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

I'm very curious now.

Yes, yes, I probably do; go on.

Hmmmm, okay...uhhh, wait a minute. I know there have been posts on other threads with regard to how important it is to get the hips aligned, but the proponents usually claim chiropractor (or other similar type of practitioner) treatments are necessary to do that. You have a solution where that is not necessary?

Wait! Please come back here! Please clarify what you mean by, "with your fingers pressed inwards one inch from each protruding hip bone".

A diagram or photo on the net would be even better! I wish to understand exactly what you are trying to describe.

Allow me to describe a little more thoroughly.

Lie flat on your back on the floor. Take your hands and place your fingertips on your respective right and left hip bones. Now, move them inwards medially about an inch, and then about an inch downwards towards your crotch. Push in with a good bit of pressure, but don't hurt yourself. Now, very, very slowly visualize drawing your left and right hip bones together. Stop at the point that you can really feel your lower abdominals bulging out and hold it for ten seconds. DO NOT FORGET TO BREATHE. The goal of this is PRECISION -- NOT just to make them stronger. If you can't do this regularly by connecting the brain to the body, forget doing it in a hard effort. This will help keep that pelvis aligned.

frustrated runner, As of now I have not gotten an MR Arthrogram. I have an appointment with Dr. Larson on January 11th. This might be the next step before going in there with surgery. And Larson seems to be doing great, I'm excited to go forward with him as my Dr.

I do think we all might have this coordinataion problem for different reasons. Time off might be all some of us need. Maybe some other people can do a lower abb exercise and it clears it all up.

For me and a few others on here I really do not believe it is a strength issue. I lifted like a crazy man, did abb ripper x every other day, took 6 months off of running, and have been doing some form of PT EVERY DAY for a little over two years now. For me, time off and strength training does not help. I also have chronic pain in my TFL area. It gets really bad when I'm sitting for extended periods. What do some other people think about the impingement surgey. I hope some people that have gone ahead with this surgery could report back.

mahogany, I recently had this surgery if you'd like to give me your email I can fill you in on my experience.

Can you email me also thanks

Budandsam@hotmail.com

HT,

Would love to hear about your experience with the impingement surgery as well.

quicksand mcghee stated the following:

"Securing the pelvis through glute medius strengthening is important, (but) the very subtle lower ab work is really going to get that spine aligned properly.

"The goal of this (exercise) is PRECISION -- NOT just to make them stronger. If you can't do this regularly by connecting the brain to the body, forget doing it in a hard effort.  This will help keep that pelvis aligned."

McGhee, did you mean "...doing it in a hard *running* effort", the key word being running?

If so, then when you say your symptoms have been "DRAMATICALLY reduced", are you implying that it is the maintaining of the tightening of these pelvis muscles, throughout the run, that is keeping the sciatic nerve from getting eventually scrunched during the run, thereby reducing the symptoms that come from inflaming the nerve?

Interesting...

Went on a hard 5 mile tempo on the roads last nite.  The (damaged) left hip and back were getting worked, so that the left hammy was tightening up by the end.  On my run this morning, I noticed that if I concentrated on keeping the pelvis compact and tight, and kept the knees slightly inward--where they just kissed each other through the stride--some of the pain was alleviated.  

sorry mahagony, I just saw this:

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

I am my own can of worms. My hip surgery recovery for the torn labrum is going well. My hip joint feels great for the first time in years (I had no FAI). I have been to three different doctor in the last 10 days alone. I can run up to 8 miles, but my alignment and years of compenstations need to be fixed so that is not a good idea as I am reinforcing bad patterns. Dr. #1 was recommended for his work with runners with gait abnormalities. He loved my wonky body and compenstations! he did lots of measuring of things I knew in bitssa and pieces, but never had a thorough work through. He told me my left leg has tibial torsion of 40 degrees rotated out. On the same leg I have femoral anteversion. This is the main stuff. So he left femur and knee rotates in and the left leg and foot rotates out and somehow I balance and run on that which is why I get so many symptoms of different stuff. You can't fix bones, but I was given stuff to work on to keep my knee from caving in and to hopefully get out of the pattern of running I am in. Then Dr. #2 a prominent podiatrist said, "Forget that stuff." and did manipulations on my knee and popliteus muscle and also on a stuck cuboid bone in my foot. At least for now I have a somewhat better alignment and use of my foot (no longer locked), but I still have some torsion in the leg (it has always been there). My PT is doing proprioceptive stuff with me and today I went back to the hospital that did my surgery. An MRI of my back looked good, so I am going to start getting trigger point injections in my glute medius on Friday. Basically, I am still trying to put myself together after running with this hip and all my compensations for so many years. I am not sure that there are many runners whose body works like mine. I was told most would have stopped years ago. I have years of racing and have done about 50 marathons while dealing with this. I still think I am figuring out a more pain free way to run, taking information from many places and pursuing all avenues of recovery.

Thanks. Keep us posted on how things are going. I was also impressed with Larson. He knows his stuff. As for your symptoms, go to page 41 and read about neliah2507's symptoms. IIRC she also had hip pain with prolonged sitting, caused by FAI. From what I can tell, only a few people in this thread have actually had the FAI/labral tear surgery. There are some other, longer threads where people who had FAI and labral tears got it repaired, but they all had the "classic" hip/groin pain that responded to all of the tests that doctors do to check for it, unlike most people in this thread who have limited or no hip pain and no obvious response to many of the impingement tests.

Hey guys I guess I will give a little update since the last time I messaged. My first message can be found on page 41, I have had very similar symptoms that neliah2507 has shared. I do not have any pain in the hip. It just feels like my leg does not know how to move after like 10 minutes of running. I can not control it and I have to stop. I have had a lot of test done: Never conduction test, mri's hip (with contrast), back. I have gone to a couple gait analysis places. I went to the University of Wisconsin's clinic, they thought I was over striding, tried to correct it. Didn't work. I went to the University of Virgina's endurance clinic. They said I wasn't over striding but had no glut strength. I have been working on that stuff for about a month. Not really working. I dont really know what to do. I have been in this pattern of doing PT work all the time and stretching and strengthening and it does not work at all.

I have always suspected a laberal tear but the first MRI I got disproved it. I had an injection that did nothing. I am totally lost as to what is the problem. In the spring of 10' I could run 80mile weeks. now I can hardly run 8 mins. How does that just happen. How could my gluts just be that weak. ALL OF A SUDDEN!. To me it makes little to no sense. I really dont know what I should do at this point. Track is coming up and I dont want to be that kid that's constantly injured. So people literally say its in my head. I am not a person that quits I want to figure this out. The only thing stopping me from going into my doctors office and ordering a CAT scan is that I dont want him to think I am a hypochondriac. What do you guys think I should do. Should I continue Glut work that hasnt really done much in the last 2 months or should I push for the laberal tear? I am literally leaving this up to Letsrun. Give your opinion. Please dont poke fun or make jokes.

Hi Lost,So you had an MR-Arthrogram in the hip on the affected side and there was no sign of a labral tear or femoroacetabular impingement (FAI)? That's very interesting. If the injection did nothing, and the MR-Athrogram shows no evidence of labral tear or fraying, and you have no pain in the hip, there is no reason to believe that surgery (or a CT/CAT scan) would help. The two most reliable diagnostic procedures, according to a study I have around here somewhere, are response to a local anesthetic injection into the hip joint and results of an MR-Athrogram. Both have ~90% specificity and sensitivity, IIRC. For what it's worth, two of the people in this thread who have found a labral tear through MR-Arthrograms (one of them being me) have found them on a 3.0 Tesla MRI machine. Normal MRIs are 0.8-1.5 Tesla. My doctor specifically referred me to a high-strength scanner so we wouldn't miss anything. If you want to be absolutely sure, you can get an MR-Arthrogram with intraarticular dye in a 3.0 Tesla machine. I think most major cities should have at least one facility with one. Have you taken an extended break from running? It worked for me once before, last fall. I had this whole loss of coordination issue in the summer, which led to me getting a sacral stress fracture on the opposite side (from compensation?) so I had to take 6 weeks off, 4 of which were in the pool. After that, I started up running really slowly and didn't have any issues (even got up to pretty good mileage and set some new PRs) until this past spring. I got extremely sick, couldn't get out of bed for a week, and couldn't eat anything for nearly as long, so I lost about 8 pounds. Ever since, I've been plagued with problems: an extremely tight piriformis, an old adductor strain, and, just when I was getting over the adductor strain, the loss of coordination issue came back and stuck with me the entire summer. I did many of the things you have done: seen many different doctors and PTs, done endless leg lifts, glute bridges, and stretches. I had buns of steel, but still couldn't run for more than ~4mi easy without losing control of my right leg. So currently I am on week #5 off and just starting up some basic strength and cross training soon. Among things that have worked for others in the past, I think (way back on page 10 or 20) one person found relief from doing hamstring curls and other heavy lifts; I think another person found relief doing prescribed PT exercises. Neliah found relief through surgery, though she had a confirmed labral tear and did have some hip pain/pinching from time to time.The only idea floated in this thread that, to my knowledge, nobody has looked into is vascular causes. A while back some people mentioned iliac artery compression in cyclists, where prolonged sitting in the bike seat "crimps" the iliac artery, which supplies the quads with blood. The symptoms of iliac artery compression are described as follows:

Symptoms may include vague lower limb pain, cramp, numbness, weakness, claudication [pain/impairment in walking], unexplained deterioration of cycling performance and swelling. The lower limb pain often affects the thigh rather than the buttock and calf

which doesn't sound too far off from the kinds of issues we've been having. Vascular involvement would also explain why, in general, we all find that our problems really only happen when we run, and get worse when we run hard.

But the main reason I steered away from this idea is that it wouldn't make sense for us to have coordination issues and pain in muscles on the opposite sides of the body—so for example, when my leg gets bad, my calf/popliteal area starts to cramp up, then my hamstring. But while this is happening, my coordination in my "swing" phase is getting thrown off too. But the muscles that swing my leg forward, my hip flexors and quads, are supplied by a completely different artery than my calf and hamstrings. I suppose it's possible that my gait is imparied because my calf/hamstring aren't functioning right because of ischemia (lack of blood supply), however.

In any case, the way to investigate this would be to see a vascular specialist. Perhaps someone familiar with athletes—probably cyclists, as this condition is most common in them. If my break from running doesn't do anything (I'll know by mid-January) I might consider this option if I can find anybody in Minnesota who's familiar with this kind of stuff. My other option is surgery, which I'm not 100% convinced will work. As I mentioned earlier, the lidocane shots (short acting local anesthetic) seemed to work, but the cortisone (long acting anti-inflammatory) did not make a difference.

So to conclude a long post, your options are:

1) try to get another MR-Arthrogram in a 3.0T machine

2) continue to see different physical therapists to try to find a muscular solution to the problem

3) explore the hence-unknown role of vascular supply by seeing/getting a referall to a vascular doctor to check your ankle–brachial index at rest and after a hard exercise effort and possibly even get an angiogram.

Hey thanks for the message.

I have had a vascular MRI done to my left leg, to determine basically the exact condition that you wrote about. The MRI is a little weird because it involves the use of an IV but I got it done at a University hospital so it should have found something if there was something to find. It came out perfectly fine. My vascular system is functioning at least how it is supposed to.

Funny thing about your last post is the symptoms of the calf/popliteal area cramping. This happens to me as well. I find that interesting that we have a very odd and unique symptom. To alleviate that symptom I have done a lot of calf strengthening but like all the other things it does not really work.

So I am ruling out any vascular problems on my left side. I am going to stick with PT for a while longer but....I feel I am on a wild goose chase to "find that one thing" that works. If you have any breakthroughs I would be very interested.

Speaking of the popliteal muscle, even though I don't have my own set of problems and symptoms, I told my PT the same thing about a tight popliteal and she did some massage and graston on it and the surrounding muscles and my podiatrist did this manipulation for the knee/popliteal area: http://www.youtube.com/watch?v=fFp2UL0E160. I have tibial torsion in my left leg so the foot points out to the side, but both of these are helping to calm it down. The podiatrist also did a manipulation on the cuboid bone in my foot, which was creating a loss of proper motion in my foot-which would then create problems higher up the chain: http://www.youtube.com/watch?v=t6G4FB37LWM Keep up the wild goose chase as there has to be something out there!These are just a couple of other things to consider.

HTRunner, yes I would really like to hear more about your expiriences with this surgery. If you could email me that would be great.

mazzados@gmail.com

What exactly were your symptoms before surgery? What tests were done to look for the condition and did any of these tests fail? Do you think the surgery helped yet or is it to soon to tell? Sorry for the barage of questions but I really need to know some more about this.

And thanks to everyone for being so helpful with this. I looked at Neliah's symptoms on pg 41 and MANY of them sound like my problem. I also have been doing research on FAI and it is most common in high level male athletes in their mid 20s, which is me (why has no Dr. brought this up yet).

Anyway, I'm planning on going ahead with an arthroscopic surgery if my Dr. will agree. I think he will too, I will keep you updated.

He'll probably want you to get the MR-Arthrogram and the injection first, as that's the best diagnostic as to whether the surgery will help. Let us know how all that goes.

TDF, I did some work on my popliteus/calf muscles initially, and it helped somewhat, but it did not fix my stride at all. I think it was symptomatic—the popliteus and calf getting out of whack because of either a) the sciatic nerve, which controls both, being out of whack or b) my leg torquing the wrong way because of issues further up the chain (seeing as those two muscles control tibial rotation).

"TDF, I did some work on my popliteus/calf muscles initially, and it helped somewhat, but it did not fix my stride at all. I think it was symptomatic—the popliteus and calf getting out of whack because of either a) the sciatic nerve, which controls both, being out of whack or b) my leg torquing the wrong way because of issues further up the chain (seeing as those two muscles control tibial rotation)."

That is why I am learning I have to hit so many of my issues. In the last two weeks with visits to 3 different doctors plus PT: podiatrist manipulations on foot, PT work with taping and graston, exercises to change mental mapping of my movement patterns, and today trigger point injections in my glute medius (really tight). Somehow everything is related to everything else. I ran 10 miles for the first time since August 2010 last night to aggrevate the glutes for the trigger point injections. That felt good.

TDF wrote:

That is why I am learning I have to hit so many of my issues. In the last two weeks with visits to 3 different doctors plus PT: podiatrist manipulations on foot,

Careful with 'aggressive' foot manipulations...a chiro used a drop table to unlock my left ankle; but similar treatment on my right foot (because of an aggravated achilles/calve) I think was root cause of getting a hitch in the foot bones/ligaments that emanated pain (when rolling foot into a very specific position) for months.

PT work with taping and graston,

Though maybe not as painful, the chiro did something similar to graston on my right calve as well, which seemed to help.

...and today trigger point injections in my glute medius (really tight).

My injections, for a suspected hypermobile sacroiliac joint, which may have been and still is the primary culprit (besides the bulged disc) consisted of uncomfortable prolotherapy injections, as well as some electrically stimulated needle acupuncture treatments for the 'sciatica'. I can emanate an audible crack in the SIJ on the 'damaged back' left-side when, standing upright, pulling the left thigh up and over (inward); upon 'cracking', a minor relief of local nerve 'tension' (pain) is felt.

Recently, I'm trying to get more consistent  in strengthening work, using a pulley machine, whereby the load-line is attached to a harness around my ankle, and I do a full range of hip/leg motion repetitions

More info on SIJ disfunction problems can be found here:

Hi -- sorry this is a bit of a late response. Just happened to see the thread and recent posts.

I want to second the latest post on here and suggest that you get your SI-joint evaluated on the affected leg and also the alignment of that Ilium in general. If if the SI-joint tests out to be "functional" I would not buy that as an answer. It sounds like you are rotated/torqued somewhere on the side with the pain. It can present itself much like impingement symptoms and is often accompanied with unexplained groin pain, intermittent hip discomfort, lower back pain, SI-joint pain that comes and goes (usually worse at night/early AM), and gives you a general sense of instability in that hip. As you attempt to "work" through this discomfort it will kinetically work its way down your leg in symptoms (i.e. traveling down into the knee). I can understand your initial instinct that it's "vascular." This instability issue is nasty because it will manifest itself near joints, which are attempting to absorb shock/impact; HOWEVER, they can't because in order to do so they must have optimal alignment so the ground force reaction is evenly distributed up your leg and absorbed properly during your gait. When something like your SI-joint (which is basically as close to your center of gravity as you will get in terms of a joint absorbing shock) is compromised, this will give you an array of symptoms.

Let me ask you this -- does it ever feel like one leg is "shorter" than the other? This feeling may come and go. Also, does it ever feel like you begin to "toe out" on one foot (most likely the affected leg/hip) more than the other leg?

I'm not saying you can't have a vascular issue but it's incredibly rare. I'm not saying someone can't treat your symptoms and give you immediate relief but permanent relief would be another story of it's a biomechanical issue..

Hey guys,

I just got done with my appointment with Dr. Larson in Edina. We really didn't do much, he did the classic ROM tests to look for impingement in my hip, and just like before, he didn't find anything. We did however set up an MR arthrogram on a 3.0T machine for early February. I kind of hope we find something and learn that I simply have an unusual presentation of this condition. Kind of a long shot at this point but I really don't know what else to go on.

He did tell me that even if a mild impingement was found he would NOT operate on me, I respect his decision but its hard to accept, my hip just aches so damn bad and I can not train even close to the way I used to. He did say the hip specialist in Vail, CO may be more likely to operate on me if we find anything but for now I'm just waiting on those tests and continuing with physical therapy. I will keep you posted on the results!