Leg Length Difference, LLD, Leg Length Difference, short leg

[KennyAndrade]

Hello Kit, I loved your post on pronation exercises.

I have a question in regards to leg length discrepency. I am starting rehab after intense treatment of lyme and sedentary time doing so. My therapist would like me to get an X-ray in regards to my right leg being shorter than the other (structural). My body does lean or sink to the right side including my hip, shoulder and more pronation on this side. I did have a broken collar bone and leg on that side however I am conflicted with this method of using levellers in shoes and believe my body can be strengthened now that the disease, that went untreated for 30 years, is now healed. Your thoughts?

Could maybe it be used temporarily until strength is built back up or is that counter intuitive?

I am also conflicted with the use of orthotics which they also recommended. I feel without them it requires me to be more conscious. Is there a middle ground that you see?

Thanks

[Frederik]

For assessing leg length difference check this out:

 

No amount of anti pronation exercising will lengthen your femur or tibia, but it might just help with the symptoms of such a difference. A great many people have differences without suffering from them ( I have about 1cm). That said if the difference is larger than say 1½ to 2 cm it might be a good idea to consider orthodics especially if you do any weighted barbell work say heavy squats - the "orthodic" in this case would simply be a piece of wood. This advice is not to be confused with an endorsement of arch/ foot support, only as a way to load your spine symmetrically. Foot strengthening will still be a very good idea, whether you end up with orthodics or not.

 

To be frank this is another case where it is impossible to give definite answers (treatment) over the internet. If this something that has given you a lot of problems, and it does sound like you have been struggling with it for a long time, I feel it would be prudent to find a good therapist / doctor / chiro / osteopath. Preferably some one who is open mindded and not crazy about orthodics either, this might mean that you have to look around.

 

Best of luck.

[Admin]

I have moved Kenny's post here from the anti-Pronation thread.

[Kit_L]

Kenny, 

As you have seen in the video above, I have a massive LLD which, since I started using Five Fingers, is rarely any kind of problem. You suggestion of using a heel lift (not orthotics; will explain) as part of the process of adapting to this structural asymmetry is useful and practical, I feel, and that's part of the multi-part process I used (long ago now).

No to orthotics, unless you have one or both strongly pronating ankles that you feel are structural (this will be visible when looking at the foot from above; the talus and/or navicular are medially displaced; in pronating ankles, the arch simply flattens onto the floor). The recommendation to correct pronation is given to protect the knees from asymmetrical wear (most knee replacements are done for medial wear), but, and this is a big but, IF you have only one pronating ankle, and this is on the longer leg (as this is in the case of the majority of people who have one pronating ankle) then correcting this worsens the LLD.

Now, bigger picture. If you do have an LLD, then for sure you will have an asymmetric flexibility and strength pattern in your body. For low back pain, reducing the asymmetry of L–R differences in lateral flexion of the spine, axial rotation of the spine, hamstrings, and most importantly, hip flexors, is fundamental.

Wearing Five Fingers, or doing any vertical load bearing exercise in bare feet will strongly encourage the body to distribute the force of gravity evenly throughout the body, and you will find that you bend the knee of the longer leg slightly more to achieve this. You will not heel strike, because that will hurt you!

Kenny wrote:

Quote

I feel without them it requires me to be more conscious.

This is accurate in my experience, and this is what MH has reported in excellent detail on the pronation thread. 

Final comment for today. Getting the whole body more flexible is a wonderful adjunct to other treatments for Lyme's disease; we have had a number of past workshop attendees report exactly this (that starting to become more flexible had a positive effect on the course of the disease).

[Julian]

Hi Kit,

I listened to your Podcast with Yusef, where you mentioned that you have a LLD of 16mm. That was so interesting for me to hear, because I have a LLD of about 15mm (due to a broken leg as a two year old) and I have rarely heard somebody talking about that topic. 

To reduce my LLD my doctor suggested me to wear heel lifts in my regular shoes and my volleyball shoes as well. The heel lifts are just about 7mm thick, because fitting thicker ones into regular shoes is hardly possible.

So, I wanted to ask you, what did you do after finding out that you have a LLD? Did you use a special approach to address it or just continued your work? And how did using five fingers help you?

[Kit_L]

IF you have pain and discomfort, using a heel (only) lift will help to reduce the asymmetrical stresses, particularly around the sacrum. Re. lifts in general: the recommended amount can be divided between both shoes (reduce one; lift the other). If you do not have problems (knee, hip, lower back), then addressing strength and flexibility asymmetries is a way of its own to progress (independent of correction). Addressing both seems to work better than addressing one of the other.

I will comment further tomorrow.

[Julian]

Thanks for your answer!

My story in short: I never had lower back pain. But since one volleyball game about 2.5 years ago I first felt a pain in my lower back. Since then it was an up and down, sometimes I felt it, sometimes it was nearly gone. In review I felt it especially when playing volleyball (due to the arching movement). I went to different doctors and physiotherapists, but they all just worked on the effect (and at this time I didn't inform myself as I am doing now).

Regarding my knees I would say that I had a lot of problems. Especially a sharp pain inside the knee. But since I started to work on my mobility in August/September last year, my knee pain reduced a lot. I am sure I can get rid of it completely.

Another problem is that I don`t remember since when I am using the heel lift. It´s been 4-4.5 years now since a friend detected the issue. It´s a bit overwhelming that there are so many factors (and even more I never thought about) which could influence the pain.

 

Well, at the moment I am working a lot on my mobility and I have a lot to catch up. It´s amazing how many things you learn during the process. I informed myself a lot about posture and I recognized that my pelvic is too much in the anterior position.

Especially my hip mobility is very bad (no surprise). When sitting in the starting position for 'swivel hips' I feel a sharp compression pain in my hip flexors. Does anyone have any experience with this?

As well I am working specifically on my right quadratus lumborum with a lacrosse ball (this is where my back hurts).

The fact that I strained my middle back two months ago during a game is not really helpful in this process. I know that there is not THAT approach to address a strained muscle. But due to your experience Kit, do you have some general advice to deal with this problem?

 

I will see a new orthopedist on Wednesday next week. I am going to ask him to measure my femoral and tibia. Maybe the anatomical difference is not that huge as expected, so I could work in other ways towards a reduction.

Sorry for the digression to all the other topics, but now I recognize how the whole picture is so important.

[Kit_L]

23 hours ago, Julz said:

I am going to ask him to measure my femoral and tibia.

Julz: whole forests have been harvested to publish peer-reviewed articles looking at this problem (how to assess symmetry via whole body x-ray, I mean). The standing test I linked to above, in addition to considering femur and tibia discrepancies, also considers small hemi-pelvis and the adaptations any/all of these may have caused. Measuring femur and tibia—even if accurate (and the expected measurement error is plus or minus 5mm) will not take the whole body into consideration. Please do the standing test; ask a friend to help, and report back.

 

 

[Julian]

On 25.3.2017 at 8:54 AM, Kit_L said:

Please do the standing test

Here is a video of mine doing the standing test.

 

[Kit_L]

And you concluded that you had a shorter R leg? Certainly looks like it. Try a heel-only lift of 5–6mm, and please report back. 

[Konrad Maggenti]

Hi Kit

 

I am so glad to have been reacquainted with your stretching workshop (27&28^th May). It was an honour and joy to speak with you and for you to share some of your wisdom throughout. As with the first workshop I attended 20yrs ago, I am looking forward to improved mobility, quality of life and independence. Thankyou again.

 

It was also informative in that I have been given more tools to help overcome this back and neck pain and spasming that has plagued me for 26yrs.  I am more aware of how important relaxing and making body go soft aid with improving flexibility (something I have found hard over the years). I am working on the nerve impingement still in my left arm. 

 

Ways I am already feeling a different (one day on)  –

·         Crossing my legs freely the other way (Sunday) when sitting.

·         Left upper arm and elbow feel lighter (Sunday).  This is where the constant nerve impingement occurs.

·         Noticed a slight improvement in left hamstring flexibility.

Ways I am feeling different (5 weeks on) –

·         Left anterior shoulder has opened (relaxed) up more. Nerve impingement in upper left arm and elbow feel same as day one.

 

I still have many questions:

 

1.       Leg length difference?

When I mentioned about the pains and extreme tightness in my left side (hamstring, quadratus lumborum, neck, nerve impingement in arm) on Saturday you suggested and tested me for leg length difference and found my RIGHT LEG to be approx. 2cm shorter (podiatrist at wksp mentioned this).  I took on your advice and removed the sole from left side and added a sole on the right side.  What I noticed that day –

·         Went for a 15min walk first thing in morning (Sun) and was getting intense sensations on the lateral and medial sides of the right knee.

·         Went for a 15min at lunch break today and these sensations had subsided considerably.

·         Went for a 10min after workshop finished. Very minimal sensations.

·         Went for a 15min walk 1hr after workshop finished. Very minimal sensations.

Still have an added sole on in R.H. shoe. 5 weeks on –

·         Very few sensations in right knee

·         Lingering right adductor soreness

 

I am left arm dominant, which reading your book, tends to exacerbate these problems. Also my four pairs of shoes are all worn out on the right sole.

If your above suggestion solves this back, neck, leg and arm problem I will be forever indebted. 

 

2.       How do I follow up more about this leg length difference?  Who do you recommend in Melbourne to check this please?

 

Since wksp I have been doing the specific piriformis, hamstring, calf, quadriceps, back extension, middle back rotation, quadratus lumborum, new hip flexor stretch, biceps brachii, lower back and latissimus dorsi stretches you demonstrated each week.  These are added to all of the stretches in your book below of which I have been doing religiously for 20yrs.

 

3.       These are the exercises (overcome neck and back pain book, 2^nd edn, 1996) I wanted you to check if I was doing correctly?

 

1.       Quadratus lumborum –  lateral flexion using a chair (ex no. 2)

2.       Quadratus lumborum – legs apart: lateral flexion with straight legs (ex no. 17)

3.       Quadratus lumborum – Standing lateral flexion ; roll out (ex no. 30)

4.       Iliopsoas (modified salute to the sun) – (ex no. 7)

5.       Levator scapulae  - Middle upper back (rabbit) pose (ex no.8)

6.       Levator scapulae – neck stretch - chin on chest variations; chair (two movements) (ex no.15)

 

You covered 1, 2, 4 and 6 (or improved variations of) in the workshop (27&28^th May).   If I can break down this unrelaxed and tight quadratus lumborum I might well on my way to improved quality of life.  As with point 5 (levator scapulae) I feel this may help with reducing the nerve impingement I experience?

 

4.       Again who is the person you would recommend in Melbourne who can check these exercises?

 

5.       Resources. Which books, DVD’s do you now recommend as I only have the 2^nd edn of overcome neck and back pain? I hope I can order these directly from your website and not amazon.com etc.  ‘You mentioned overcome neck and back pain –update DVD’ to compliment the 2^nd edn book?

·         ‘Have now bought overcome back pain, individuals version’ off vimeo and will do these exercises next stretch.

 

 

I am looking forward to going over all the information on this (for me) new found stretch therapy website.  From what you were saying there many links, forums to help, youtube video that will aid all.

 

By the sounds of it over the years you have touched, helped and fixed a lot of people with your insights and knowledge on how to overcome problems and pains in the body by listening to it.  I have already been touched and helped by you and now I hope to be also on the fixed list.

 

Warm regards

 

Konrad Maggenti