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About 10% Of Our Patients Have A Leg Length Discrepancy That’s Causing Their Back Pain And Don’t Know It. Could You Be One Of Them?

Research shows us that those with unequal leg lengths usually begin to notice low back pain in their mid-twenties to early thirties, but it may show up much later. It’s often especially bothersome during prolonged standing, walking or running. Often the symptoms can make their ugly appearance in a job or sport that demands more time on their feet. In the years that follow, the uneven wear that occurs to their joints can lead to disc herniation, degeneration, arthritis and spinal stenosis. Think of a tire that isn’t balanced. The wear is accelerated. The same is true for our structure.

How Can I Check To See If My Legs Are Uneven?

Here’s a couple of questions you should ask yourself:
1. Do I believe or has anyone ever told me that I have a scoliosis?
2. Do I have to hem one pant leg at a different length than the other?
3. Look at the bottom of a worn pair of shoes. Do they wear unevenly (in a different spot or to a different degree)?
4. When I stand barefoot and bend forward, does one side of my spine appear more raised than the other (see figure1)?
5. Do the folds on my buttocks not line up (see figure2)?

Could The Length Of Your Legs Be Causing Your Pain?                                    Could The Length Of Your Legs Be Causing Your Pain?

Don’t Most People Have One Leg That’s Longer Than The Other?

Many people have a “functional” leg length discrepancy which is due to the twisting and turning of the pelvis or legs and is quite common; but it’s not due to uneven leg lengths. To determine if it’s truly anatomical (and not just functional) and needs to be corrected with a heel lift, a standing x-ray must be taken.

Wouldn’t My Doctor Have Already Noticed The Problem?

No. Less than 10% of our patients with a leg length discrepancy have been inaccurately diagnosed by their doctors, even though their back problems continued to worsen. The problem starts with the standard, accepted way of measuring leg lengths used by most doctors today. Many medical text books incorrectly instruct the student doctors to measure from the inside of the ankle to the prominence at the top of the pelvis. As you can imagine (even without medical training), this measurement crosses the hip and knee joints and are affected by the twists and turns of abnormal posture and alignment. Also, these reference points are so broad that precise measurements are impossible. To make up for this lack of specificity, the doctors are advised to be concerned only if the difference is greater than a ½”. That’s 12 mm.. Well over 9 mm is shown to cause early arthritis!

Obviously, a standing x-ray measuring where the legs meet the pelvis, is the only, currently used, practical method of evaluation we have today.

If The Standard Method of Measuring Leg Lengths is Wrong, Why Is It Still Used?

Unfortunately, the traditional medical field has never emphasized structural alignment for their treatment of back pain. All doctors notice the spinal damage that may be caused by structural malalignment, such as bulging discs, arthritis, spurring and spinal stenosis. But, the postural causes of the excessive wear and tear are rarely, thoroughly investigated. Instead we hear throw away lines such as, “You’re not getting any younger,”, “You could lose some weight,” “You’ve exercised too much,” or “You’ve exercised too little.” It’s not these points aren’t valid; but, all to often they’re just an excuse for the doctor not digging deeper.

Another reason medical/orthopedic doctors “under emphasize” leg length discrepancies and alignment, may be due to their on going battle with the fields of Chiropractic and Osteopathy, who’ve championed this ideology. Eventually, traditional medicine had to recognize extreme cases of leg length inequality, such as when patients damaged a growth center or had surgeries that obviously altered leg lengths that couldn’t be ignored. So, a crude method of evaluation was used and it is still taught to this day.

What is The Only Way To Accurately Check For Leg Length Inequality?

The only correct method requires taking a standing x-ray and measuring the heights of the legs where they join the pelvis (in the hip joints). The test is inexpensive (usually less than $100) and can be measured accurately to the millimeter. But, it is essential the patient is positioned carefully including standing only and being barefoot.

Who Needs To Be Screened?

Absolutely everyone needs to be screened after the age of 13 and again when we’re fully grown (about 20 years old). Always get screened following lower extremity fractures, diseases or surgery.

Although everyone should be screened, very few need to be x-rayed. The screening takes five minutes. We look at the top of your pelvis, the height of your hips and the twists and turns in your spine. If there is a potential for a leg length problem, we’ll suggest a specific, leg length x-ray. These couple of minutes can save you years of pain and disability.

But, as I’ve said, everyone should be screened. It’s ridiculous to have your spine and hips wear excessively and prematurely when a simple lift in your shoe (that no one can see) would absolutely stop the degeneration, stenosis and arthritis! Everyone who’s had a hip or knee replacement needs to be evaluated! Often after a hip or knee replacement, your leg lengths are left uneven. When asked, your surgeon may tell you your leg lengths are fine, but in my experience that’s often not true. Often the back or leg pain starts 6 months to a years after the surgery.

Make sure to set up a brief appointment with us to find out for sure. Yes, we are twisting your arm, but it makes the difference between chronic pain and health.

If you think you may have a leg length discrepancy, you need to come in. All other treatments are meaningless if this problem is misdiagnosed.

Article written by Rick H. Morris, D.C.

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