Have you ever thought that one of your legs is longer than the other? Have you experienced incidences of lower back pain? These two things could be related. Most individuals have a small difference in their leg lengths. A difference of leg lengths greater than 5 millimeters (1/4 inch) can contribute to lower back pain. Leg length discrepancies is rarely due to having one bone that’s actually longer than the other. Usually they are caused by an imbalance in the pelvis, due to a tight hamstring or iliotibial band that jacks up the other side of the pelvis. Runners with this imbalance overcompensate by favoring their “longer” leg, and this can lead to injury.
Specific diagnoses that occur along with leg length discrepancy include: scoliosis, lumbar herniated discs, sacroiliitis, pelvic obiliquity, greater trochanteric bursitis, hip arthritis, piriformis syndrome, patellofemoral syndrome and foot pronation. Other potential causes could be due to an injury (such as a fracture), bone disease, bone tumors, congenital problems (present at birth) or from a neuromuscular problem.
Some symptoms include:
• An obvious observance of one leg being longer than the other
• Affected posture
• Problems with gait (walking)
• Pain in the lower back, hip, ankle or knee
Leg length discrepancies can be classified as a structural leg length discrepancy or a functional leg length discrepancy. A structural leg length discrepancy is a hereditary circumstance that one leg is simply longer than the other leg. This is determined if the patient’s pelvis and sacroiliac joints are symmetrical and the leg length is simply due to one leg truly being longer than the other. The best way to determine if a structural leg length discrepancy is present is with an anterior-posterior x-ray of the pelvis. A clinical alternative is using a tape measure to measure the length of the leg from the hip to the ankle.
Functional leg length discrepancy is diagnosed when there is a torsion or pelvic rotation, commonly a sacroiliac joint dysfunction, which causes one leg to function as though it is longer or shorter than the other. In order to determine if a true structural discrepancy exists, the chiropractor must treat the pelvis and return it to a neutral position before measuring for the leg length discrepancy. Once the pelvis is symmetrical, it is determined if the leg length discrepancy remains or if it goes away. If it goes away, it is classified as functional. If it remains and has a measurable difference, it is a structural leg length discrepancy.
Structural leg length discrepancy can be treated with a heel lift in the shorter leg’s shoe, if the leg length is greater than 5 mm. In certain cases, surgical intervention may be needed to either shorten or lengthen the limb. An important component to any surgical procedure to correct leg length discrepancies is physical therapy. Physical therapy helps to stretch muscles and maintain joint flexibility, which is essential in the healing process.
For a functional leg length discrepancy no heel lift is required, but proper manual therapy techniques and specific therapeutic exercise is needed to treat and normalize pelvic and lower extremity compensations. The number of treatments needed to hold the pelvis in a symmetrical position is different for each patient based on their presentation and biomechanical dysfunctions in their lower back, pelvis, hip, knee, and foot/ankle.
If you have pain in your lower back or lower extremity and possibly a length discrepancy, the two symptoms could be related. Come in for an evaluation to determine whether you have a leg length discrepancy and if it could be contributing to your lower back pain, hip pain, knee pain, or leg pain. Give us a call at (408) 248-8700 to schedule an appointment.