Symptom Locus and Symptom Origin Incongruity in Runner’s Dystonia – Case Study of an Elite Female Runner

Abstract

Objectives: Runner’s dystonia is a task-specific dystonia that occurs in the lower limbs and trunk, with diverse symptomatology. We aimed to identify the origin of a dystonic movement abnormality using combined three-dimensional kinematic analysis and electromyographic (EMG) assessment during treadmill running.Participant: A 20-year-old female runner who complained of right-foot collision with the left-leg during right-leg swing-phase, which mimicked right-ankle focal dystonia.Results: Kinematic and EMG assessment of her running motion was performed, which showed a significant drop of the left pelvis during right-leg stance-phase, and a simultaneous increase of right hip adductor muscle activity. This resulted in a pronounced adduction of the entire right lower limb with respect to the pelvis segment. Trajectories of right foot were seen to encroach upon left-leg area.Discussion: These findings suggested that the symptom of this runner was most likely a form of segmental dystonia originating from an impaired control of hip and pelvis, rather than a distal focal ankle dystonia.Conclusion: We conclude that, for individualized symptom assessment, deconstructing the symptom origin from its secondary compensatory movement is crucial for characterizing dystonia. Kinematic and EMG evaluation will therefore be a prerequisite to distinguish symptom origin from secondary compensatory movement.

Treating Dystonia in a Soccer Player Through an Integrated Rehabilitative Approach: A Case Report

“…35,36,38 Furthermore, this patient experienced the need to use a motor trick to move his lower limbs (see the Case Presentation section) and improving proprioception and motor integration could play an important role in his rehabilitation process. In addition, whole-body proprioceptive training through Tai Chi exercises could also be important in SRDs where symptoms are limited to 1 limb, which may mask a more distributed segmental dystonia, as shown by Ogasawara et al 55 Finally, we integrated (3) dental interventions and swallowing rehabilitation for this patient. The association between lower limb task-specific dystonia and an abnormal motor pattern of the oral muscles is not recognized in the literature; only one case of running-induced cervical dystonia has been described.…”

Function and dysfunction of the dystonia network: an exploration of neural circuits that underlie the acquired and isolated dystonias

“…These dystonias have the interesting feature of being associated with environmental factors or "overuse," namely, professional use of voice in laryngeal dystonia or extensive practiced fine motor control in writer's cramp or musician's dystonia [70-74]. In addition, frequent case reports arise in the literature of various dystonias associated with other repetitive focused tasks including, briefly, laryngeal dystonia in a telemarketer and focal appendicular dystonias in a typist, a billiards player, a blacksmith, during braking while driving, and in a runner [75][76][77][78][79][80][81]. Despite the association of this class of dystonias with environmental factors, there is evidence of underlying genetic associations including both predisposing family history and the identification of genetic mutations [82,83].…”