Stowers Jared A, Day Derek S, Jow Steven, Heins Sarah, Forrest Euan, Assefa Yonathan M, Lind Paige M, Mushtaheed Afreen, Sheehan Frances T, Alter Katharine E
MedStar Georgetown National Rehabilitation Hospital, Washington, DC 20010, USA.
Department of Physical Medicine and Rehabilitation, University of Utah Health, Salt Lake City, UT 84132, USA.
Toxins (Basel). 2025 Mar 3;17(3):121. doi: 10.3390/toxins17030121.
Runner's dystonia (RD), a rare task-specific lower-limb dystonia affecting high-mileage runners, presents as abnormal lower-extremity muscle contractions during running. Treatment of RD is challenging and often confounded by significant diagnostic delays due to overlapping symptomatology with other conditions. This case series examines the relationship between stiff knee gait RD and musculoskeletal (MSK) knee pathology.
Eight RD cases, evaluated at the NIH Movement Disorders Clinic since 2018, were retrospectively reviewed. Patients underwent neurological, biomechanical, and MSK evaluations, including 3D motion analysis, surface electromyography, and knee ultrasound. Therapeutic interventions, including botulinum neurotoxin (BoNT) injections, were assessed.
Seven patients demonstrated stiff knee gait subtypes, with all having ipsilateral and/or contralateral knee effusions or tendinopathies. Three patients who received MSK interventions (e.g., aspiration, corticosteroid injections) combined with BoNT therapy experienced significant symptom improvement. One patient with isolated foot dystonia displayed different biomechanical patterns without knee pathology.
RD patients with stiff knee gait often exhibit knee pathology, most likely due to altered biomechanics and running history. Addressing both issues is essential for optimizing treatment outcomes, reducing pain, and improving function, especially since pain can trigger dystonia. Future research should determine the ideal sequence of interventions for RD patients with MSK issues to develop effective, personalized treatment algorithms.
跑步者肌张力障碍（RD）是一种罕见的特定任务性下肢肌张力障碍，影响长跑运动员，表现为跑步时下肢肌肉异常收缩。RD的治疗具有挑战性，且由于与其他病症症状重叠，诊断往往会出现显著延迟。本病例系列研究了僵膝步态型RD与肌肉骨骼（MSK）膝关节病变之间的关系。
回顾性分析自2018年以来在美国国立卫生研究院运动障碍诊所评估的8例RD病例。患者接受了神经学、生物力学和MSK评估，包括三维运动分析、表面肌电图和膝关节超声检查。评估了包括肉毒杆菌神经毒素（BoNT）注射在内的治疗干预措施。
7例患者表现为僵膝步态亚型，均有同侧和/或对侧膝关节积液或肌腱病变。3例接受MSK干预（如抽吸、皮质类固醇注射）联合BoNT治疗的患者症状有显著改善。1例孤立性足部肌张力障碍患者表现出不同的生物力学模式，无膝关节病变。
僵膝步态型RD患者常伴有膝关节病变，很可能是由于生物力学改变和跑步史所致。解决这两个问题对于优化治疗效果、减轻疼痛和改善功能至关重要，尤其是因为疼痛会引发肌张力障碍。未来的研究应确定针对有MSK问题的RD患者的理想干预顺序，以制定有效的个性化治疗方案。
