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

Very interesting thoughts Neliah. I have been on this thread forever it seems, but not as long as I have been dealing with my left leg issues. I learned about labral tears here and had surgery last July. While many people's complaints on here sound similar to mine, they never quite exactly matched. I also found out over the past two years that I do have femoral anteversion and tibial torsion (to the outside) on my left leg, so it is interesting that you are mentioning that as I do feel that they contributed to my labral tear and the postioning of my femur in the hip joint. No muscular therapy seems to fix that as they are a structural problem. Strangely enough, I saw this blog post last night saying some of the same things that you say: http://www.bettermovement.org/2012/skeletal-structure-movement-function/#comment-13277. I also saw an article http://recoveryourstride.blogspot.com/2012/03/world-champion-kirani-james-and-his.html on World Champion 400 meter runner Kirani James where he mentions his (and his dad's)funky left legs that he describes as working in the same way that I have described my left leg working for years, "Our hips face inwards so our knees face inwards, and the leg sways outside — just to explain that in a nutshell." He goes so fast it is hard to see what his leg really does, but it sounds like femoral anteverion and tibial torsion to me.

I guess what I'm getting at is...say somebody's problem IS femoral version-related. Then what? It doesn't sound like there's any way to fix that.

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Also since I am having surgery in 3 weeks now (and am having all of the concomitant worries about what I'll be doing "after"--or NOT doing, as it were...) I just remembered that I had a CT scan to check up on all of my femoral stuff a while ago. Looking at it, the only things that are even close to "abnormal" are on my LEFT side--the good one!

Anyways here's the raw data, if you can make any sense of it. Don't read too far into differences of a few degrees, since I'm sure the margin of error is several degrees at least. All numbers are degrees.

Measurement.......................Right.....Left

Lateral Center Edge Angle.........31^........34^

Anterior Center Edge Angle........60.........58

Acetabular version

.....1 o'clock....................9 antev....14 antev

.....2 o'clock....................7 " "......15 " "

.....3 o'clock...................12 " "......18 " "

femoral neck-shaft angle........135^........138

femoral version angle.............7^.........9^

alpha angle

.....max..........................59........59

.....extent........................2-3 o'clock 2-3 o'clock

beta angle........................66........81

measures marked ^ are ones I have validated as "normal" with some research. Also they must have used a different version of the beta angle, since everything I've seen has them in the 40-degree range. Of course (just to fluster me) that's the only thing that's significantly different side-to-side, except for the acetabular version. The only thing noted by the radiologist was the alpha angle, not anything else, so I'm assuming nothing else is glaringly abnormal (<55 degrees for the alpha angle is "normal"). And by just looking at the 3D CT scan, my femur looks pretty darn normal compared to some of the really messed up ones you see in the scientific papers. Anyhow, see if you can make any sense of it and see if it backs up your theory or not. I'm working on understanding the femoral version stuff more, but haven't seen anything to convince me that this is "the answer" any more than any of the other flavors of the week--or rather, whether it's a significant advance over the "FAI/labral tear" theory in a useful sense.

How old are you and are you male or female?

I tend not to worry about a few degrees as much as unilateral differences.

Nothing is popping out as dramatic to me. I am going to check three of those numbers though and get back to you but it would be better to know your gender first.

Also, who is doing your surgery?

Have you been diagnosed with cam/pincer impingement?

Are both of your hips being looked at or just one?

I don't want to over complicate your situation and have you worrying about specific degrees and numbers. I did give degrees and numbers in my post but it was more for a reference for everyone to get a general understanding of what I was referring to. Having a base/norm to refer to when trying to understand the joint mechanics makes it easier.

When I look at your numbers they aren't 100% symmetrical or perfect but as you have already hinted, that doesn't mean they aren't within the norm.

I'd like to take a step back and share more of a personal opinion about surgery and not get too medical related for a second...

Surgery is not for everyone. I don't want every poster to think I advocate for it (especially hip surgery). What made me finally decide to go through with it was the fact I had no quality of sleep, NO type of progress in terms of PT/rehab, my pain level was a 6 even during normal daily activities (walking/squatting/stairs/sitting, etc). Sometimes worse. I literally avoided having sex because I was terrified of feeling tight/sore for days later. I hadn't run in 12 months and could no longer even do elliptical or pool run. Even walks hurt. For 27 years old that is not a great quality of life in my opinion. I knew something had to change. I also knew I was young enough to recover well if I found a good surgeon and even if I never was 100% normal I had faith that I would have dramatic improvement. I have had dramatic improvement. I am able to run (although not train competitively at the moment). I'm only 16 months post-op. Many athletes are not 100% until 18-24 months. Some sooner.

I do not want you to be scared or anxious any more than you should be normally. It's important to have faith in what you are going to choose to do. No matter what your measurements say now, they cannot 100% predict your outcome. It could be way better than you hope, or slightly worse. You never know. What I do know is if you are strict and patient about your rehab, have a good surgeon you can trust, and have good health, you are going to DO WELL.

Since you are getting surgery in 3 weeks, if you ever want to chat about physical therapy or rehab difficulties, what types of things help a return to running, etc...feel free to e-mail me. I like sharing ideas because usually it's where I learn the most. Books and articles leave a lot out.

A couple of years ago I started to develop some scuffing in my left foot. I also found myself tripping while I ran in the trails. I would also find that my big toe would tingle or occasionally go numb. I also had three stress fractures occur in my left shin two years ago. The doctor took an MRI of my lower back two years ago and they felt it was a pinched nerve at L5.

Fast forward to this past summer I found myself scuffing and an increasing pronounced foot drop. I asked to have another MRI and all looked good. The doctor agreed to take another MRI further up my spine and they found an egg sized tumor in the upper thoracic spinal canal. I went in for surgery to have my tumor removed and thank god it was not cancerous. I was left paralyzed from the waist down and rehab has been going well and there is hope I may be able to walk and possibly run again.

My recommendation to anyone with loss of coordination is to make sure you advocate for yourself. The neurosurgeon told me that if I had not pushed for the another MRI of the upper spine I might of had only another month and it would of left me completely paralyzed from the waist down.

I remember going to this thread many times trying to figure out what might be my issue along with numerous dr. appointments and endless pt and massage sessions.

whoah-glad you pushed and found that tumor. I really hope you get to walking and running again!

could be venous reflux. is checked with ultrasound. venous hypertension can occur in absence of varicose veins. also sacral subluxation can cause problems in venous return.

That is terrifying! I am sorry to hear about your experience but definitely glad you are OK. How long have you been rehabbing for? My uncle had a very similar experience although caught the tumor earlier I think. Really hope to hear you are walking again soon.

Double Whoah- Tumor, I just saw the article in the local paper this morning and you have to be AD as this is exact the same story as in the paper. I have been out of the local running scene with my own injuries, so I had no idea you were struggling like this. Knowing that you are one of the most knowledgeable running guys around and very strong, I know you'll pull through this and I hope you get back to being able to run some day in the future. Best wishes! You'll figure out who I am from a link above. You coached my son in HS.

I'm the person who was diagnosed with a labral tear by an MRI-A a couple weeks ago. I got a cortisone shot in my right hip on Monday and took off til Saturday to let it take effect. I ran 6 yesterday and felt kind of awkward due to not running for a few days. My right leg is always worse after time off and it felt a little bit "off" during the run but that's also because I was thinking about it a lot.

Today I went for a tempo run to test out the leg. I tried to make it a perfect storm of elements which would bring on the loss of coordination symptoms; I wore trainers instead of flats, I didn't do a dynamic warmup (only a 20 minute jog), and I stuck to the roads.

I ended up making it the whole 5 miles without my leg "going"! It felt a little bit weird at times, and I definitely wasn't smooth, but that's the farthest I've made it in a tempo run without the leg totally "going" in probably a year.

I don't know my exact pace during the tempo run, but probably around 5:30 pace. I sometimes go a little faster in my tempo runs, but after the couple days off this felt right for "tempo" effort. There's a chance 5:30-5:40 pace is not fast enough to make the leg "go", but I've had it "go" on runs as slow as 6:00 pace so this is definitely a good sign.

Is there any literature that mentions labral tears causing loss of motor control while running but that also doesn't present with pain?

trying to get doc to give me tests for labral repairs but know I need to be prepared when he asks why I have no pain.

Is there any literature that mentions labral tears causing loss of motor control while running but that also doesn't present with pain?

trying to get doc to give me tests for labral repairs but know I need to be prepared when he asks why I have no pain.

Hi gloworm,

There is scant to no scientific literature that deals with this issue. I have done a ton of reading on labral tears/FAI and here are a few relevant snippets from a pretty good article that might help explain a bit of what's going on:

From "Hip Arthroscopy: current indications, treatment options, and management issues." Kelly, Williams, and Philippon, American Journal of Sports Medicine, Vol 31, No 6.

I think the "functionally/physiologically weakened gluteus medius" is a phenomena that most of us have experienced, as well as the torso moving over the bad leg in an effort to "drag" it through the stride. And the feeling of instability is definitely something I identify with, and could possibly explain the loss of coordination.

However, it's important to note that pain in the joint is still the "hallmark" sign of labral tears/FAI, so even if this turns out to be the problem for most/all of us, it will represent a very small subset of people with labral tears. I'm still not convinced that we can pin the blame on the labrum for people who've had this issue for months or years off and on who don't really get much worse. My own experience is/was a lot more severe than a lot of people in this thread: my loss of coordination came on pretty rapidly and even bothered me on most easy runs. I could fake it for a while on trails or going easy or doing short intervals, but that imploded pretty quick with my stress fracture. When it returned about 6 months later, it was fast and affected pretty much any running.

If you can't find any answers through PT/strength/stretching and the usual examination for nerve issues (lumbar MRI or whatever that may entail), definitely push for the MR-arthrogram and the diagnostic numbing injection of lidocane or similar. Your doctor will probably be skeptical, and rightfully so, since even if this does turn out to be the issue, it will be a very abnormal presentation.

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On a more personal note, my surgery is on Tuesday. I'll update on here whenever I have the chance, but I'll also update this twitter account:

!/JDruns

on a daily-ish basis during my recovery so people can keep tabs on me if you'd like. I was using it as a mini-running log back in August/September because I was too discouraged to keep a "real" running log, and I've left that up so you can get something of an idea of how things were going for me back when I was still trying to run. As I've said before, I didn't decide to go ahead with surgery until I started getting legitimate hip pain, even when I wasn't running. I'm trying to set my expectations pretty low: my doctor will probably chalk my surgery up as a success if I'm able to live an active life without pain. And of course I'd LOVE to be able to run competitively again, and that's probably my "secret" goal. But even if that happens, it will be a long time from now. I'll also know more about how bad the damage in my hip is after surgery.

Once I get through with the surgery, I'll have a clear path forward in terms of rehab: working back towards being able to walk, being able to use the exercise bike, the elliptical, and so on. So that's what I'm focusing on now, not if/when I'll be running big miles again. Best of luck to all.

Good luck with the surgery. Please keep us updated on your progress. Also, who is the doctor doing the surgery?

Good luck for your surgery frustrated runner!

I thought I'd give a quick update from myself...

I've been dealing with this problem for around 6 or 7 months now. After lots and lots of PT and no improvement I had an MRI of my hip which showed a labral tear. So I went in for a cortisone injection but wan't allowed to run for 2 weeks (so I didn't get to test out the effect of the local anaesthetic). That was around 5 weeks ago and I've been trying to run for 3 weeks but I don't think the cortisone did very much :( Not sure where I'll go from here... given that I don't have any pain and don't have anything to confirm that the hip is the source of the problem I don't think I'll be pushing for surgery.

How many of you guys have been checked hamstring tendinitis or tendinopathy?

Why weren't you allowed to run after the cortisone shot? I have never heard anything like that before. It is not supposed to cure you. When you run after the cortisone shot, you should be able to run without the pain. I ran two days later, had a couple perfect pain-free runs and then on the 6th day I had to stop running midway through an 8 miler. That was a sign that I had a labral tear. Usually you feel good for a few days or weeks and then the pain comes back. After that I got the MRI with contrast dye confirming the tear, and then eventually the surgery. I have heard of a few people where the cortisone shot did have long- lasting effects, but the point for confirming a labral tear is checking for the temporary relief (which you never got to check for).

Everything I've read says that it takes a few days for cortisone to start taking effect and up to 2 weeks for it to reach maximum effectiveness. I'm not sure why I wasn't allowed to run sooner though. The doc was pretty insistent that I didn't, and at this stage I'm sticking to doing what I'm told. I'll ask next time I see him though, as its interesting that the relief can happen so quickly (as in your case and others) and also be short lived.

I think that perhaps there has actually been some slight improvement since the injection, as I ran for 15 min on the road yesterday without the leg totally losing it... which I couldn't do before. Its pretty difficult to know for sure though when I have no pain, maybe I was just having a good day.

If my leg doesn't improve or gets worse I might try to get another injection and try running sooner. Although as I said before, even if the labral tear is definitely the cause I'm not sure about surgery... however from reading this thread it appears that it would eventually lead to pain anyway so maybe it would be better to get it done early before I cause more damage!

Very strange that your doctor did not let you run after your cortisone injection. For me they injected cortisone AND a short acting numbing agent and had me run IMMEDIATELY after. For what it is worth I got some relief with the numbing injection but little/none from the cortisone.

I had my surgery done and am rehabbing now. It is no joke of a surgery I will tell you that. I have a long and substantian recovery ahead but at least I have goals and markers now. I am going to tr.y to get a copy of the surgical report but I was told my doc saw what he expected: a tear in the labrum and moderate cam impingement.

I'm a senior and I am watching my last track season and dreams slip away from me. I seriously need your guys help because so far no one has been able to help me. I have seen an ART therapist, trainers, PT specialists, and Orthopedic dr. So far I have been given an MRI of my hip/leg which have come back clean. Of course this is only one piece of the puzzle. My symptoms have varied and I really have no idea what is wrong with me. It all started after a steeple, long run the next day, regular run, then hard track workout. Through the long run, run, and track workout- I felt a pretty bad tightness in my hip and butt region. After finishing the track workout I felt as if my femoral SF had come back. This is when I decided it was time to get an MRI. This is when I diagnosed myself with piriformis syndrome. Stretching, tennis ball, and icing seem to help a bit but not completely. My pain is worse in the morning, and gets better with stretching-especially hamstring. Standing up is pretty painful and so is shifting weight from one leg to another. This is when I get shooting pain that feels like sciatica. The Dr. treated it as piriformis and gave me a cortisone injection. While this helped the butt pain it made the pain move. The pain moved more lower in my butt, hamstring, and great trochantor where the IT band connects. I have to think about lifting my leg off the ground- but once I do it feels fine. I don't have trouble balancing myself once i am up and standing. But sometimes if I rotate my leg to a weird angle is when I get the shooting pain (sciatic pain maybe?)-This pain has since improved about 50% with the piriformis injection. Running needs to very slow and I feel like my push off is minimal. My right leg gets pretty tired when walking or running. I am going to ask my Dr. about a spine MRI and arthogram. Could such pains be related to simple overuse and muscle imbalances? Or does this sound very severe?