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.
How common is a short leg?
In young men suffering from LBP, the authors of this Leg Length Inequality Research paper found that
The other 77 percent had unequal leg lengths,
The incidence of short right vs left legs was nearly equal. The average shortening was slightly more than 7 mm.
Whenever there is a pelvic tilt, a scoliosis of the lumbar spine coexists.”
“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.”
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."
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.”
The transitional areas of the spine, and in particular the lumbosacral joint are particularly prone to anomalies, causing biomechanical aberrations.
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.
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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