairs/cycle/elliptical-train bec its muscles r already too overused and short and so cannot contract as extensively as before bec they cannot lengthen to the same extent as normal muscles. Just strengthening the glute med will not change this.

(But u did mention weak hamstrings, probably from infrequent activation when u run, as u might be overly quad-reliant when u run as I mentioned in my last post. Doing hamstring strengthening is one thing; actually using them effectively when u run is another.)

Yr bad leg's hip flexors/adductors r still tight and pulling yr hip downward and forward. This means that yr glutes and hamstring r still being impeded and so cannot contract very much. It should also appear to be larger and shorter than the hams on yr good leg (pls check to verify, cos I may be wrong)

In this position, u will have very little forward knee lift bec yr rectus femoris is still short. Yr iliopsoas is also still short and tight, pulling yr torso down diagonally toward yr bad side. This causes the bad leg (wh is now shorter) to step slightly behind yr general centre of mass (hence the way higher back lift and way lower forward lift), while yr good leg (wh is now the functionally longer leg) is made to step more in front of yr GCM as a form of compensation (hence the higher forward lift and greater range of motion for hams). U might be heel striking more on yr good leg and forefoot landing more on yr bad leg (again, correct me if I'm off)

I think yr quads on the bad leg have either developed a thick fascia around it, and/or have some knotted regions that require intensive myofascial treatment (ie. massage). Usually the colour, texture, thickness, flexibility and strength levels of yr bad leg will be way different. It may appear 'darker' and feel thicker as far as the skin texture is concerned.

Its probable that yr bad leg's adductors require the same treatment. U might need a combination on massaging and then stretching (plastic deformation) in order to get the two legs back to more similar length and strength.

Check for any heel/achilles pain on yr good leg and shin/ankle/soleus soreness on yr bad leg to verify. Check also for the lengths between both lower legs. Chances r yr bad lower leg will be shorter, with tight shin and calf muscles. A positive for the above points would mean that u need to lengthen those muscles in order to aid in solving yr upper leg problems, cos a short leg will continue to pull yr hip down and forward, thereby activating yr quads more than yr glutes/hams. This will begin the entire viscious cycle all over again.

Its possible that the full length lift under yr good leg is contributing to making that leg step more forward and yr bad leg to step more rearward. I believe that lift was prescribed initially bec yr bad leg was stepping more forward than yr good leg, even tho it is functionally shorter. The lift under yr good foot will make yr good leg step more forward so that yr bad leg will not be so quad-reliant when u run/walk in that leg lift. But it doesn't change the condition of the existing shorter and tighter muscles. Yr bad quads will still continue to fatigue bec they r still too tensed up with thick fascia, coagulated toxins released in yr body due to overuse, scar tissue, etc.

Slower cross country courses will, to a certain extent, mask the problem and keep u fr losing coordination bec SOFTER GROUND GIVES MORE READILY under yr body weight, giving the effect of helping yr body compensate for its discrepancies. Mud, for eg, will adjust itself according to where u place more pressure on it. Thus it doesn't matter which leg is longer or stronger. U will also push off less on mud/grass, relying more on yr hamstrings to pull yr feet up and under yr hips. U will also try to take smaller steps and have a fuller/flatter foot plant so that u will not slip or lose balance. U can se why then that u run ok on slow courses.

Flatter ground/faster courses DO NOT GIVE WAY, and so yr body has to adjust itself relative to the rigid terrain. Thus it can no longer hide its imbalances. U will also rely more on foot pushing off bec u can feel solid platform agst wh to drive forward. This leads naturally to larger stride length and more high-stepping/forward-reaching run action, achieved by greater quad activation. This will tax the deficient areas in yr hip/leg wh u have outlined for us in a more pronounced fashion than on slower courses.

My suggestion would be to ditch the full length lifts and concentrate on fixing the shortened/tightened muscles on yr bad leg. Besides strength work, include massage and stretching and technique work. Try to relax yr quads when u run and rely on upward pulling of lower leg w hamstrings, and lean forward. Things won't improve immediately but when they do, the cure will last.

Technical changes will also slow u down noticeably, and so u might wanna consider not racing for a while. But the slowing down is only a transition toward the next acceleration forward and so yr patience will pay off in the long term.

Runner's dystonia.

Wu LJ, Jankovic J.

Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA.

Adult-onset focal dystonia in the upper limbs is well characterized whereas such dystonia has been rarely reported in the lower limbs, especially in proximal parts. When such focal dystonia occurs in an athlete it is often wrongly attributed to an orthopedic disorder. We present five cases, three female and two male with mean age of 44.6+/-10.43 years, mean age at onset of 37.4+/-10.33 years, and mean duration of symptoms for 7.2+/-4.44 years, who initially noted dystonia of one leg during long-distance running. The clinical features of dystonia in these long-distance runners overlap with those of more recognizable forms of focal dystonia including relief with sensory or motor "tricks". They also share features with paroxysmal dyskinesia and carbamazepine markedly ameliorated the symptoms at least in one patient. One patient benefited from an oral anticholinergic, one from levodopa, and another two patients benefited from repeat botulinum toxin injections. Our patients differed from the typical childhood-onset leg dystonia, such as the DYT1 dystonia, in that there was no family history of dystonia and the leg dystonia remained focal without spreading to other body parts. Two of our patients had prior injury to the affected leg within 1 year prior to the onset of the dystonia, raising the possibility of peripherally-induced dystonia. We draw attention to this rare, disabling, adult-onset focal dystonia involving proximal lower limbs. When recognized early, it may be treated effectively with either anticholinergic drugs, anticonvulsants, levodopa, or botulinum toxin injections.

PMID: 17097111 [PubMed - indexed for MEDLINE]

I googled Dystonia and it found a key symptom is "burning heels". But, I don't know if that's a symptom for all the types of dystonia, including Runner's Dystonia.

I don't have burning heels when I lose muscle coordination... Anyone else?

any one ever get back to you spinal stenosis? It looks like my 17 year son has a case of it and he is a tremendous runner and all around athlete. I am unsure what his future is at this point. Most the info is on elders getting it, quite naturally, so I am curious how other runners have dealt with it. Please email with your response.

i would spend hours at a time on the computer searching and a few years back came across dystonia. I would rule that out, its all glute related.

also when I found dystonia there was no runners dystonia. I wonder if in the last 3 or 4 years this term has been created.

I'm getting fed up. I've switched from a heel/mid foot striker to a forefoot striker, but my stride never feels normal, even at the beginning of a run. When this problem first kicked last fall, I at least would feel normal up until coordination loss. Now, if it's not my hamstring and upper calf cramping up and losing coordination, it's my lower quad area (maybe rectus femoris and vastus medialis?) cramping and fatiguing til I'm forced to stop. Some days I'm able to get through an 8 mile tempo run without being forced to stop, but my left leg feels tight and weak throughout and I never feel normal.

The worst part about it is I even feel it walking around on ba days, and if I take time off from running, upon resuming, the condition is even worse which is really the only thing keeping me going. It scares me to think if I take a few months off I won't be able to run a mile without being forced to stop.

Do any of you do lunges on a regular basis? I did about 50m worth of them tonight after my run, and noticed as my legs were fatiguing towards the end, I was losing control of my trail leg as I was bringing it forward.

My problem evolved somewhat like yours- it switches around to different areas.

At different times last year it was a bad calf problem, then more upper calf, and then lower hamstring, etc

I also had the 'take time off from running, start up worse than before'

The only time when I was okay was a time that coincided with a drop in mileage and an increase in core/general coordination and strength work. I took some time off due to illness, stopped doing the core work, and i have never been able to fix it to this day

mlbfan - I used to do lunges with the hope that it would cure me. I remember that it was way harder for me on my bad leg. I stopped doing them after about 3 months, because they did not help.

I too could never figure out where the problem really was...at times it seemed like the lower quad, then the hamstring, then the calf, then behind the knee. My stride always felt choppy on the left side. My theory as to why we feel it in so many different places is because some critical muscle is shutting down with repetitive use and it is forcing other muscles to take on a lot more work than they can handle. So it seems logical depending on the surface that you would feel it in different places.

I think its the rectus femoris again, probably still very short and tight on the bad leg. The muscle simply cannot stretch and contract as much as that of the good leg and therefore it fatigues real easily.

Once the rectus femoris is short, every time u exercise it the muscle wil pull down on yr pelvic girdle (creating a pelvic tilt to that side) and cause impingement of the gluteus complex behind. This in turn leads to overloading of the hamstring to compensate for gluteal inactivity. As the hamstring is connected directly to the calf, the overloaded and tightened hams will pull hard at the calf muscles, causing pain/discomfort at the back of the knee, where they meet. This creates a 'short leg' at the bad side and so u lose coordination when u run.

Once more, u need to release the tight rectus femoris by myofascial treatment followed by stretching. As long as u keep training thro this condition with yr rectus femoris shortened, u will always lose coordination in spite of all the strength/core/technical work.

Usually the iliotibial band on the bad leg wil also be shortened along with the rectus femoris. U will not necessarily feel any pain at yr hip or knee but the tight ITB contributes to the haywiring stride mechanics also bec it causes yr bad foot to step way inwards across yr body's midline, leading to over/under-pronation (depending on how u choose to compensate. This can lead to achilles/shin pain or ankle sprains.

Besides massage and stretching the aforementioned tight areas, I would recommend trying the exercises from the following link to see if it helps:

www.egoscue.com/htdocs/pperformance/itband.asp

Posetech.com also has this great ITB exercise found in one of Dr Romanov's articles on ITB syndrome. Just check out the website any search for it under Pose training articles by Dr Romanov.

Thanks for the info foomiler, very informative.

So I noticed the weirdest thing when I was working on my hamstrings at the gym. When doing seated leg curls, my left (bad) leg supinates tremendously on every rep. It's completely involuntary and there is little I can do to straighten out my foot. When working on my right leg, my foot is perfectly straight. What causes this??

I ran a hard 10 miler and noticed that my left foot also begins to supinate around the same moment when the loss of coordination occurs. I guess this is very similar to what Miss Osage County experiences.

Anyone know what could be causing this one sided fatigue induced supination?

I don't know what causes it, but my leg does something very similar. If you can imagine your femur being able to spin, mine feels like it is spun outward as I run.

If you take a few days off, does your coordination feel worse? I just went for a 6 mile jog after 3 days off from being sick with the flu, and my bad leg was the worst it has been in over a month. Everything was going wrong today...calf, hamstring, quad, restriction, weakness, you name it. And I was just jogging along at roughly 8 minute pace.

I've noticed that the more time off I take, the worse the condition gets. This is the only injury I've heard of that gets worse by not running...Like mlbfan24, I can't pin-point where the loss of coordination begins (which makes it even more frustrating when trying to explain the injury to medical professionals).

As for the supination, that's why I believe I have such a weird wear pattern on my left shoe.

On a bright note, we've had a tonne of snow here and I've found that the snow, like gravel trails, facilitates running with this condition.