Case Notes 1 - Retired Engineer, Left Lower Limb Mechanism
This is a summary of the first dramatically successful treatment of Short Right Leg Syndrome in my clinical practice dating back to 2018. A healthy active client in his early 70's had successively suffered left leg issues over a 20 year period. Initially left sided Piriformis Syndrome and Sciatic pain which resolved to only begin experiencing Plantar Fasciitis. Much therapy received for both conditions kept them at bay but I am guessing a subtle and sometimes not so subtle tightness down the backline of the limb persisted. Then in the space of two years a 3rd degree tear of the left Hamstring occurred when slipping on wet ground and on recovery from that full rupture of the left Achilles hitching the trailer to the car.
Seeking massage treatment after recovery from surgery, I had to tell him we would not be able to clear tightness from his left leg. Any treatment outcome would be limited and temporary. He had then and still does today have a significant leg length discrepancy. The right leg is structurally shorter than the left. Examined from the front in the standing position, the pelvis had a right leaning tilt. Lying supine on the table, knees bent and feet together, the left knee undoubtedly sticks up. The bones are longer in the left leg. Short of surgical intervention, this cannot be adjusted or corrected by manipulation. While maintaining high flexibility through the pelvis, good muscle tone and good posture is preventative, once acute symptoms have developed and injury has occurred it is almost like we always have to resort to use of an adjusting prosthetic heel lift under the short leg.
What I now describe as the Three Cardinal Signs of Short Right Leg Syndrome were present. The left hip in high range anterior rotation in the Sagittal plane. In supine, tractioning legs from the ankle, the right hip was rigid and wooden whereas the left hip soft and giving. Mild scoliosis present in the spine with right convexity through the thoracic. The structural leg length discrepancy may be small but what it does to the body is amplified and easily seen.
The First Cardinal Sign's hip rotation binds the Sacro-Iliac Joint blocking energetic flow down the backline of the lower limb. I describe this as the Left Lower Limb Mechanism. There is a Left and Right Lower Limb Mechanism. The symptomatically similar on the backline of the lower limbs but the mechanism at the hip differs under the influence of a structurally short right leg.
Chronic binding of the SIJ was cause for the litany of left leg issues experienced over 20 years. When energetic flow is blocked, a thickening and tightening occurs through the connective tissue. Depending on loading and the nature of activity, this can waft and wane from barely discernible to an acute condition with high degrees of thickening and tightening causing chronic pain and/or injury. The rigidity this imparts reduces tissue flexibility and it become prone to rupture and tear. The thickening and tightening is often mistaken for inflammation but, unlike inflammation, on clearing the energetic block the thickening and tightening rapidly resolves and pain abates in a matter of minutes.
Despite having been examined and treated by a large number of medico's and therapists, he did not know he had a leg length discrepancy. None had considered this minor postural anomaly at the hip had anything to do with his condition. This is typical. Even in cases of lumbar injury where it is a major contributory factor, leg length discrepancy is not a part of medical examination in this country. However, leg length discrepancy is readily demonstrated to the client and seen with their own eyes. They can feel the compensating patterns through their body as the therapist palpates.
Being a retired engineer he got it and inserted a 5mm heel lift under the right foot as recommended. This is only a fraction of the actual leg length discrepancy. While I can say he was a higher range case (appx 15mm), a definitive leg length was never determined. It is not necessary. There is no formula based on the size of the leg length discrepancy for determining the amount of adjustment to apply.
The idea in treatment is to incrementally back off tightness through the joints of the pelvis so that energetic flow resumes. There is no expectation of being able to fully realign the body into perfect symmetry. After seven decades on the planet, this man's structure is permanently altered.
It is a trial and error process to find the amount of adjustment the body is willing to accept. This is typically between 3mm and 5mm.
Following insertion of the heel lift in his shoe, muscle tone in the left leg returned to normal over a six month period as the left hip gradually unwound and position began to normalise. I found this occurred when the left hip rotation returned halfway from its position at full rotation to level. This allowed sufficient loosening through the ligamental structure of the SIJ to improve energetic flow to the leg.
This process could have been accelerated by carrying out rehab exercises but the subject was not interested in doing so. His only exercise was a daily walk and maintaining the block on his two acre country retreat. This was probably a good thing because after being twisted and strained for all his adult life, the SIJ can possibly become unstable and prone to injury if change is too rapid. It takes time for stretched ligaments to shorten once again when strain is taken off the structure as joint position is normalised. Conversely, the longer term effect of the First Cardinal Sign's chronic strain on the SIJ can result in damage and injury to the joint.
With continued use of the heel lift in the right shoe, gait, balance and vitality improved over a two year period. The overall effect has been wider ranging than the left leg issue being treated. The left hip eventually achieved a normal, level position. Where he had previously stopped climbing ladders at age 60 due to poor balance, he now walks about on the cambered tiled roof of his house with leaf blower in hand cleaning the gutters.