Leg Length Inequality Research

Keywords; leg length inequality research.

Chiropractors are certainly not the only doctors interested in Leg Length Inequality Research. More than 60 years ago radiologists were considering the subject.

American Journal of Roentgenology and Radium Therapy. Vol. 51, No. 5, November 1946, 616-623.

1000 American soldiers complaining of LBP were sent for Xrays. After meticulous study and measurement, the researchers concluded, in the first instance, that it was indeed possible to accurately determine the difference in leg length radiologically, using the femoral heads as the reference point.

The greatest difference in leg length measured was 44 mm.

Concerning spinal biomechanical dysfunction, they noted that a short leg was associated with a tilt of the pelvis and a scoliosis.

  • The xrays were taken in the upright position; erect rather than supine.

How common is a short leg?

In young men suffering from LBP, the authors of this Leg Length Inequality Research paper found that

  • 23 percent of the soldiers had legs of equal length.

The other 77 percent had unequal leg lengths, 

  • 1 – 5 mm Short Leg: 40 percent
  • 6 – 10 mm Short Leg: 23 percent
  • 11 – 21 mm Short Leg: 13 percent
  • More than 22 mm Short Leg: 1.7 percent

The incidence of short right vs left legs was nearly equal. The average shortening was slightly more than 7 mm.

Pelvic tilt and Scoliosis

A patient with scoliosis.

Whenever there is a pelvic tilt, a scoliosis of the lumbar spine coexists.”

  • “Because this scoliosis, in every single case, compensates for the pelvic tilt, it is known as a compensatory scoliosis.
  • “The presence of this compensatory scoliosis associated with the tllted pelvis, due to shortening of one leg, has clinical significance.
  • Furthermore, it is our opinion that the presence of scoliosis cannot be determined with any degree of accuracy from the physical examination of the patient.
  • The taking of xrays of the spine in the recumbent position, as is most commonly done, is quite useless in doing a scoliosis study.
  • “It was consistently noted that the degree of spinal curvature was directly proportional to the extent of the pelvic tilt. The person with a short leg will have to compensate completely if he wishes to hold the upper portion of his body upright.

“A consistent observation which has been made is that in those cases with a shortened leg there is a corresponding tilt of the pelvis and a compensatory scoliosis of the lumbar spine.”

Non-compensatory scoliosis

Of the nearly 800 observed short leg cases seen in this study of young soldiers, only eight were suffering from a non-compensatory scoliosis. These spinal curvatures were associated with pathology such as bony changes from old trauma to the disc, facet, or vertebral body; we called them a structural scoliosis.

Such would be far more common in older persons who have undergone trauma from falls on the ice, osteoporotic fracture, and the like.

"I believe the best definition of man is the ungrateful biped."

Fyodor Dostoevsky

When is a LLD clinically significant?

Leg length differences exceeding 5 mm were associated with greatest low back pain or disability, and therefore 5 mm is labeled as being a “marked difference.”

The authors of this remarkable Leg Length Inequality Research paper stated further:

"It is our opinion that the existence of a short leg exceeding 5 mm is significant from the standpoint of symptomatology and disability.”

Ancillary findings of Leg Length Inequality Research

  • Sacroiliac Joint Arthritis 5.5%
  • Increased Lumbosacral Angle Above 50° 4.3%
  • Lumbosacral Transitional Segment 3.7%
  • Pars Defect With Spondylolysthesis 2.7%
  • Reduced Lumbar Lordosis 2.5%
  • L5-S1 Facet Tropism 1.5%
  • Pars Defect But No Spondylolysthesis 1.0%
  • L5-S1 Retrolysthesis 0.6%

Lumbosacral Transitional Segment

The transitional areas of the spine, and in particular the lumbosacral joint are particularly prone to anomalies, causing biomechanical aberrations.

Hip replacement surgery

The single most common cause of a leg length inequality in the elderly occurs after hip replacement surgery; it's an art to get the legs exactly the same length, and many surgeons miss the mark. I personally recently examined a patient who had a difference of 30mm post surgery. It cause a very severe pelvic tilt and scoliosis.

Useful links

Physical Therapists providing a Chiropractic adjustment?

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.

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