Do you have more swing in your hips with walking than the average joe? Thought it was your sexy swagger? Have you ever been told you walk lopsided? Does one pant leg feel longer? Perhaps you were not born with a sexy swagger, maybe there is actually something uneven in the lower half of your body.

Or, if you answered “no” to all the above questions…..don’t stop reading.  Many people have no idea they have this problem going on.

About a month ago, I evaluated a lady that received a total knee replacement three months prior. Her left knee was red, swollen, and hurt constantly throughout the day. It had gotten so bad, she could not sleep through the night.

As I was walking her back to the treatment room, I noticed her walking pattern.  It was as if she had a spring in her step, a painful spring.  Her left hip was higher when she stepped on her left leg, her knee was not able to straighten out as much as the right leg.  She was just off.

I went through my normal orthopedic assessment of her strength and balance. Her strength was decent, her balance, on the other hand, was impaired.  And I am not talking about something really difficult like balancing on one leg.  I am talking about standing with her feet together.  Simple enough, correct? Well, she was all over the place.

I surprise her and ask her about urinary leakage. She admits leakage has increased in the past couple of months.

After many other objective tests, I measure her legs while she is lying on her back from her belly button to her ankles.  I measure her left leg is 1 cm longer.  1 cm!

I tell the patient my findings and she looks at me like I am crazy.  She says and I quote, “What do you want me to do about it?” I tell her it is easy…….she can wear a heel lift in her shoe.  She is not sold on this idea.  It is not her fault.  She doesn’t know me from Timbuctoo. She had a knee replacement, she is here to get her knee treated. I drop the issue because I want her to come back and this information is just too much for her right at this time.

Why is telling someone their leg is 1 cm longer such a far-fetched concept?  I see this more than I would like to admit.  MD’s are taught in school that a leg length discrepancy more than 1 cm can compromise the stability of the low back, hip, knees, and feet.  But many times, this is overlooked in the assessment at the doctor’s office.  Do they assess you walking? Or have you lie flat on your back with your legs straight and compare them? I have seen numerous patients with nonhealing ankle fractures, meniscal tears, and labral hip tears due to an undiagnosed leg length discrepancy. And this could be as small as a 0.5 cm leg difference.  It was small, but it was that particular person’s tipping point, their personal aggravator for re-injury.

What about lumbar spine fusions?  If you have a 9 mm leg length discrepancy you have a 6x greater likelihood of having low back problems.  If you have a longer leg, the force vector to the low back is exponentially greater on that side.  Think about it.  Your right leg is 1 cm longer, you are compressing your hip harder into the pelvis bone, your pelvic bone is jamming harder on the lower lumbar vertebrae.  The vertebral disc is just the padding between the two bones and with time, gets smashed (i.e bulging disc) and results in a fusion.  Hardware is placed in the back but the driver for why the disc bulge occurred was never corrected.  Your longer right leg is going to incorrectly load the fusion site and two things will happen with time.  One would be hardware failure because it’s loading mechanics are wrong or you will begin to break down the level above and below the fusion site. Then anywhere from a few years to longer, you need to get another fusion to correct the unstable segment.  It is an unending saga.

It is hypothesized that more than 60% of the population has some sort of leg length discrepancy.  We are almost all created unequal!  It is easy to screen for leg length discrepancy.  Lie on your back with your legs straight and have your partner or friend gently pull both your ankles equally to even your hips out.  Have your friend put their thumbs underneath the inside ankles and compare how they compare to each other.  If they look uneven, then perhaps you have a leg length discrepancy.

I wish this test was straightforward and you could immediately go to Amazon and purchase a heel lift and all your ailments were cured, but…sigh….it is not that simple.  You may have underlying pelvic obliquity that may need be addressed.

I recommend for you to go to your medical provider and ask for a physical therapy referral for a thorough assessment or an x-ray to measure your legs’ length.  Or if going to the doctor is not an option, there are plenty of chiropractors that can diagnose this as well.

Once a leg length discrepancy is confirmed begin wearing a heel lift whenever you are standing or walking.  If you are a barefoot walker, put them in house shoes. You will need your body on an even playing field.

My disbelieving lady with the total knee replacement made it through 2 weeks of therapy before she was open to the idea of talking about treatment for her leg length.  She started wearing a heel lift and her functional tolerance and pain levels dropped within the first week. Her knee swelling was gone, she could go to the grocery store, she could sit at the computer for 8 hours, and she was sleeping throughout the night.

Oh! And her urinary incontinence stopped.  I will explain this connection in future posts…so keep reading.

And for people with a hip or knee replacement, I have been told first hand by an orthopedic surgeon that gaining up to a 1 inch leg length discrepancy is very common after surgery.

So, the take home message here is…sometimes a complex issue can actually have a simple resolution.  A leg length discrepancy needs to be ruled out for anyone with a reoccurring ankle sprain, knee meniscal tear, excessive arthritis in your hip, knee, and ankle joint for your age, low back pain……really any musculoskeletal disorder or pain in the body, particularly in the lower half!

And last but not least…..leg length discrepancies comes with all ages, young and old!

Simple explanations and more for your pain in future posts.

 

I had the cutest lady come to me for low back pain.  She had a true leg length discrepancy and one way to fix the elevated pelvis is to do a hard leg pull at her ankle while having her lie on her stomach.  Well, I had been working with her for about three weeks and she arrived with a completely new hairdo.  It was a full-blown afro.  It spanned about 4-5 inches around her head. It looked great, but was not what I was expecting at all!

 To do the manipulation correctly, I have a co-worker help stabilize the patient to the table.  Then I have to pull.  Many times, the patient will involuntary tense up their body.  I have to cue the patient to “Relax their leg” and provide tactile cueing like tapping to get them to relax. 

On this day, the lady would not relax.  So, I tapped her leg and blurted out, “Relax! Try to relax!  Relax your hair!”  Boy, did my coworker and patient laugh like all get out.  My patient thought it was the funniest thing she had heard all week.