Chiropractic
Leg Length Difference and Low Back Pain
Dr Jemal Khan,
Chiropractor
Chiropractors frequently have patients ask them if it is possible for someone to have a short leg. Perhaps this because someone has told them they walk funny or a tailor has noticed that one pant leg always requires shortening.
Studies on the effect of leg length difference on back pain have had differing results. Most authors have found a significant correlation between a leg length difference, and low back pain. However, there does remain debate about the degree of leg length inequality necessary to cause low back pain. Interestingly it has been shown that of low back pain patients, 75% had a leg length inequality of 5mm or more.
Travell and Simons were medical pioneers on treatment of trigger points (a type of muscle spasm), and the effect of pain syndromes due to trigger points. Travell and Simons felt that "a discrepancy of 5mm or more should be corrected (by shoe lift) if low back symptoms coexist and that a discrepancy of 1.3 cm or more should be corrected, even in the absence of symptoms". Travell and Simons were concerned about trigger point formation and muscular imbalance leading to back pain. In addition to muscular imbalance, most chiropractors are also concerned about disc degeneration, scoliosis, and spine/hip arthritis developing from a short leg.
Treatment of leg length inequality depends on careful evaluation of the patient to determine the degree of anatomical versus functional discrepancy. This determination is best made through careful radiographic (x-ray) analysis.
Anatomical short leg is the difference in the length of the leg bones (femur, tibia & fibula,) from the ground to the top of the femur compared between the left and right leg. The causes of anatomical short leg could be from trauma, polio, birth defect, surgery, or asymmetrical growth.
Functional short leg is the difference in the alignment of the structures from the ground to the top of the femur compared between the left and right leg. The cause of a functional short leg is usually foot pronation, knee deformity, or compensation in the spine.
If anatomical difference predominates, then shoe-lift therapy is appropriate.
The heel lift lengthens the shorter leg, thereby creating a more level platform or base for the spine. A level foundation reduces stress on the intervertebral discs, reduces force on the spinal joints, and normalizes the muscular balance of the back.
Chiropractic treatment of chronic low back pain complicated by leg-length inequality is a two-part process. The first consideration is spinal manipulation to reduce misalignments and muscular tightness in the lower back and pelvis. This misalignment and muscular compensation is a normal occurrence with leg-length inequality. This is usually complemented by a series of stretches and exercises performed by the patient on a daily basis.
Second is the utilization of a heel lift. This is a gradual process, with the amount of heel lift increased in small increments. This is not a process that should be attempted without chiropractic supervision.
Your chiropractor will be happy to talk to you about the effects of a short leg on your skeletal system, and whether a heel lift is appropriate for you.
The Canadian Chiropractic
Association
Dr. Jemal Khan,
Chiropractor
Cayman Chiropractic Clinic