Leg Length Difference (LLD) - 15mm

[Johannes Schlögl]

Hii,

the last three years were quite a challenge for me, in which I've learned a lot about my body. Here is a short outline of my journey and then I will add the specific questions I have regarding my LLD.

 

I started to have back problems on and off for roughly 3 years, which haven't been too bad for the first 2 years. But from October 2022 until I got surgery in July 2023, I was in some really excruciating pain, for around 3 month, which I could alleviate after some time with conservative treatments/ practice (spine work, dancing, stretching, and strengthening of my glutes, back & trunk muscles). Still it was quite painful; the diagnosis: spondylosisthesis (Meyerding II); evolving from a connate defect of my pars intercularis (they were broken since I am born literally). After most practitioners and even doctors advised against an operation, while selling me their conservative treatments, I finally went to a neurologist/ neuro-surgeon who affirmed that in my case he would highly recommend me to get surgery; especially pointing to my already visible nerve damage. Now over a year post-surgery, I am pain free, but still experience some weakness in my left leg (glutes, abductors, and  tibialis) and that it gets tired faster than the right leg, resulting from the nerve damage. I was told that the nerves could need up to 3-4 years to fully recover, if at all. In retrospect, I should have gone a bit earlier to the neurologist; but anyway, there is no point in thinking about the if's.

 

I got back to all my sports which is mainly based on a morning routine from 'Fighting Monkey - Zero Forms' (spine work), organic strength work and movement based on the the movement culture from Ido Portal, Gaga Dance, Contact Improvisation and some Capoeira. Basically I am doing all my sports again.

 

But I've also noticed that I still experience some pinching in my lower back on the left side. And even sometimes some pain sending out through my left leg. Plus the weakness in my left leg, especially when lifting (people) in the Contact Improvisation practice, or standing or walking for a longer period. My neuro-surgeon said, that my body has stored that kind of mechanism when there is too much stress, and responds with the pattern it was used to respond with when I was in pain pre-surgery. After a period of weired sensations and cramps in my left glutes and back (tense QL), coupled with neurological increasing weakness in my left tibialis, I've just got a MRI 2 weeks ago. My neuro-surgeon said that my lower back is all fine, and my neurologist confirmed that I've maltreated my peroneus nerve, probably by sitting in a cross-legged position for too long. So that was kind of a relieve that the weakness in the tibialis muscles wasn't necesserily coupled to the back tension. And the peroneus nerve needs some time, attention, and exercises to get back to full strength.

To get back to the response of my neuro-surgeon that my body remembers the response mechanism pre-surgery. I kind of see his point, and in the same turn, over the period I was with back pain, I've also found out, that my right leg is shorter than my left leg. I've done the self-assessment test described in your book 'Overcoming Neck and Back Pain' and had my findings approved by a X-Ray covering the length of my leg bones - my right leg is anatomically 15mm shorter than my left leg.

I've tried to wear a heal lift of different heights, starting off with 5mm and atm 8mm. This have improved my felt experience of back tension after only a few days wearing them. My Rolfing practitioner that I trust recommended me to fully balance out the difference, which would mean to get customized shoes with 15mm difference.
But I've also read you writing about it, that the body over the course of my life (28 years) has got used and functionally adjusted to that imbalance - the myth of being anatomically symmetric. This made sense to me which is why I chose to explore and find out through tinkering what heel elevation would benefit me most. Atm I wear 8mm.
I) Could you elaborate on that? Full compensation of 15mm vs just as much as needed to get pain-/cramp free?

II) Another thought is: Once I have more strength and endurance in my left leg (especially the glutes, and abductors) I have more stability in my leg, and less tension in my back (especially the QL). So maybe these two factors are adding up to each other? By that I mean that part of the tension is caused by the LLD and the other part by the instability in my left leg.

In the course of my backpain journey, I've also done a walking/ running analysis, which showed that my hips when walking actually are functionally in balance, which shows the elaborate system of the human body to work around and cope with imbalances/ assymetry in the structure. While standing it makes a lot of sense to me that I am wearing insoles, as the body is not in motion and the hips are not leveled. But what about dancing, movement practices, or the 'simple' act of walking? These are usually practiced barefoot in my community, plus I also just love to walk and move barefoot. But my practitioners recommended me to wear the insoles as often and long as possible, and in particular when I am working out or practicing my movement disciplines. And I do realize, that my back tensions are less when I am wearing them, also during practice, which I just start(ed) to explore. Here are some more questions:

III) What kind of shoes or insoles do I use in minimal/ barefoot shoes? The question of elevating the whole shoe and literally buing a customized shoe where the right shoe sole is 8-10mm thicker than the left? Or having an insole where there is a 8-10mm heel elevation? Does it make a difference to the static? I'm thinking about the heel elevation that this is literally what the barefoot community is trying to avoid, because it is causing stress in the knees and consequently the hips.

IV) What about walking barefoot? I read that @Kit_L for example has 20mm LLD, and I wondered what your journey looked like and what insights you gained for your body? Do you still practice/ do sports/ walk barefoot? Or do you use insoles pretty much most of your time? Or only when standing, when the body is not in motion?

 

I am pretty active and movement means really a lot to me and my personal health - physically and psychologically. I am just getting back to the Lying Meditation Scripts on a daily basis, starting to focus on the S.T. stretches (Hip Flexor, Hamstrings, Piriformis), and picking up my leg practice from physiotherapy to strengthen my left leg. In all that, I am still quite confused how to adress my LLD. I hope that through that post, I get some stimulating answers and questions to keep tinkering around.

 

Thank you very much for your help!

Johannes

 

 

[Kit_L]

Johannes, 

I will copy your whole post back here, so I can interpose comments, more like a conversation.

I started to have back problems on and off for roughly 3 years, which haven't been too bad for the first 2 years. But from October 2022 until I got surgery in July 2023, I was in some really excruciating pain, for around 3 month, which I could alleviate after some time with conservative treatments/ practice (spine work, dancing, stretching, and strengthening of my glutes, back & trunk muscles). Still it was quite painful; the diagnosis: spondylosisthesis (Meyerding II); evolving from a connate defect of my pars intercularis (they were broken since I am born literally).

Understand completely; the pars defect is the most common deep cause of spondylosisthesis. As well, in my experience, spondylosisthesis is very highy correlated with tight quads and hip flexors—you need all the HF stretches from our YT channel, and once-a-week sessions on the partner HF stretch. All are here:

https://www.youtube.com/@KitLaughlin/search?query=quad hip flexor

After most practitioners and even doctors advised against an operation, while selling me their conservative treatments, I finally went to a neurologist/ neuro-surgeon who affirmed that in my case he would highly recommend me to get surgery; especially pointing to my already visible nerve damage.

Very good advice, in your case.

Now over a year post-surgery, I am pain free, but still experience some weakness in my left leg (glutes, abductors, and  tibialis) and that it gets tired faster than the right leg, resulting from the nerve damage. I was told that the nerves could need up to 3-4 years to fully recover, if at all. In retrospect, I should have gone a bit earlier to the neurologist; but anyway, there is no point in thinking about the if's.

Yes, agree with the neurologist, completely. And the more you can stimulate the associated muscles, the faster the nerves will grow back – there is a massive redundancy in our bodies' systems which is not clear to anyone who hasn't done this kind of thing themselves. And of course the research is not really clear on this aspect either.

I got back to all my sports which is mainly based on a morning routine from 'Fighting Monkey - Zero Forms' (spine work), organic strength work and movement based on the the movement culture from Ido Portal, Gaga Dance, Contact Improvisation and some Capoeira. Basically I am doing all my sports again.

Excellent; this is the best you can do.

But I've also noticed that I still experience some pinching in my lower back on the left side. And even sometimes some pain sending out through my left leg. Plus the weakness in my left leg, especially when lifting (people) in the Contact Improvisation practice, or standing or walking for a longer period.

Understand.

My neuro-surgeon said, that my body has stored that kind of mechanism when there is too much stress, and responds with the pattern it was used to respond with when I was in pain pre-surgery.

100% accurate. Until a body part is able to be stressed beyond its historical experience, the embodied experience/memory of past injuries continues to influence the body's experience in the present. This is completely to be expected. In fact this expectation of injury 'pre-stresses' the part, and the paradox is, unfortunately, that "apprehension reflex" (as we named it in the last edition of Overcome neck back pain) renders the part more liable to injury, not less. Once these parts experience a greater stress than they experienced in the past, though, that memory and association will be over-written, and you will not feel this apprehension. In other words, you will be completely better.

After a period of weired sensations and cramps in my left glutes and back (tense QL), coupled with neurological increasing weakness in my left tibialis, I've just got a MRI 2 weeks ago. My neuro-surgeon said that my lower back is all fine, and my neurologist confirmed that I've maltreated my peroneus nerve, probably by sitting in a cross-legged position for too long.

Do you change legs when sitting cross-legged, or do you always arrange them the same way? 

So that was kind of a relieve that the weakness in the tibialis muscles wasn't necesserily coupled to the back tension. And the peroneus nerve needs some time, attention, and exercises to get back to full strength.

Yes.

To get back to the response of my neuro-surgeon that my body remembers the response mechanism pre-surgery. I kind of see his point, and in the same turn, over the period I was with back pain, I've also found out, that my right leg is shorter than my left leg. I've done the self-assessment test described in your book 'Overcoming Neck and Back Pain' and had my findings approved by a X-Ray covering the length of my leg bones - my right leg is anatomically 15mm shorter than my left leg.

That is significant; my own is 18mm, as far as can be determined. No problem. The research supports this: ~50% of the general population have an LLD of 5mm or more, and 10% of the population have an LLD of 10mm or more.

I've tried to wear a heal lift of different heights, starting off with 5mm and atm 8mm. This have improved my felt experience of back tension after only a few days wearing them. My Rolfing practitioner that I trust recommended me to fully balance out the difference, which would mean to get customized shoes with 15mm difference.

Definitely not. If you correct the whole of any measured difference, you are just as likely to render the adaptations the body has already made to the leg bone length differences into problems of their own – we know (with much evidence to support this) at the body can cope with modest differences in leg length with no problems whatsoever. I recommend somewhere between less than half and an absolute maximum of half of any measured difference as what should be used as a heel lift. And make sure you chamfer the front edge down so that the lift is just underneath the heel bone and that the front of it does not irritate the bottom of the foot. It is most important to use a lift when you are doing vertical loadbearing exercises, like squats or deadlifts.

But I've also read you writing about it, that the body over the course of my life (28 years) has got used and functionally adjusted to that imbalance - the myth of being anatomically symmetric.

Precisely.

This made sense to me which is why I chose to explore and find out through tinkering what heel elevation would benefit me most. Atm I wear 8mm.
I) Could you elaborate on that? Full compensation of 15mm vs just as much as needed to get pain-/cramp free?

The latter: "just as much as needed to get pain-/cramp free".

II) Another thought is: Once I have more strength and endurance in my left leg (especially the glutes, and abductors) I have more stability in my leg, and less tension in my back (especially the QL). So maybe these two factors are adding up to each other? By that I mean that part of the tension is caused by the LLD and the other part by the instability in my left leg.

Very likely. So in all your movement training, try to move as symmetrically as possible and keep the knees slightly bent – you will automatically bend the long leg a little more than the shorter one. The net effect of this will be to keep your hips and eyeline line roughly level.

In the course of my backpain journey, I've also done a walking/ running analysis, which showed that my hips when walking actually are functionally in balance, which shows the elaborate system of the human body to work around and cope with imbalances/ assymetry in the structure. While standing it makes a lot of sense to me that I am wearing insoles, as the body is not in motion and the hips are not leveled. But what about dancing, movement practices, or the 'simple' act of walking? These are usually practiced barefoot in my community, plus I also just love to walk and move barefoot.

Barefoot is zero problem, and I have been a bare-footer for 20+ years now, as you know. More on this below.

But my practitioners recommended me to wear the insoles as often and long as possible, and in particular when I am working out or practicing my movement disciplines. And I do realize, that my back tensions are less when I am wearing them, also during practice, which I just start(ed) to explore. Here are some more questions:

III) What kind of shoes or insoles do I use in minimal/ barefoot shoes?

None. You probably will already have realised this, but when you go barefoot and or minimalist shoes, you have to move differently to when you're wearing ordinary shoes – in other words your body will make all sorts of adaptations to minimise the impact on the soles of the feet and on the rest of the body. What this will mean is that your legs become shock absorbing mechanisms, and you will never land on your heels. 

So, if you do do any Olympic lifting or powerlifting or any heavy vertical loadbearing activities, that is the time to wear your seven or 8 mm heel inserts. The body seems to be able to compensate for a difference in the height of the heels in relation to the ball of the foot in a leg length difference situation. In other words we are sharing the asymmetry over the ankle joints, the knee joints, and hip joints, and the rest of the body.

The question of elevating the whole shoe and literally buing a customized shoe where the right shoe sole is 8-10mm thicker than the left?

Not necessary, in my personal experience.

Or having an insole where there is a 8-10mm heel elevation? Does it make a difference to the static? I'm thinking about the heel elevation that this is literally what the barefoot community is trying to avoid, because it is causing stress in the knees and consequently the hips.

A lesser problem, and once you learn to move barefoot properly (when you run, for example, make no noise—as soon as you try this, you will see that you have to make a new movement pattern, and that will be one where the LLD is simple not significant, because the knees will be differently bent). It is critical to learn how to feel how to use the body symmetrically. Once you turn your attention to this, the understanding will manifest. This was my experience.

IV) What about walking barefoot? I read that @Kit_L for example has 20mm LLD, and I wondered what your journey looked like and what insights you gained for your body? Do you still practice/ do sports/ walk barefoot? Or do you use insoles pretty much most of your time? Or only when standing, when the body is not in motion?

I only used the inserts in my Olympic lifting boots, and work boots. I never use inserts now, and I am barefoot pretty much everywhere (but I carry a pair of flip-flops with me everywhere, and when I walk into a shop, for example, I simply put them on as a gesture of politeness!).

I am pretty active and movement means really a lot to me and my personal health - physically and psychologically. I am just getting back to the Lying Meditation Scripts on a daily basis, starting to focus on the S.T. stretches (Hip Flexor, Hamstrings, Piriformis), and picking up my leg practice from physiotherapy to strengthen my left leg. In all that, I am still quite confused how to adress my LLD. I hope that through that post, I get some stimulating answers and questions to keep tinkering around.

Today's response should get you started! Trust in the body; when you give it the right stimulation, which all your sports do, then it will fix itself. Lastly, identify any of symmetries that you find in your system, whether strength or flexibility deficit, and work on those. The rest will take care of itself.

[Johannes Schlögl]

Hii Kit,

thanks a lot for the quick and very helpful response. I am in the middle of moving to a new country, so it took me quite some time now to settle in and reply to your very detailed response.

On 9/27/2024 at 8:55 AM, Kit_L said:

tight quads and hip flexors—you need all the HF stretches from our YT channel, and once-a-week sessions on the partner HF stretch

yes, that's true. I really need to be consistent on all of these now as I have slowly arrived in my new appartement. Plus the daily relaxation scripts - thanks for providing these!

 

On 9/27/2024 at 8:55 AM, Kit_L said:

[...] the more you can stimulate the associated muscles, the faster the nerves will grow back

do you have some experience with 'blood flow restriction' training? A physiotherapy friend studying sport neurology suggested me to do a light work out on the affected leg. Every day for around 20min. As far as I remember he stated that this has plenty positive effects on the body, and in this specific case could benefit the nerve nutrition. So I am just about starting with that.

 

On 9/27/2024 at 8:55 AM, Kit_L said:

Do you change legs when sitting cross-legged, or do you always arrange them the same way? 

Usually I do change legs. But for example, when I was at this retreat, I was sitting on the floor in a 90/90 position for longer periods at a time. And unfortunately always to the left side.. because that's the side where it's the easiest for me / the right side I can't comfortable sit in a 90/90 position, because my right glutes are too tight. So this is definetely a weakness of mine I have to attend to.

 

On 9/27/2024 at 8:55 AM, Kit_L said:

Definitely not. If you correct the whole of any measured difference, you are just as likely to render the adaptations the body has already made to the leg bone length differences into problems of their own – we know (with much evidence to support this) at the body can cope with modest differences in leg length with no problems whatsoever. I recommend somewhere between less than half and an absolute maximum of half of any measured difference as what should be used as a heel lift. And make sure you chamfer the front edge down so that the lift is just underneath the heel bone and that the front of it does not irritate the bottom of the foot. It is most important to use a lift when you are doing vertical loadbearing exercises, like squats or deadlifts.

Thank you very much. That is very helpful to hear. I guess for squats with additional weights, right? But not necessary with body-weigthed squats.

 

On 9/27/2024 at 8:55 AM, Kit_L said:

III) What kind of shoes or insoles do I use in minimal/ barefoot shoes?

None. You probably will already have realised this, but when you go barefoot and or minimalist shoes, you have to move differently to when you're wearing ordinary shoes – in other words your body will make all sorts of adaptations to minimise the impact on the soles of the feet and on the rest of the body. What this will mean is that your legs become shock absorbing mechanisms, and you will never land on your heels. 

So, if you do do any Olympic lifting or powerlifting or any heavy vertical loadbearing activities, that is the time to wear your seven or 8 mm heel inserts. The body seems to be able to compensate for a difference in the height of the heels in relation to the ball of the foot in a leg length difference situation. In other words we are sharing the asymmetry over the ankle joints, the knee joints, and hip joints, and the rest of the body.

 

On 9/27/2024 at 8:55 AM, Kit_L said:

IV) What about walking barefoot? I read that @Kit_L for example has 20mm LLD, and I wondered what your journey looked like and what insights you gained for your body? Do you still practice/ do sports/ walk barefoot? Or do you use insoles pretty much most of your time? Or only when standing, when the body is not in motion?

I only used the inserts in my Olympic lifting boots, and work boots. I never use inserts now, and I am barefoot pretty much everywhere (but I carry a pair of flip-flops with me everywhere, and when I walk into a shop, for example, I simply put them on as a gesture of politeness!).

both quotes refer to walking barefoot and vertical loadbearing activities.

Walking barefoot I totally see your point and understand that "[i]t is critical to learn how to feel how to use the body symmetrically. Once you turn your attention to this, the understanding will manifest."

I haven't been using my heel lift for most part of my activities and sports and literally haven't experienced any difference in sensation. I only used them for the powerlifting in crossfit. So for the specific exercises I just quickly put the heel lift into my shoes and then started the drill which worked so good so far. 

I was wondering though, when I am working at my standing desk for an hour or longer, would you recommend wearing the heel lift? Or when I know I will be out at any kind of event, where I will stand somewhere for quite a while? Meaning probably light vertical loadbearing / standing versus the body in motion / walking. You wrote: "So in all your movement training, try to move as symmetrically as possible and keep the knees slightly bent – you will automatically bend the long leg a little more than the shorter one. The net effect of this will be to keep your hips and eyeline line roughly level." Does this also refer to (longer periods of) standing? I think of Qigong or Taiji, where it is also recommended to stand with slightly bent knees. I can't help myself because I am curious about the 'when' and 'how long' you wore insoles. You mentioned the "Olympic lifting boots, and work boots." What kind of work did you do that you decided to wear them in your work boots? And why did you decide to stop wearing the heel lift after all? Do you still engage in powerlifting and even there don't use the heel lift any longer? Did you use the heel lift in your standing meditations or other long periods of standing situations?

Looking forward to hearing from you!

[Kit_L]

6 hours ago, Johannes Schlögl said:

would you recommend wearing the heel lift? Or when I know I will be out at any kind of event, where I will stand somewhere for quite a while? Meaning probably light vertical loadbearing / standing versus the body in motion / walking.

Yes, but even this will not be necessary, in time, as you learn to feel what your body is doing more, and as you reduce any strength/flexibility asymmetries. Definitely not necessary for standing meditation or Taiji, because as you've noted, knees are bent; and in time when you can feel more, one bent slightly more than the other.

6 hours ago, Johannes Schlögl said:

What kind of work did you do that you decided to wear them in your work boots?

Working on engines, standing on concrete floors, and where my attention was on the fine work I was doing. I stopped using the heel lift for anything once I had changed over to being barefoot all the time. The transition from Vibram Five Fingers to bare feet took about five years to be complete.

I only do bodyweight exercising now, including for legs and hips.

Re. a question above about "blood flow restriction" training—don't overthink this. Going for a walk as all you need to do. The body is extremely intelligent if it's given the stimulation that it needs.

[Johannes Schlögl]

Maybe two more questions on that topic.

Walking barefoot or in barefoot shoes on hard surfaces. There is a whole discurse on the negative effects of walking barefoot on concrete, asphalt, and so on. What is your opinion on that? At the moment and in the near future this will be the surface I will most often walk on, as I live in a city for now.

Vertical Loadbearing. In the movementclass we had a 6 week cycle of partnering where we explored some Judo, including different partner lifts. My assumption is, that these kind of lifts are vertical loadbearing. And at the same time, I didn't experience any negative body experiences during or after those classes. So I guess, because the movement is done with full attention on the vertical (?) loadbearing, it is fine to include these kind of partner lifting exercises into my practice? Or probably, you can't even call this pure vertical loadbearing, as the body is in movement - and probably more similar to contact improvisation, but with more weight, as the partner is resisting instead of cooperating to get off the ground.

[Kit_L]

8 hours ago, Johannes Schlögl said:

There is a whole discurse on the negative effects of walking barefoot on concrete, asphalt, and so on.

Where is this discourse; if you have any good sources, please link.

I walk on concrete and asphalt every day. But, and this is a big but, I do not heel strike, and I am silent. This is one of the best ways to re-learn how to walk, or run: make no sound. The first time you try jogging silently, you'll find your knees are slightly bent all the time (have you seen how Groucho Marx walks?).

https://media1.tenor.com/m/nZmK2TfTwXQAAAAd/groucho-treat.gif (might have to copy this into another window to see)

The quads are doing all the work (his movement of course is exaggerated; yours will be a fraction of this, and each leg will be bent slightly but unnoticeably differently). There will be no strain on the rest of the body as a result.

If you're worried about your feet getting dirty, wear Vibram Five Fingers, or thin zero-drop shoes with toe socks.

Re. the kind of vertical load bearing you are doing in the movement class: no problem at all, both for the reason you adduce, and because your whole body is involved, and you're paying attention to distribute the load and (another big and) it's dynamic.

[Johannes Schlögl]

Hii Kit,

I was paraphrasing an osteopath friend of mine, who brought that to my mind. But she actually didn't find reliable resources, except of some research showing an increase of injuries when turning to barefoot walking; all leading back to the reason that you mention here:

On 11/13/2024 at 9:27 PM, Kit_L said:

But, and this is a big but, I do not heel strike, and I am silent. T

These two videos helped me to see your point between heel-strike and forefoot/mid foot strike.

https://youtu.be/6hHifp9kpW4

https://www.youtube.com/watch?v=7jrnj-7YKZE

 

[Kit_L]

Those are good YT videos, and you will have seen my comment on the first one. And the 'Barefoot Professor' runs softly and beautifully. The slo-mo footage of how he lands makes the key points perfectly, and his knees are never straight. And as I mentioned in my comment there, on my toe shoes (Vibram Five Fingers), the little toe pocket wears out first, and now I know why.

[Matt Chung]

Thanks for sharing those YT links. From the second video, I learned about the negative impacts of the heel strike while running (which I've seen mentioned around here on the forums). In addition, also mentioned (cannot find the post) is the quadricep flexibility required for optimal running and in the second video, such a night and day difference between the two runners. So envious of their ability (on the right)