Few topics are as controversial as the short leg in orthopedic medicine.
According to the AAOS (American Academy of Orthopedic Surgeons), a leg-length discrepancy of 1/5inch to 3/5inch is normal. The AAOS stipulates that greater differences may need treatment since a significant difference, they state, can affect a patient’s wellbeing and quality of life.
I happen to agree and disagree with the AAOS. I agree that a leg-length discrepancy can affect a patient’s wellbeing and quality of life. I do not agree with the fact that a 1/5inch to 3/5inch discrepancy normal.
Think physiologically for a second. Can it be considered normal to function with an asymmetry in bone length, muscle tension, or range of motion of joints? If one of the body’s objectives is the preservation of energy, how can it be considered normal that these asymmetries can often coexist in the same system?
If we agree that the body instinctively works at spending the least amount of energy for the most significant results, it simply makes no sense to consider that a leg length-discrepancy of any difference is physiological.
The floor we walk on does not adapt to a leg-length discrepancy.
This being said, excessive wear and tear of the joints of the lower body invariably has to occur as vectors from ground reactions forces affect the entire body asymmetrically.
Posturology practitioners have their own spin on the leg-length discrepancy. First off, posturologists make sure they only correct actual leg-length discrepancies.
Globally, 3 steps make up the assessment and treatment of the leg-length discrepancy:
– Step 1: Management of all functional factors
– Step 2: Evaluation of the pelvis in the 3 planes
– Step 3: Assessment of the entire postural system in the context of a corrected leg-length discrepancy
STEP 1: MANAGEMENT OF ALL FUNCTIONAL FACTORS
Two body parts contribute to the body’s upright posture and overall muscle tone. Two other body parts can affect posture and muscle tone by dysregulation of the postural system.
The feet’s position on the ground and eye tracking on the horizon provide the horizontal and vertical coordinates for the brain to develop a strategy to stand upright. This strategy conditions the base tone of the musculature of the entire body.
When the data provided by the feet and the eyes is uneven, the brain develops an asymmetrical contraction of the many muscles responsible for posture and movement. The net result can be the appearance of a leg-length discrepancy, or short leg.
This short leg is, in fact, not a short leg. Posturologists are trained in utilizing innovative yet simple technology to normalize this sensory stream from the feet and the eyes to rule out their involvement in the diagnosis of a short leg.
The skin of the human body and the stomatognathic system (mouth, jaws and closely associated structures) are the two body parts that, when they function normally, do not contribute to muscle tone. They only contribute, negatively, that is, when they present with a dysfunction.
For example, a surgical scar can create an interference field leading to muscle compensation. A surgical scar can also create a fascial dysfunction, affecting the capacity of the muscular system to perform its duties in a just manner.
If, at rest, an individual breathes with his mouth open, typically, his head will be forward. This will affect posture and muscle tone of the entire body. It could easily cloud the assessment and treatment of a supposed short leg.
Posturologists dispose of specific tests and tools to, once more, neutralize these factors in order to truly assess the joints position when focusing on the pelvis and the possibility of uncovering an actual short leg.
STEP 2: EVALUATION OF THE PELVIS IN THE 3 PLANES
Two methods usually make up the evaluation of the supposed short leg:
– Physical examination;
The physical examination is usually performed in the context where functional factors have not been neutralized (influence of the feet, eyes, stomatognathic system and skin). Therefore, that measure cannot be valid as it does not differentiate between a functional and an anatomical short leg, based on our standards as posturologists.
The x rays provide a 2D image whereas a thorough assessment of any joint or complex of joints necessitates a 3D view. Only precisely chosen and meticulously performed biomechanical tests can give the practitioner a complete picture of the situation. It is therefore with tests that give rise to a 3D reality that posturologists assess and treat a short leg.
STEP 3: ASSESSEMENT OF THE ENTIRE POSTURAL SYSTEM IN THE CONTEXT OF A LEG-LENGTH DISCREPANCY
It’s one thing to neutralize all of the potential functional factors contributing to clouding the assessment of a leg-length discrepancy. It’s yet another to parallel the correction of a supposed short leg and relate it to how the entire body, from head to toe, lines up, once that short leg is managed. Yet, that’s exactly what posturologists do.
This is exactly how a posturologist can precisely correct an anatomical short leg. The goal of the posturologist is to create structural balance on all levels, in all 3 planes. As well, the idea is also to normalize two specific neurological tests. It is in that setting that a posturologist can know if the short leg is of 2mm or 4mm… We correct until balance is achieved. We are that precise and it is to the body’s benefit!
So is a short leg a big deal? Absolutely!
Stay tuned next month for Part 2 of this article on the less obvious factors contributing to a functional short leg!