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

Strengthening the glutes is great, but i think the problem for me and anyone, else who has labral tears (as i have one in each hip), is that they shut the glutes down. Strengthening only works if the muscles fire properly.

fly137 wrote:

Strengthening the glutes is great, but i think the problem for me and anyone, else who has labral tears (as i have one in each hip), is that they shut the glutes down. Strengthening only works if the muscles fire properly.

Are you well enough to try strengthening the hip flexors, esp the ones mentioned in the article I posted?

I am well enough. I do a ton of exercises at PT, but nothing translates into normal running.

The problem with me is that they don't know whether my muscles are just stuck in a bad pattern where the hip flexors are overworking and the glutes and lower abs don't work enough or my bilateral labral tears are actually shutting my glutes down and/or other bad stuff.

If it's the first case, then I just need to keep up with the PT. The problem with this solution is that I have already gone this route over the summer. I was doing 1-2 hours a night worth of work for over a month. My legs felt about 75% better. I went back to school, and was running about 55 mpw. After one week of letting up on my exercises, all the symptoms came back full force.

If the labral tears are shutting things down, then I will need surgery.

BUT, I saw my doc today and he is sending me to see if I don't have some sort of arterial compression going on in the quads. He wants to go this route because I have symptoms even at rest where I feel a sensation that, when I run, feels like a deadness or fatigue. Any thoughts?

Fly137, here are my thoughts... Loss of muscle coordination/dead leg/leg dragging/whatever we all want to call it:

***Key Question: Is it coming from the foot up, or from the back down?***

1. Get on an Alter-G @30% body weight to remove the variable of full ground contact and note what happens compared to when you are bearing full weight running outside

2. Stand in front of a mirror and do a few standing lunges (stay in lunge position with one foot forward and go up and down repeatedly, then switch sides), noting the difference between your foot/knee/hip alignment on each side and the position of your knee cap and the line of your VMO up toward your hip (first watch what your knee does for a few, and then watch what your foot is doing for a few when your bad leg is the forward leg)

3. Ask someone to stretch you out on a sports med/massage table and specifically notice the diff between your good and bad legs when they stretch the adductors and when they stretch the hamstrings (see if they can feel your femur rotating like it's hypermobile)

So, I say back down, specifically in the hip, specifically a labral tear. And, I say glut exercises aren't enough. Essentially, the "seal" if you will, in the hip is broken and it can't properly stabilize. Thus, the muscles around it live in a state of dysfunction. Before I even knew I had a labral tear, I described what I was feeling as my leg feeling like it was a lightbult loose in a socket and it needed to be tightened to work. I don't want to do Foomiler's flipping glut exercises. I've done them... FOR YEARS. And, know I now they are never going to FIX my problem. No amount of strengthening exercises has ever eliminated my symptoms.

Miss Osage County:

I have three questions for you:

1) Do you have any of the pain typically associated with labral tears? Clicking, Catching, deep pain...?

----I have a little catching sensation on occasion, but nothing else and this makes my doctors/PT skittish about sending me in for surgery.

2) Does your deadness or fatigue sensation bother you at rest?

----Sitting here right now I have a very annoying sensation that runs along basically what is my left sartorius muscle and affects the whole VMO. When I run this turns into deadness and the muscle shuts down.

3) Are you doing anything to have your labral tear repaired surgically? If so, what?

I absolutely agree that this is a labral tear problem, or at least that strengthening alone will not do the trick.

Also, I have this problem in both legs. The left is worse, but I have bilateral labral tears and the deadness affects both quads. So your #3 suggestion might be tricky, as will #1 b/c they aren't too easy to come by.

My next step is to get my muscles tested for any vascular/compartmental problems. May as well rule something out.

After that I am flying out to Colorado. I have an appointment with Marc Phillippon, who is supposed to be the best in the country for labral tears. Basically whatever he says I will probably have to do b/c I don't know who could give me better advice.

Fly137 and Miss Osage County,

What are your physical responses to the exercise "hip suck" mentioned in "No glutes=No results"?

Try holding that sensation as u walk and even run; does it change any of the coordination problems?

Also check out the material in the following article, esp the stuff on hip suck, femoral glide and external rotators.....

http://www.sportsinjurybulletin.com/archive/hip-exercises.htm

From pure personal experience, the iliopsoas, glutes and transverse abdominus shd be kept engaged (as opposed to tight) as a unit when you run or perform athletic activities. I realise the labral tear effectively negates proper engagement of hip muscles but there's a reason why yr PT kps addressing those same exercises, its that u have to engage those muscles in activity to increase the time the femur is properly hinged to the pelvis. This gives the labrum optimal positioning from which to heal. Same logic goes for spinal treatment using TVA strengthening.

When u go running next time try engaging yr groin muscles to keep the femur firmly in the hip socket throughout, effectively doing the "hip suck" all thro the run. Chances are your TVA and glutes will co-currently engage. You shd get a feeling that yr quads and hamstrings are 'freed up'and loose, that yr legs r like one of those stick-thin Kenyan runners, and that power seems to be returning to yr lower body.

But with the labrum still disjointed u will not be fully asymptomatic of coordination issues, but do try this and see if it has a more positive impact on yr running. Keep practising and see if there is improvement all the time. This is effectively translating all the strengthening work into movement.

foomiler and others,

I have followed this thread forever it seems. I don't think I had the loss of coordination, but I have had similar problems with mechanics and alignment in my left leg. I have also tried every therapy I could find over many years now to straighten out my running. The thing that is finally doing it for me is that I lucked into a PT that did something called Postural restoration

http://posturalrestoration.com

. Through specific exercises and strengthening, I am getting the aligment and stride back that I lost 20+ years ago. I am not sure I understand the "hip suck" but it may be similar to some of the exercises that have worked for me. Here is a page on some of their running specific exercises

http://posturalrestoration.com/media/pdfs/Running_handout_-_July_2008.pdf

(none are what was exactly given to me by the PT) but the first one shown seems to be doing something similar to the "hip suck' that you mention and is similar to the exercises that are putting me back into order. The PT explained to me that I had an overactive left TFL, with low strength in the left Glute Medius which led to problems in my hip flexor, ankle, and foot, plus my upper body was rotated with the right shoulder back. My running was a mess, but it is cleaning up. I had 2 months of therapy ending a month ago and I noticed improvements right off the bat and I still continue to do better as my body adjusts. You can learn a lot looking through their athletics pages:

http://posturalrestoration.com/resources/athletics/

What do you think?

i've had the same problem with a tight left tfl and it snow balled into alot of other problems groin injuries hamstring strains ect. one small injury can through everything out of wack. stretching out your hip flexors are key for most people because we spend so much of our day sitting and undoing any stretching we would do with a pt or running. think about it how long do you stretch your hip flexors vs how long you sit in a chair with them flexed?

also something important i've found isn't just DOING strengthening for glutes or an affected muscle but using that muscle RIGHT. which is a pain in the ass(pun intended.) you need to worry more about firing sequence than how strong it is because it can be the strongest muscle in the world and you can still use it wrong

running is a skill that needs to be learned

TDF,

The article looks promising; I'm trying the exercises out to find out how effective they are. If they helped you then I guess it's got to be helpful in some ways at least, if not totally, for others with the same pathology as yours.

Here's another article that describes the "hip suck":

http://www.marchellerdc.com/pro_resources/Articles/DC_67_Anterior_Femoral_Glide.pdf

But the main idea is that we tend to mk the TFL and rectus femoris do what the iliopsoas/glutes shd be doing in terms of being primary hip flexors/stabilisers, and that leads to muscular imbalance. Most ppl train their quads more and allow their hip to sag laterally towards the TFL w each footstrike, and this forces the femur to be pulled forwards and outwards diagonally. But w a functional psoas the glutes are kept in optimal firing position, which keeps the femur firmly inserted in the hip joint all thro movement.

I have tried running with my TVA engaged. It's quite uncomfortable and difficult to breath when you run with your stomach sucked in, but it does help my symptoms. This is not surprising. Some of the pressure is off the hip flexors, but it doesn't fix the problem because a) I can't keep my stomach sucked against my spine all day and b) the tear will never heal. It can't. Surgery can repair it, but the suction seal it privides for my hip is gone forever.

Right now my status is as follows:

I am visiting Dr. Phillippon in mid-May. He is the best, and I will probably do whatever he recommends.

In the mean time, I am following the Wharton's stretching and strengthening plan. A doctor suggested that I visit Jim Wharton, who advised me to do strength training that will train my muscles to reach the proportion of strength required for running. right now my adductors are too weak, quads too weak and hamstrings and glutes tight.

I am also getting my quads tested for compartment syndrome since they get a feeling of pressure and a little swelling with any lower body movement.

Fly137,

All the best on yr upcoming treatments.

Regarding TVA engagement, its not really sucking in yr navel per se, as an isolated movement with the rest of the body passive, that enables the muscles to protect yr spine and to align yr hips. That's done in training the muscle itself doing strengthening work.

The actual activation of TVA is the result of a combination of several bodily adjustments. First with the lengthening of the back of the neck to tip the chin down and to lengthen the rest of the spine, which effectively shrinks yr waistline and sucks in yr navel automatically. Yr shdrs will move back to open up the chest for better breathing as a response to the prior postural adjustments. All the above combined with strong, flexible and functional hip flexors and glutes will (theoretically speaking) brg abt efficient movement.

From my perpective, this is different from what a lot of coaches call "keeping the hips forward", which is often taken to mean achieving a posterior pelvic tilt by sucking in yr abs. With this postural cue it is often the quads and calves that become the main driving muscles in running, and encourages a potentially rounded back. This is just my own opinion based on working with athletes and my own training, not backed by experts.

With the postural cues I've described before, u shd feel "long" and reaching for the sky with the back of yr neck, as well as light on yr feet. You shd feel like a long stick falling forward from yr ankles, versus a muscled mass sitting hunched on yr hips trying to drive and push agst the ground to get moving.

Look at the East Africans versus Caucasian distance runners, esp the mid-d guys. Caucasians often have way larger quads and calves, while the Africans are equipped with a pair of chopsticks. You wld expect mid-d Africans to be more muscled than their longer dist counterparts, but this is often not the case. Where the Africans are particularly strong at is in the middle, in the lumbo-pelvic region. They're often not taught to kp hips fwd, but to be real light on their feet, due to the kind of terrain and lifestyle they have in their native land. And to be light-footed requires that the entire upper body holds itself upwds and not just dumped on the pelvis. Of course genetics have a large part to play too, but you can see how posture plays a part when comparing how Africans and Caucasians run. The first is more nimble-footed, while the latter is often lumbering power. I believe this can be altered to a large extent with training.

I'm digressing a bit here, but its to say that good running posture is not just TVA sucking, but a combination of a series of physical cues which shd make u run more like an East African. Maybe that would be less toil on the hip joint area?

Fly137,

Have you had your quad compartment syndrome test? I had a calf compartment syndrome test back in 3/08 that was normal.

Also, if you've seen Jim Wharton, did he notice any hypermobility in your femurs? (I remember you said you have labral tears in both legs.)

I ask because I've seen Jim's son Phil Wharton in Flagstaff for treatment and follow their stretching routine. Tom Nohilly works with Jim Wharton and Tom trained a local friend of mine who periodically stretches me out as well. I credit this friend for also partially helping me with my labral tear diagnosis because he often commented how hypermobile my left femur was when he would try to stretch my left leg. On certain stretches, like for the adductors, my left muscles wouldn't even engage to be stretched...compared to the right. So, on first appearances, it seemed my injured left was more flexible/greater ROM, but in reality, my left femur was just so loose, those left leg muscles weren't engaging...

Foomiler,

Please try this:

Straighten your arm and make a fist. Stand over your couch and firmly press/punch your fist into a soft couch cushion. Just as you begin to firmly depress the cushion, let your shoulder relax and give out so that it is no longer stable/rigid and feel your fist/arm sort of collapse into the cushion.

Yes, I realize the shoulder joint and the hip joint are not identical. But, I use this analogy to explain to others what my leg feels like. My left hip is *intrinsically* unstable. I can, AND HAVE, strengthened my leg/hip/low back/core but have never eliminated or even reduced my symptoms because no amount of strength work can magically repair my damaged hip.... Just as, years of biceps curls and shoulder presses will *NOT* keep your arm from collapsing into the cushion.

Post after post you talk about strengthening. Yes, strengthening is needed. But is will *NOT* correct a leg problem that is caused by a damaged joint. You may very well have the best of intentions with all your posts, but if this was simply a matter of strengthening, many of us who diligently did our strengthening routines would have corrected our loss of coordination problems long before now. But, we haven't, because something was going on in our bodies that led to weakness and tightness. We didn't just develop unilateral weakness and tightness randomly one day and it continued/es to get worse.

Weakness and tightness is the effect, not the *cause*. You have to find your intrinsic cause. Until then, all your strengthening is futile.

I'm going to back up what she is saying. There are many structures that combine to stabilize a joint, bone shape and alignment being the most prominent. As a PT, if you're working to stabilize a joint, exercise will only take you so far if there is a structural deficit such as a significant labral or capsular tear. Improving strength and control of the involved musculotendinous units just can't overcome a deficiency that large no matter how hard a patient works. That is part of the trick of being a PT because it is not always black and white and you have to decide if the ortho referral is next. The labrum deepens the socket and provides added stability. Basically the bones,labrum, muscles/tendons, ligaments are all a team(not all created equal though) and when one fails, more demand is put on the others and they may or may not be able to compensate.

Miss Osage County,

Glad you found your intrinsic cause, and managed to rule out strengthening as beneficial for your case.

Yes, post after post I do sometimes mention strengthening. And discipline to maintain correct posture. And the need to develop proper movement habits. And the need to have balanced training methods. Have you also ruled out the latter ideas as helpful?

I'm sure you've wondered how you tore your hip joints in the first place, right? Can we assume that to some extent it can be caused by the other stuff I discussed? Having discovered the injury cause does not mean you cease paying attention to strengthening, posture, technique, etc., because that would mean allowing yourself to be totally unable to function any more.

For example, let's say your labrum tore because your psoas, glutes, TVA and lumbar multifidi on your affected side was weak or poorly positioned to fire, thus allowing the femur to drift forward from the hip socket. Your pelvis would now be posteriorly tilted and anteriorly rotated on affected side. By continuing to engage to hard training with such a physical set-up would lead to overstraining the hip joint, possibly resulting in rupture.

So your labrum is now torn. But those same weak muscles still need to be conditioned. May not cure your labral tear and subsequent weakness in that region, but you still need to work on them because the labral tear is not the only consequence of those weak muscles and subsequently misaligned pelvis. You can also hurt your spine, ITB, knee cartilage/tendon, foot metatarsals on the affected side, and possibly the achilles/calf/plantar fascia on your better side due to the body's attempt to compensate for the rotated pelvis.

And by working on the weak muscles I do not just mean strength work. If you'v read all my posts you'll see I place equal emphasis on the other points discussed. You'v already torn your labrum; would you want to add your spine, ITB, Knee, achilles tendon, etc to the list? I think not.

So it is my opinion that you still need to continue working on the areas we've discussed in this thread thus far whether it does anything for your hip joint or not, because that injury is merely warning from your body telling you that something is very wrong with it as a whole, not just at the labrum. That lack of wholeness is what resulted in the tear in the first place.

Also, not every one who has coordination problems have a torn labrum. These people do need to do strengthening, stretching, postural and technical re-education, etc., and unlike in your case they will actually benefit from these.

I'm not replying to any particular person on this forum but wanted to leave a post in the hope it helps someone else. I read this entire forum, looking for a solution for my daughter. An avid runner (logs 55 to 65 miles a week), she started experiencing loss of coordination in her left leg about a year ago. Oddly it never occurred when she ran on grass but on other surfaces the problem became more frequent and problematic. We visited PTs, doctors, and specialists of different flavors. After 12 months of therapy, diagnostic tests, and considerable out-of-pocket expense, a great many things had been ruled out but the specialists still hadn't found the cause or a cure. (Parallels the stories of most the people posting to this forum).

Then completely out of the blue I found someone with an answer -a former Olympic running coach. He gave my daughter these words of wisdom - stop over-striding and the leg problem will go away (and BTW you'll be a more efficient runner, too!). His explanation of the forces at work made considerable sense so my daughter did her own research on the internet (some slow-motion YouTube videos were great visuals), and changed her stride accordingly. She found it tiring at first and her calves were very sore but she was motivated to keep at it because amazingly, the leg problem disappeared in the first couple days! It has not resurfaced in 3 weeks, the improved stride now feels more natural, and to her delight, she's running faster because of better foot turnover.

Clearly leg problems can come from many sources but I wanted to post this success story since I didn't find much in the way of success stories on the internet after months of searching. What had seemed like a huge problem actually had a relatively simple solution. Just as proper ergonomic design is necessary to prevent repetitive stress injuries which develop over time, proper body alignment in running is also necessary to prevent repetitive stress injuries that develop over miles and miles. I suspect this is something primarily seen in runners who log a ton of miles.

BTW. We haven't done this yet but plan to ask a local running coach to watch my daughter run and assess her new stride. While she's able to get a good sense of her center of gravity, she can't see herself run so think it's important for someone knowledgeable about striding to see if any further correction might be called for.

We hope others will be helped by what we learned!

Thank you for posting your success story. That is great news for your daughter. Congratulations and all the best.

Or.... hahaha.... happy April Fools???

I started having loss of coordination in my left leg almost 20 years ago - always in road races over 5k. Slow running or running on soft surfaces or short races on the track were never a problem.

I think my problem came from being extremely tight particularly hamstrings, hips, lower back and outside of quads. I haven't run any races for a while so I can't say whether it's gone away or not but I can say I felt much better once I started stretching regularly. I had a yoga/pilates instructor really show me how to stretch so I think you should be willing to learn from others who know more than you do (and I knew nothing about stretching). My IT band is not like a cord any more. This was not something I could just learn on my own without an expert teaching me - a good teacher will find your weak spots much better than you can yourself.

I can understand why one might wonder if our success story is too good to be true. I had my own doubts when the coach was so quick with his diagnosis and so certain he was right. Seemed incredible that he could be SO sure of himself when the doctors and PTs were still clueless. But he explained the excess forces at work on the body when one overstrides and he suddenly seemed to be making a lot of sense. Figured we had nothing to lose and everything to gain to test his logic. We could have never anticipated the results would be so immediate. The doctors and PTs had all told my daughter it was ok to keep running given that their tests hadn't found anything wrong. I'm now convinced her problems would have worsened over time - that being the nature of repetitive stress syndrome that isn't addressed with appropriate changes. Given too much time to do damage, the results might not have been such a total reversal.

Due to this experience, I'd encourage anyone who over-strides and logs a lot of miles to make a concerted effort to correct their stride - even if they haven't experienced this problem! Make it a priority and save yourself a lot of problems later.