Wednesday, August 5, 2015

My history with loss of leg coordination while running




I try to avoid anecdotes and personal histories when dealing with running injuries.  They're fraught with the dangers of recall and confirmation bias, and worse, people seem hardwired to give more credence to a personal story than reams of scientific data.  But in the case of loss of leg coordination, I don't really have a choice—the scientific data is extremely sparse, and there aren't even any case studies in the medical literature describing anyone with the hip-centric loss of leg coordination symptoms that seem to be a variant of "runner's dystonia."  On top of that, I know of only a handful of people who claim to have made full recoveries from the loss of coordination problem—and I'm one of them.  As you read my account, remember that I'm not a doctor, and I'm also not an unbiased observer.  My views on solving loss of leg coordination are no doubt informed by my own experience.  For a more objective review of the problem, see my extensive article on loss of coordination published last week, or the executive summary.


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Background

To understand my story about loss of leg coordination, it will help to have a bit of a background on my journey as a runner.  I started running cross country and track as a freshman in high school, having done a little bit of each sport in middle school.  I didn't become a runner until my sophomore year of high school.  Until then, my times were decidedly unimpressive, and I did not train in the offseason or take the sport seriously.  Starting in fall my sophomore year, I began running year-round.  I was not particularly athletic, so I did not have other sports to do in the winter and summer anyways.  Plus, I wanted to see if I could improve.

And I did—I dropped from 5:40 in the mile as a freshman to 4:40 as a junior.  During those two years, I started experimenting with doing longer runs (12+ miles), and even ran Grandma's Marathon after my sophomore and junior years.  I did not start doing what I would now consider "high mileage" until before my senior year; that summer, I had a few weeks around 80 miles, and that winter, I averaged over 70 miles a week for almost three months, with a high of 90.  Again, this paid off, and it set me down the path of being a high mileage runner.  Throughout high school I was eminently healthy; I never missed a single day due to injury.

I ran in college, and continued improving thanks to high mileage training.  A few 100-mile weeks my freshman year dropped my times further, and going into my sophomore year, I logged eleven weeks in a row over 100, including several at or above 120.  This culminated in probably the best race of my career, a 25:34 cross country 8k in Wisconsin.  I missed that winter for a non-running-related injury, but with that exception, I did not miss much time due to injuries until my junior year.  Starting that summer, and for the rest of my college career, my progression was interrupted by overuse injuries, mostly in my hips and feet.  Later, I would realize that a lot of these were likely the result of not enough hip strength work, but that's a story for another time.

In many ways, my background fits the typical profile of a runner who develops loss of leg coordination: young, fairly serious and competitive about training, and a history of high-volume training.


Loss of coordination problems begin

The summer before my senior year of college, I was doing chemistry research in New York and training hard for my final season of cross country.  I had gotten a late start on summer training because of some foot problems in late May and early June, so I was (foolishly) ramping up training very aggressively.   After an IT band flare-up in mid-July, I had ramped up to 92, 107, and 117 miles.  The following week, I did a threshold session of 10x900m around a grass loop with some fairly tight turns.  The next day, the medial side of my right calf felt tight and "off" when I ran on it in the morning, but I ran an all-comer's 1500m race in the evening anyways.  The next day, the back of my knee and my entire calf started hurting and locking up when I tried to run. 

I took a few days off, but during my first run back, I noticed that my right leg was swinging across my body in a strange manner when I ran.  It was so off-kilter that my calf would actually crash into my opposite knee when my leg swung through.  Even after taking several more days off, my stride still felt "off" and my leg still swung wildly across my body when I ran.  I also had calf and hamstring tightness all along my right leg.  Some days were better than others, and gradually the ratcheting calf tightness gave way to a more dull tightness or ache, but the awkward stride didn't improve.  One day, I did a short run with a friend from high school, and she immediately noticed that something was very off with my running stride. 

Because cross country was approaching quickly, and I could still sort of run if I just ignored the fact that my leg wasn't working, I kept training.  Not nearly as much—only 6-8 miles a day most of the time.  I tried some faster tempo running; it did not go well.  "Pretty much a disaster...my right leg was still dead.  It just splays out in front of me wildly, and I can't control it or make my leg go," I wrote in my log on August 26th, 2010, after a 30 minute tempo run. 

Later, I found that the weakness and loss of coordination feeling would spread to my hamstrings and my quads on bad days.  I also started noticing that my right foot would "skid" on impact, and there was a drastic difference in wear along the lateral edge of the heel of my right shoe versus my left one.

Strangely, I found I could run on technical trails without too many problems.  Two days after that disastrous tempo run, I did a 90 minute run on trails that went surprisingly well.  Other days were up and down.  Unlike a lot of people who posted on the LetsRun thread, I wasn't always able to do easy running—some days, even seven miles at eight-minute pace would cause problems. 

When cross country started, my coach didn't really understand what was wrong with me.  I ended up racing an extremely disappointing 8k at the beginning of the season, in which I barely broke 29 minutes.  From my log that day:

Foot slapped the ground horribly, and I couldnt "go." My stride is still way messed up. At night, felt pain in left gluteus medius / piriformis area. Probably a compensation thing. Limped the whole race, it felt like.  Bottom of shoes show bad 'skidding' on right foot, plus pronation.

Two days later, my coaches, who still couldn't spot anything wrong with my stride, had me do a hard 5 x mile workout on the roads.  That day proved to be what broke me for the season.

Leg f***ed up the whole time. Practically no warmup. Wasn't planning on running at all, but Dave [my coach] somehow convinced me that fast running would be good for my injury.  I pounded through the first few, limping pretty bad. [...] Left glute med KILLS, I can't walk normally anymore since this stupid workout.

I stopped logging for the season after that day.  The pain in my left glute area ended up being a stress fracture in my sacrum, almost surely caused by the drastic, sudden change in my running mechanics because my right leg wasn't working correctly—I'd never had any bone injuries in the past, even though I'd run prodigious volumes before.

Recovery, Part I

After that workout on Friday, September 2nd, I didn't run at all for two weeks.  I did one test run, then found out that an MRI had uncovered a sacral stress fracture.  At this point, I thought that the stress fracture was the cause of my coordination problems—the nerves that go to your quads, hamstrings, and calves go right through the sacrum, and my doctor hypothesized that irritation or inflammation on my left side had thrown off my coordination on my right side.

After the abortive two weeks of total rest, I switched to aquajogging in the pool in an attempt to preserve my fitness and perhaps try to run at my cross country conference meet.  I also focused on getting more protein and calories in my diet, since blood tests ordered by my doctor showed some abnormal hormone levels that might have been the result of undereating.  I was also 5'10 and barely 130 pounds that fall—again, something my high school friend spotted immediately, but my coaches didn't.  Funny how that works.

After six weeks in the pool, I started a progressive walk/jog plan to return to 30min of continuous running on alternate days, getting in the pool on the non-running days.  These went well: I had no pain, and no loss of coordination.  Once I was able to do a 30 minute run on alternating days, I tried doing a few workouts to find out whether running conference was a realistic plan.  A progressive tempo run went alright, but a 3x2000m session a few days later caused some pain in my sacrum to return—plus, I was only able to run the 2k repeats in about 7 minutes, meaning I couldn't hope for much better than 28:00 for 8k cross country.  Notably, though, I had no coordination issues.  Regardless, I decided to scrap the season and took two more weeks off from running.

Over my six-week winter break, I gradually worked back towards doing easy running every day.  I took this opportunity to overhaul my running stride, moving from a heavily-structured supportive shoe and SuperFeet insoles to soft, low-drop, unstructured shoes (alternating between the Nike Free 3.0 and the Saucony Kinvara), and working to develop a midfoot strike.  I was convinced that my running mechanics were part of what caused my issues.

I also improved my muscular strength markedly by doing body-weight circuits and medicine ball workouts.  By January, I was running about 60-70 miles a week and I weighed 138 pounds.  During the winter, I returned to doing workouts on the roads and on the track without any coordination issues.  I raced that track season with decent success.

Regression

Early spring of my senior year, I succumbed to a series of recurrent viral and bacterial infections.  I would get sick, getting about 50% better, then getting even more sick again. This repeated about three times, culminating in a week-long period where I was so sick and tired I couldn't even get out of bed for more than a couple hours at a time.  My immune system was so fried one doctor actually checked me for HIV! Several courses of antibiotics had knocked out all of the good bacteria in my body, so I'd developed a fungal infection in my throat and mouth that caused painful sores.  These prevented me from eating, and between this and the week of bed rest, I was about 128 pounds when I was healthy again.  The cause of all of that is also a story for another time, too.

All of this happened in the run-up to the final race of my college career, the outdoor conference meet.  Being the recklessly dogged runner that I was, I jumped back into training very quickly after I was healthy enough to run.  I only had about two weeks before my college career was over.  During these two weeks, I suffered a rapid succession of hip injuries, which were no doubt the result of trying to train hard so soon after having lost so much muscle mass.  Worse, my specialty was the steeplechase—no other track event puts so much impact and stress on your hips. 

I did end up competing at the conference meet, finishing 8th to score one point; it was a Rocky-like "go the distance" moment for me.  However, I had excruciating pain in my left groin at the base of my adductor muscles following all of my workouts in the final week.  Afterwards, I took over three weeks off from running, but the groin pain persisted.

After graduating and returning home, I continued to try to find a solution to my groin problems.  I finally found a rehab routine that made a difference (described in this paper by Per Hölmich).  But just as I was returning to running without groin pain, I started getting loss of coordination problems again.

Loss of coordination redux

Even though I was only doing 4 to 5 mile runs at an easy pace, I started getting the same tightness in my calf that would quickly spread to my hamstrings, quads, and even shin on a bad day.  This time, the awkwardness when my leg swung forward wasn't usually bad enough to make my calf crash into my opposite knee, but I still had the same general sensation: my right leg was flopping along uselessly whenever I tried to run. 

I spent the rest of the summer trying various strength exercise routines to fix my loss of leg coordination.  By fall, I was seeing several different doctors, trying to figure out the cause of my problems.  I was still running most days, but by this point, I was trying to make it worse, just so the doctors might be able to pinpoint the problem.  I'd run over to a bike path that had a one-mile loop, run it hard, and see how my leg felt.  Sometimes I'd do hard intervals on grass, and as usual, this would provoke the problem to a more significant extent.  Unlike the first episode, easy running on trails was still problematic—sometimes, the abrupt changes of a rough, uneven surface would leave my leg feeling more tight and uncoordinated than running on flat grass would.  Roads, however, were still worse than grass.

Looking for an answer

Doctor's appointments and MRIs ruled out a herniated disc or sciatica.  Chiropractic adjustments, ART, and Graston technique didn't prove useful.

After a few months, I started looked into the possibility of a labral tear being at the root of my problems, as I was getting some intermittent pain near my glutes when the loss of leg coordination got particularly bad.  Initially, I was referred to a physical therapist who regularly worked with elite distance runners.  Working with her, I made some mild improvements by doing hamstring strength and some coordination drills, but I wasn't even close to where I wanted to be.  After several weeks of physical therapy, I returned to the orthopedist for more testing. 

My orthopedist scheduled an MR-Arthrogram in a high-resolution magnetic resonance machine (3 Teslas versus a standard machine's 1.5 Teslas) to image my labrum, and a diagnostic injection of lidocaine to see if numbing the inside of my hip joint would improve my coordination.  I didn't have the typical groin-centric pain of someone with a labral tear, so my orthopedist was skeptical, though I did have some mild femoroacetabular impingement (FAI) evident on X-rays and some pain on a few hip mobility tests.  Further, the MR-Arthrogram did show a tear in the labrum of my left hip.

Excerpt from the radiologist's report of my MR-Arthrogram
 For diagnosing a typical labral tear, you'd get a diagnostic injection, then do a few exercises that would usually provoke pain.  If a torn labrum is the problem, the pain should go away (or at least be diminished) following the diagnostic injection.  The only catch is that the numbing effect only works for two hours or so, so you need to test it out right away.  For me, that meant getting the injection and MRI, then going for a run immediately afterwards. 

With loss of leg coordination, it can be hard to definitively say whether an acute intervention like this works.  Yes, I could run eight miles with some surges of faster running, and I felt pretty good, aside from some hamstring tightness, but was I just having a good day? My response to the initial diagnostic injection was promising, so my doctor and I decided to schedule another injection into my right hip, this time one with cortisone and lidocaine.  The idea here was that I could do a test run with the diagnostic injection, and hopefully the cortisone would kick in after a few days, solving the problem at least for a while. 

I wasn't logging regularly at this time, but I did keep track of how I felt for several days following this injection:

Day of hip injection [Thursday]

Some soreness in medial ham and a tiny bit in medial calf but did not spread out
coordination was pretty darn good.  no loss, able to run hard 400s or 800s at the end of a 5mi run
able to run hard up hill
feet landing in line, no external rotation and splay
a bit more heelstrike than usual
a bit of [left] adductor tightness a few times in run

[Later that evening, I went for a brisk walk to see if I could provoke my leg again.  Usually I could feel at least some tightness if I walked hard for a few miles]

evening walk:
pretty much 100%, hamstring a bit sore in first few minutes and a tiny bit of passing calf "staleness" midway through but only lasted 5-10min.  Nothing off at end, walk took about 45 min.

NEXT DAY [Friday]

first 17min of run was pretty much 100%, after that some calf and hamstring soreness, seem to lose some coordination when I go faster.  Hard ~500 at end, some loss of coordination in last bit.  Ham and calf sore/stiff after, unlike yesterday where they were not

Evening walk: good for about 1mi or so? then medial lower ham, medial upper calf.  Not too bad, no spread.  Jogged a few bursts, sore after.  calf/ham a bit off later in the evening.  45min walk

will do same duration run and see how it feels

NEXT DAY AFTER [Saturday]

felt ham pretty much whole time. 
coordination got bad when i went faster. 
Final burst at the end was pretty bad, leg "shutting down" pretty much right away
A bit of crossover and external rotation but not a ton...adductor pain after but not during

might do walk later to see how it does...cortizone [sic] should start working pretty soon here...


Sunday

somewhat better for first half of 4.5mi run.  more in calf than hamstring
coordinating perhaps a bit better but not much
in second half, almost as bad as yesterday but not quite as much
could hold it together a bit better on faster bursts, but still sore in ham and calf during/after
didn't have quite as much of a hitch, maybe.

As it turns out, the cortisone didn't start working at all, and I was pretty much back to the usual loss of coordination by the next week.  Because the next step in treating this as a labral tear would be surgery, I decided to try what worked last time: an extended break from all running.  On November 9th, 2011, I stopped running for the longest continuous stretch since I was fifteen years old. 

I was more or less totally sedentary for eight weeks.  Right around January 1st, I joined my local community center to start working out again.  I did some basic PT-style exercises for my hips, hamstrings, calves, and quads, and I got in the pool to aquajog.  The plan was to aquajog for four to six weeks, then try to start running again.  But after about two weeks of aquajogging, I noticed that I was having pain in my hip joint during the second half of my 30-40 minute aquajog sessions.  Over the next few weeks, I started noticing mild hip pain in other daily activities, like getting out of my car or doing the "clamshell" hip strength exercise.  At this point, I was pretty convinced that I had a labral tear caused by femoroacetabular impingement, so I returned to see the orthopedist.

Though a lot of doctors are so confident they can fix all your problems, my orthopedist was very straightforward with me.  He said he was willing to do the surgery on me, and that it would alleviate my hip joint pain and limit the risk of my femoroacetabular impingement causing cartilage damage and arthritis several years down the road, but he couldn't make any guarantees that the surgery would fix my loss of coordination problems.

If I hadn't had the hip pain that interfered even with my ability to aquajog, I might not have elected to have surgery.  Beyond the ability to train and compete again, I wanted to be able to live a reasonably active life.  Going into surgery, I knew there was a decent chance I still might not be able to run again, and I was comfortable enough treating this as my last shot at running—I was mentally ready to move away from the sport.  Part of why I started my blog and started writing about running was so I wouldn't feel guilty about leaving the sport after having learned so much about it.  Aside from my own blogging, I didn't keep track the sport anymore.  I didn't check LetsRun, I didn't recognize the names of top NCAA runners, and I hardly ever went to watch track or cross country meets.

Surgery and recovery

Once I decided to have surgery, the next thing I had to do was wait.  The decision to do surgery was made in February, but since my orthopedist was a widely-renowned surgeon, he was heavily booked for several months.  I ended up waiting until April to have the operation.  In the meantime, I stayed active by swimming (front crawl only—I didn't want to do any more damage to my hip joint) and doing some token upper body lifting. 

I had the surgery five months after I had stopped running.  For all the wonders of modern medicine, arthroscopic hip surgery is still a bit barbaric.  To get the arthroscopic tools into your hip joint, the surgeon has to puncture through the muscles and connective tissue around it, and to keep the joint "open," your leg is strapped into a harness that puts your lower leg into significant tension.  Fortunately, I was unconscious for all of this.

On top of this, my surgery involved shaving down the head of the femur to alleviate the femoroacetabular impingement that caused the labral tear in the first place.  As with any surgery that involves carving into your bones, recovery is quite lengthy. 

For several weeks, I felt like I was four years old again.  I had to get help tying my own shoes, I couldn't drive, and for the first two weeks, I couldn't even sit in a chair for any prolonged stretch of time.  Unless I was doing my rehab exercises, I spent most of my time in bed hooked up to a GameReady machine, an automated compression and icing machine that my doctor prescribed.  The prescription painkillers I took for the first few days caused some very irritating constipation, and once I removed the bandage over my hip, I found that a large area of skin on my thigh had become numb due to temporary nerve damage caused by the leg traction device used in surgery.  As you can imagine, it was not a fun first few weeks.

I was on crutches for four weeks or so, and was assigned a very specific, comprehensive physical therapy program.  I worked with the same running-specialist PT as before.  I was extremely diligent with doing exactly as I was told—I went to my local community center to do my exercises every single day the entire summer. 

My rehab program progressed over sixteen weeks from basic range-of-motion exercises and initial strengthening to stability and functional strength.  Any kind of running was forbidden for sixteen weeks.  Initially, the plan was to get in the pool and aquajog after six or eight weeks (if I recall correctly), but the scabs over my surgical incisions had not fallen off, so the risk of infection was unacceptably high. 

Pool & AlterG mechanics work

I ended up getting in the pool about twelve or thirteen weeks post-surgery.  The pool work I did was not focused on fitness; rather, it prioritized getting familiar with running mechanics again.  I did deep-water running with a flotation belt, doing the running motion with my legs very slowly at first.  Over time, I progressed to doing some chest-height "shallow water running."

Typically, lap swimming pools are deeper in the middle and shallower at the ends, with a gradual slope down towards the middle.  If you can find a pool with the right configuration, and go at a time when the lane lines are either removed or set perpendicular to the slope of the pool, it's possible to find a 10-20 meter stretch of the pool where the water is just the right height for shallow water running.  When the water was just about up to my armpits or a little higher, I could do a natural running motion in the pool, landing on the bottom of the pool and pushing off,  without much impact at all.  This was not aerobically challenging, but it proved to be a very useful tool for re-learning how to run.

I was also lucky enough to live less than two miles from a physical therapy office with an AlterG anti-gravity treadmill.  About sixteen weeks after surgery, I started doing some running on the AlterG.  I started out very slowly (nine or ten-minute mile pace, I think) at 50 or 60% of my body weight.  I used the AlterG three times a week for a couple weeks.  Again, the focus here wasn't on aerobic fitness, but on re-learning proper running mechanics.  My hope was that reintroducing running in a careful, methodical way would be beneficial for my hip, and for rewiring the neural patterns in my brain, if my loss of coordination really was a central nervous system issue.

The AlterG work only lasted a few weeks.  Initially, I still had some hamstring tightness on my right side at the end of my runs, but no loss of coordination.  At the end of my third week of AlterG training, just as I'd built up to 90% of my body weight (and was soon to transition to outdoor running), I got pain in my plantar fascia during an AlterG session.  Even dialing back my effective body weight to 60% didn't help, so I shut down all impact exercises for two or three weeks to allow my plantar fascia to heal.  At this point, there was no sense to run on any type of secondary injury.

The long road back to running

After my plantar fascia had healed, I was almost twenty weeks out from surgery, so I was cleared to do overground running.  I started up with very easy walk/jog sessions on grass, like 6x1min jog / 4min walk.  I ran every other day, moving to 2min of jogging and 3min of walking, then 3/2, and so on.

I got up to 20 or 25 minutes of continuous running without any problems, but my plantar fascia problems proved to be a harbinger of similar issues that I would work through for the next seven months.  Though I never had any hip pain following surgery, I had a slew of secondary injuries, all on my right leg—the surgical one.  After the plantar fasciitis episode, my hamstring flared up, then just as I'd built up to two miles of easy running again, my talonavicular joint became aggravated.  Following that, I had more hamstring issues, lateral calf problems, a brief stint of runner's knee, more hamstring problems, more lateral calf problems, some IT band issues, and oh, even more lateral calf problems.

I was not really surprised by all of this, nor was I even frustrated.  I knew that I had run on a seriously messed-up leg for several months, which no doubt led to scar tissue and adhesions forming in my muscles.  On top of that, I had undergone surgery which totally changed my hip mechanics, plus spent a significant amount of time on crutches.  To some extent, I anticipated having these sorts of problems.  The more important part was the fact that I never experienced any loss of coordination symptoms after surgery.  Even though loss of coordination was associated with tightness in my calves and hamstrings, the problems I had post-surgery were decidedly different—these were just plain, boring tightness and soreness in the muscle.

My recovery from each of my secondary injuries after surgery also shorted over time.  It took me three weeks to shake the initial bout of plantar fasciitis; hamstring problems set me back about two and a half weeks; the talonavicular joint problem lasted two weeks; and the recovery time for the subsequent injuries dwindled down too.  The final bout of lateral calf problems only sidelined me for three days.  I interpreted this trend as a good thing.

Running and training

Ten months after surgery—in late February of 2013—I was finally running every day again.  At that point, I was working in Northern Virginia and running was not a huge priority in my life.  Following a blessing-in-disguise job loss, I moved back to Minnesota and started coaching and focusing more heavily on freelance writing.  Over the next eight months, I worked back towards real, actual training again.  At each step along the way—doing true long runs, doing interval workouts, doing tempo runs—I was always a little bit afraid that my loss of coordination would return, but it never did.  By October of 2013 I was racing on the roads again; by January of 2014 I'd set a lifetime PR in the mile on the track.

Since then I have largely been training as any normal post-collegiate distance runner would.  I have been able to reach similar levels of training as before my loss of coordination issues, and I've done pretty much any type of workout that would have provoked the problem before.  I've run over 100 miles a week, I've done long, hard tempo runs on paved roads, and I've done interval workouts with up to 10 km of fast running on the track.  I've raced distances from 5k to the half marathon on the roads, and 1mi to 10,000m on the track. 

In retrospect: How was I able to recover? A thought experiment.

From the "loss of coordination in leg" thread on LetsRun.com, it's clear that having surgery for a labral tear and FAI is not  the key to everyone's recovery.  First of all, not everyone with loss of leg coordination while running even has a labral tear.  Second, there have been a few posters who claim to have gotten the surgery, gone through the rehab process, and still have coordination issues when they returned to running. 

A detailed analysis of the possible role of labral tears in loss of leg coordination is covered in my main article on loss of leg coordination while running, but for now, I'd like to consider a thought experiment.  Let's say that my labral tear wasn't the cause of my loss of leg coordination.  Could we still come up with an explanation of why I was able to return to running after recovering from the surgery?

 The most plausible explanation is that the very gradual and methodical return-to-running program that I followed, from the day I had surgery all the way up until I started doing overground running again, was able to rewire my brain circuitry and override the faulty movement patterns that were causing the loss of leg coordination. 

My rehab program started with mind-numbingly simple isometric, single-muscle exercises.  Gradually, it progressed towards more complex isometric or concentric tasks like glute bridges and side leg lifts.  Once I'd mastered those, my physical therapist moved me to more complex functional exercises like squats and lunges.  This progression is not unlike the simple-to-complex progression of "neuroplasticity" exercises used in experimental treatments for musicians with task-specific focal dystonia.  This progression wasn't exactly intentional on my part, but I was at least vaguely aware that this sort of approach might work.

All the while, I was doing low-intensity cyclical aerobic exercise, mostly for hip mobility.  The first few weeks after surgery, I was on the stationary bike. After eight weeks, I was cleared to use the elliptical machine.  Later, I moved to deep and shallow-water running in the pool, and eventually to reduced body weight running on the AlterG treadmill.  Much like my strength exercises, these cyclical aerobic exercises progressed from very simple and non-running specific towards more complex, precise, and running-specific movements.  Finally, after a ten-month break from running and eighteen weeks of this type of work, my brain circuitry had been rewired so that I could run normally again.

At least, that's one idea. It's also possible that my loss of leg coordination while running spontaneously resolved sometime between November of 2011 and August of 2012.  I don't think this is likely, given how many other runners report never having a spontaneous recovery.

There may have been other factors at play, too.  On both occasions when loss of leg coordination struck, my muscle mass was quite low.  During the summer of 2010, my body weight was only about 128 or 130 pounds.  Throughout the winter of 2010/2011, I was substantially stronger and heavier.  Loss of leg coordination returned about two months after I'd lost much of that weight following my string of illnesses.  Looking back, I can see that muscle mass and strength might have played a role, too.  Since recovering, I haven't weighed any less than 134 pounds. 

At the end of the day, I still believe that my labral tear and FAI played at least some role in my loss of leg coordination while running.  It is interesting to note that, of the sixteen respondents to my survey, the only two who have made a full recovery and return to sport at the same level as before have both had surgery for labral tears and FAI (me being one of them, of course).  Another survey respondent who has come close to a full recovery had surgery for a herniated disc in his back and reported significant improvement afterwards.

Would I do anything different during my recovery? I probably should have tried to do more walking, once I was cleared to do it.  I moved more or less directly from the pool to the AlterG, without doing much walking before I started running.  This might have helped avoid some of my initial secondary injuries.  Beyond that, it's hard to point out anything else.  My recovery took a long time—it was almost a year after surgery before I was even able to go run 30 minutes a day on a regular basis—but there was no point in trying to rush things. 

Conclusion

I don't want to draw too many conclusions about loss of leg coordination in general from my own experiences.  That's not the purpose of this article—as the famous saying in medicine goes, "the plural of 'anecdote' is not 'data.'"  Many people have requested that I post my personal history with loss of leg coordination while running, and I feel obliged to comply.  Not just because of some strange form of survivor's guilt, but because the medical literature is entirely devoid of case studies on anybody with loss of leg coordination while running, as defined in the main article (i.e. hip-centric, not spreading, etc.). 

I'm also putting my story out because an impartial observer might be able to read through it and see things that I, blinded by the inevitable bias of writing about myself, cannot.  Maybe my rehab program will inspire a neurologist or physical therapist to construct a neuromuscular re-education plan to rewire brain circuitry in runners with loss of leg coordination.  If nothing else, my story can serve as some marker of hope, evidence that it is indeed possible, if rare, to return to running again without restrictions after loss of leg coordination. 

Acknowledgements

I would be remiss not to thank everyone who supported me and helped me through one of the most difficult stretches of my life—namely, my parents, my family, and the doctors and physical therapists who worked with me and put up with my frustration and unhappiness with my inability not just to run, but to even figure out what was wrong with me.  Without their help, I surely would have given up on running for good.


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This personal history, alongside the executive summary and the accompanying 21,000 word full article were the culmination of five years of research, nineteen months of writing, and considerable emotional investment.  I have published it free for anyone to read and distribute because I don't believe in restricting access to this kind of information.   I am a freelance writer and part-time high school coach, not a professional scholar, so if you have made it all the way down here and found this article helpful, consider donating a few dollars to support my work.  

2 comments:

  1. I thought of runners dystonia at first. Then ruled it out. Arthrogenic inhibition may be a possibility, too. If one considers "yips" that golfers get it may have shown up on an EMG/NCV test. There mental retraining seems to play a large role. Thanks for sharing. Very readable blog.

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  2. It is generally considered to be of utmost importance and guides for the students to understand in detail all those concerns which are indeed considered to be so essential.

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