Disclosures: Stacey Isidro, BA: Nothing to disclose

Case Description: Our patient had 2 years of insidious left plantar flexor tightness and abnormal posturing that made running difficult. Over 2 months, the symptoms progressed to every step and were most pronounced at terminal stance and pre-swing phase. There is no history of musculoskeletal and neurologic trauma or deformities. She saw multiple physicians over two years before presenting to PM&R. They tried knee arthroscopy, a piriformis injection and release, and therapy without any success. After a PM&R evaluation and a movement disorder specialist, she trialed medications of transdermal rotigotine, carbidopa/levodopa, and carbamazepine. None of these provided symptomatic relief. An EMG/NCS and a brain, cervical, thoracic, and hip MRI were normal. There was difficulty with left-sided calf raises, but there was 5/5 muscle strength bilaterally, no sensory loss, or increased tone at rest and slow walking. Action-induced dystonia was noted in the anti-gravity muscle groups such as the plantar flexors and quadriceps during fast walking, which was worse when running.

Setting: Outpatient clinic

Patient: 56-year-old female multi-marathon runner

Assessment/Results: A diagnosis of runner’s dystonia was made and a diagnostic motor point block with lidocaine in the quadriceps and plantar flexors showed notable improvement in function. Botulinum toxin injections were done on different muscle groups with variable dosage and only showed mild improvement. A gait analysis confirmed our initial observation of anti-gravity muscle group involvement. Subsequent botulinum toxin injections only focused on these muscle groups with dosage adjustment. Physical therapy, oral trihexyphenidyl with upward titration, and a trial of dry needling were started. She showed significant improvement in her function.

Discussion: The challenge with treating runner’s dystonia is that treatments are based on patient responses, thus following a trial-and-error methodology. Possible treatment includes deep dry needling, physical therapy, antimuscarinics, botulinum toxin injections, intrathecal baclofen, and deep brain stimulation.

Conclusion: This case illustrates the difficulty in treating runner’s dystonia.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-complexity-of-treating-runners-dystonia-a-case-report/