# The Relationship Between Stiff Knee Gait Runner’s Dystonia and Musculoskeletal Knee Pathology: A Case Series

## TL;DR

This study explores how knee problems might be linked to a rare movement disorder in runners and how treating both can improve outcomes.

## Contribution

The study identifies a novel connection between stiff knee gait runner’s dystonia and musculoskeletal knee pathology, suggesting combined treatment approaches.

## Key findings

- Seven out of eight RD patients with stiff knee gait had knee effusions or tendinopathies.
- Combining musculoskeletal interventions with botulinum neurotoxin therapy improved symptoms in three patients.
- One patient with foot dystonia showed different biomechanics without knee pathology.

## Abstract

Background: 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. Methods: 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. Results: 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. Conclusions: 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.