Leg length inequality leads to more arthritis in the hip, knee and spine.
The relationship of limb length inequality with radiographic knee and hip osteoarthritis was researched by Golightly et al, and reported in the journal Osteoarthritis and Cartilage. They conclude that there is strong correlation in the knee, but to a lesser extent in the hip, where the hip on the short leg side was more likely to be arthritic.
Interestingly, folk with a short leg were also more likely to be obese, with an average BMI of 29.0. It would seem they are less likely to be active.
The causes of knee and hip arthritis are legion, but leg length inequality must be included.
Health is additive, both in a positive and a negative sense. If you are a couch potato and smoke, you're even more likely to get a host of diseases.
Likewise, if you are overweight, and have a short leg, then arthritis of the knee and hip are highly likely.
Conversely, if you are active and walk or swim regularly, for example, and use an orthotic to correct for a short leg, then you are far less likely to have these arthritic disabilities; eat plenty of omega 3 rich foods and you're home and dry.
It is well known that osteoarthritis is one of the most common, chronic conditions and a leading cause of disability among older adults. This is particularly true in the USA where obesity compounds other known causes, arthritis of the knee affecting six percent of the adult population and of the hip, three percent.
This study examined the relationship of limb length inequality (LLI) with radiographic hip and knee osteoarthritis (OA) in a large, community-based sample.
Hypothesised is that a short leg alters gait symmetry and joint mechanics during weight bearing, potentially contributing to the development of arthritis in the knee and hip.
They found that those with LLI were 80% more likely than those without a short leg to have radiographic knee OA, and but only 20% more likely to have hip arthritis seen on x-ray.
In the presence of a short leg, hip OA was found to be 30 percent more common on the short leg side versus 18% on the longer limb.
Here's the hypothesis.
They speculated, with support from other studies, that mechanical factors, including joint instability and malalignment, contribute to the progressive degeneration that characterizes radiographic OA. Said the authors;
Individuals with short leg often modify their movement patterns to functionally minimize the inequality, i.e., increasing knee flexion or hip adduction of the longer limb. These compensatory mechanisms may amplify forces across a smaller joint contact area, thus acting as a biomechanical precursor to lower extremity OA.
“A short leg may lead to altered or amplified joint forces, resulting in accelerated degeneration of joint structures and increased OA severity.”
The authors's definition of short leg was a difference of more than 2cm, as they felt that a lesser inequality would not be "clinically meaningful", an opinion that chiropractors, with the spine rather than the hip and knee in mind, would take issue with.
“These results may have important clinical implications for patients seeking treatment for knee or hip OA. Evaluation of LLI should be incorporated into physical examinations for these patients.”
“Treatment of the anatomically short leg in patients with knee or hip OA, with heel or shoe lifts, may aid in reducing joint stresses, pain, and disability, but more research needs to be done.”
Leg length inequality is one of the most common causes of scoliosis and degenerative change in the lumbar spine too.
How common is LLI in persons suffering from LBP?
In a remarkable study done on servicemen suffering from LBP, researchers discovered that ...
For the Chiropractor
How does this work out in practice? The first thing a chiropractor would do would be to check out the feet when examining a new case file. A dropped medial arch with concommitent pronation would obviously contribute to a short leg syndrome. A suitable arch support such as provided by FOOT LEVELERS, without a heel raise may be adequate to level the pelvis.
Short leg is of course just another name for leg length inequality; would a rose smell any different if you gave it another name? Does lumbago hurt more than low back pain? A leg length inequality is often a consequence of conditions such developmental hip dysplasia.
Sacroiliac Joint Treatment
Due to altered biomechanics leg length inequality also contributes to
osteo-arthritis in the sacro-iliac joint. For more about the
chiropractic Sacroiliac Joint treatment
click here: SACROILIAC JOINT TREATMENT.
A Journal of Rheumatology report confirms the connection between LEG LENGTH INEQUALITY AND LOW BACK PAIN, and invites questions about the use of heel lifts in the treatment of recalcitrant neck pain.
Knee Joint Distraction
Research confirms that unloading of joints and increasing cartilage perfusion can dramatically reverse osteoarthritic changes.
There is nothing simple about leg length inequality, particular when it's associated with other syndromes. It frequently causes a sacroiliac syndrome, perhaps a Maignes, often in the older person there is associated Immobilisation Arthritis from a life time of subluxations. Perhaps there might be hip arthritis, more common with a short leg... it takes a chiropractor as pertinacious as the Bruce's spider to sort all the threads out...
(PS. Know the story about how Robert the Bruce was inspired by a spider... google it, fascinating yarn.)
Leg length inequality
Chiropractor Dr Bernard Preston writes his chiropractic anecdotes from his own coalface with disarming honesty. Humorous, sometimes tragic, his theme is no spread the good news of better health through chiropractic, more exercise and a better diet.
His third chiropractic book is written from his seven years practising in Holland.
Many insurance companies now only pay for physical therapists to provide a chiropractic adjustment; that's in the face of powerful research proving that inclusion of DCs to perform their own technique would save them a good deal of money. One has to conclude that political medicine has gone off on another tack to contain our profession.
It's being successful with some doctors of chiropractic quitting. Others become involved in some dodgy practices, like demanding that patients sign up for a whole year of treatment in advance, in order to stay in business.
In recessionary times, the going is tough when the insurance won't pay.
Is the day approaching for a new Wilk versus the AMA and the insurance companies?
The chiropractic profession has tried hard to stay on the moral high ground; those who stoop to unscrupulous practices need to be exposed and disciplined if we are not to stoop to the low blows that medicine has often resorted to contain and eliminate us.
Leg length inequality
Interesting questions from readers
Chiropractic Books.com and its two sister sites Chiropractic Help.com and Bernard Preston.com bring you plenty of information about new books, care of the body, and healthy living tips from your own vegetable and fruit gardening, to flaxseed for omega 3 and much more.