Do you have Leg Length Inequality?
Do you have a Pelvic Tilt?
“Leg length inequality more common than you may think and without correction this postural imbalance will eventually cause terrible wear in your spine.”
-By Tim Errington, DC
Leg-length inequality is surprisingly common and can go undetected for many years. Usually, there will eventually be some varying symptoms which can be from mild to extreme. If leg-length inequality is suspected, a focused examination by a qualified structural chiropractor is the best course of action. He will determine the discrepancy and establish whether or not it is impacting on the patient’s spine or gait.
The chiropractor should determine the source of the inequality, and establish whether or not a correction should is needed. Finally, he should determine, by evaluation, whether the treatment has sufficiently addressed the problem.
The leg length inequality examination should be in a standing position
The examination should commence when the client is in a standing, weight-bearing position. Measurements of leg-length discrepancy obtained pronely or lying down in non-weight-bearing positions are unreliable. They are unreliable because muscle imbalance will affect the results. If there is a pelvic tilt due to a possible leg length difference, an X-ray is the best course of action. Spinal degeneration that results from leg length discrepancies can be devastating to a person’s health. Therefore a proper clinical evaluation must be made. There can be no guessing here; there is too much at stake. Once we precisely determine the issue, then effective chiropractic care can proceed. Since the legs provide support for the pelvis both during standing and walking, it is of no surprise that inequality can have a far-reaching effect on both pelvic and spinal alignment.
The X-ray above shows a 40-year-old woman from the front. We see a leg length inequality of only 5mm (on the left), which is tilting the pelvis and causing a lumbar curvature. If you look at the spine from the side (on the right), we can see that already the lower disc space is thinning with degeneration.
Here we see a 60-year-old man whose inequality was never recognized. The result was massive degeneration, and he used a walking stick to get around. When he came to our clinic, he had already suffered 25 years of terrible pain. Finding the right chiropractor is essential to stop this from happening.
If one leg is shorter than the other, the pelvis becomes un-level, and it tips the spine to one side. This imbalance causes an abnormal lumbar curvature or even scoliosis. Walking patterns are altered subconsciously in compensation. These altered walking patterns can lead to uneven wear and eventually hip or knee replacement surgery. A leg-length difference of 5mm or over statistically results in a higher incidence of low back pain. Athletes, on the other hand, and those who spend a lot of time on their feet may develop chronic symptoms with just 3 mm of a discrepancy.
Anatomical or Functional?
There are two classifications of a short leg based on structure and cause. Each needs identifying and will require different treatment. A difference in the length of the actual leg is an anatomical short leg. An anatomical short leg can happen after a fracture or perhaps a hip replacement. However, it is often the result of asymmetrical growth. A short functional leg isn’t a short leg at all; it just seems that way. The most common cause is excessive pronation of a foot (flat foot) on one side. Another possible cause that we often see here in Singapore is excessive valgus (bow legs). If one leg is bent more than the other, then this may also be a cause.
Correction – Orthotic or Lift?
When we know that there is a pelvic tilt due to a Leg Length Inequality, providing support to improve symmetry is the most effective treatment. When an anatomical difference in leg length affects the alignment of the pelvis and spine, chiropractic care should include the recommendation of an appropriate amount of heel-lift to raise the pelvis on the low side. The body can tolerate a small discrepancy, and generally, it is accepted that anything under 3mm difference is OK. The exception may be athletes (such as long-distance runners), who spend many hours a day exercising and competing on their feet.
If the cause is partly or entirely a functional one due to foot pronation, then the use of orthotics to stabilize the feet must be incorporated into the correction. Only the standing postural exam, with careful evaluation of lower extremity alignment, permits this determination.
For most patients, a slight under-correction (to within about 3 mm) is generally the best way to achieve good results while avoiding any adverse reactions. If the amount of lift needed exceeds 6 mm, then usually the additional lift must be built onto the shoe. A lift above 6 mm will push the foot out of most shoes. Do this by adding half of the heel lift amount to the sole of the shoe.
Why are X-Rays so necessary with leg length ineguality?
At times the spine is such that a correction of the leg length will push the spine further away from normal alignment, and this can have disastrous results. So, the correct weight-bearing X-rays with the right interpretation is a must!
How long does leg length inequality correction take?
If a pelvic tilt is left untreated long enough, this will usually result in severe damage to the spine and especially the lower intervertebral disc. If this is the case, then the treatment may take some weeks or months as the functional changes required to evoke change and healing must happen gradually.
At Total Health Chiropractic Singapore, we will not introduce all the changes in one go. If there is a provocation of symptoms, then we want to know what is causing it. We will loosen the pelvis and the spine with adjustments before gradually introducing corrective lifts. The heel lift may be introduced from about the sixth adjustment, depending on the particular case. The lift will be introduced 3mm at a time with at least 4-8 weeks between to allow the body to adapt gradually. The more degeneration there is in the spine, the slower will be the changes. It’s usually better to be over-conservative rather than over-aggressive with the correction.