Case Notes 4, Part 1 - Short Right Leg Syndrome, Simon Crittenden, History and Outline of Condition, Treatment Outcome

I knew I had a slightly short right leg prior to a catastrophic low back injury in June 2016...looking at the saddle of my race bike you could see it...carbon fibre reinforced plastic and titanium rails pushed down on the right side. Little did I know what it might do to my lumbro-sacral region. Two months off work, three years of rehab exercises before the symptoms cleared until relapse with minor disk bulge in October 2020 >>> rehab like mad and a course of Thymosine Beta 4 >>> all good but the niggles are still there. What this does not depict is the steady gradual deterioration of leg function since the injury in 2016 and increasingly painful knees that gave me a Frankenstein like gait. 

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The Chiropractor at the inner city clinic at which I work said to me at some time in 2018, "Simon, you are moving so badly...you have to let me help you." I agree and commence Chiropractic treatment. While there was always some minor improvement or relief to spine and neck after these treatments, the status quo of lower limb symptoms never really changed.

Then in March 2020 I was afflicted by high levels of pain and a thickening through the right leg. This was assessed by the acupuncturist at the clinic as an underlying Kidney weakness causing pain in the Bladder meridian...I was feeling it in the hamstring, calf and lateral aspect of the heel. She recommended commencing TCM herbal treatment for the condition. This was undertaken and for the rest of that year weekly acupuncture treatment sessions were carried out and medicinal herbal teas prescribed for the Kidney condition, rheumatism (knees) and fluid circulation (fluid retention in feet and ankles).

I have prescribed them for others and now experiment with a heel lift under the right foot for myself. Every case is different and I have written extensively about my observations of Short Right Leg Syndrome. Within two days of commencing the trial on 28 January 2021, good but unexpected results. Pictured below is a prototype constructed of 1.5mm fibre reinforced rubber sheet. 

History:  Left knee unstable due to multiple injuries... patella fractured age 20yrs, medial meniscus tear age 25yrs, patello-femoral syndrome age 45yrs leaving ROM restricted to something just over 90 degrees, partial dislocations at head of fibula 3x during 50's. Age 60yrs forced to retire from sport due to instability at head of fibula and ongoing deterioration of weight bearing ability. Onset of this instability coincided with the lumbro-sacral injury and defied rehabilitation on resuming training. Left knee would not hold together on the upward pedal stroke riding with strength above 45kph. Walking up hill OK...downhill, impossible to bear weight and forced to walk stiff/straight leg. Standing stationary for any extended time (minutes) caused knee pain at head of fibula and limp that would then need to be walked out. Recent x-ray reveals close to bone on bone spacing at medial meniscus of both knees. Full thickness at lateral meniscus. No sign of arthritis reported. Despite regular Chiropractic, TCM and Thai Massage treatment post the 2016 back injury, leg function continued to deteriorate. I walked like Frankenstein. In the latter stages considered retirement and purchase of a mobility scooter to get to the supermarket. Also relevant, since age of 15, I experienced varying degrees of aches and niggles about the left SIJ which I now know is the result of binding in the joint from the anatomically adjusting anterior rotation of the hip functionally reducing leg length of the longer leg. In my mid 60's this SIJ was becoming unstable and more readily aggravated if I did not actively ensure the hip flexors were not stretched, abs strengthened and glutes activated by daily rehab exercise.

 

Twice in my life I have experienced low back injury. Firstly at age 23. Three months medical and Chiro treatment was ineffective. TCM treatment proved miraculous...one session removing all pain. Two more sessions and no further treatment required. Condition was still "delicate" and two years passed before it felt strong again. Then at age 60 years the second event described above.

 

Fitting:  A 3mm heel lift was completely un-noticeable when inserted. A 5mm heel lift and I could just detect slight elevation or kick up at the right hip. I go with the latter. While I do not have a high degree of anterior rotation at the left hip due to daily rehab exercises for the low back injury and left SIJ instability, there is some which is expected to normalise with the influence of the right heel lift. This change from a position of anterior rotation to level changes functional leg length...making the left leg slightly longer. Hence, the possibility exists to increase the thickness of the right heel lift as the structure changes and adapts over time.

Fitting a heel lift for SRLS is more trial and error than a rigorous science. Heel lift size is not a function of leg length difference. It is more a matter of what amount of adjustment will the body accept to reduce the compensating distortion through the pelvis that is accommodating the leg length difference. The structure and condition of every body is unique. Regardless of leg length difference, the adjustment amount will typically be 3mm to 5mm. Where lower back symptoms of pain and discomfort are being experienced, using a heel lift that is too high will quickly become apparent as soft tissue already sensitised is pushed too far in the other direction. If niggles or sharp pain experienced, stop using it immediately and consider fitting a thinner one instead.

Observations:  Since insertion of a 5mm heel lift in right shoe on 28 Jan 21 for treatment of SRLS, on the very next day pain at the head of the fibula of the left knee which had been felt with every step taken was no longer there. Also, I had the sensation of being able to once again breath energy into my feet. Weight bearing and ability both up and down stairs improved. Pain reaction from standing stationary reduced. The reason for trialling the heel lift was to improve the lumbar spine. Improved knee function of this nature was not expected.

At day seven, I realised I had stopped doing rehab sessions for lumbar symptoms three days prior. 

Also in the therapy mix at that time had been daily use of a Healy frequency assessment and treatment device. Interestingly, running the Chakra assessment in Resonance mode, the lower Root, Sacral and Plexus Chakras always registered poor vitality/energy levels compared to the higher Chakras in the body. After a week of using the right heel lift, these lower Chakras were now consistently registering high levels.

34 days after inserting the heel lift I experience three days blissful release through the Thoracic spine. ROM increased remarkably when turning to look to the rear reversing the car. Increasingly, use of mirrors had been necessary and what had been put down to "age" has become easy to do again. In fact, thinking about it, while driving the ute...rear vision is better now than when I first bought it 20 years ago...looking over the right shoulder when checking the blind spot changing lanes, I am looking into and seeing the right rear corner of the cab. I have never seen that in 20 years of driving this vehicle.

 

Note: Right hand drive, in Australia we drive on the left side of the road...the right rear corner of the cab is behind the driver.

At the six week mark, the left hip was still elevated over the right in the Frontal plane with the 5mm heel lift fitted. I trialled a 6.5mm heel lift seeking a better result thinking bigger could be better. By the end of the day which included several hours yard work and a leisurely stroll with the dog in the forest, I was getting the very niggles about my sacrum that inspired me to use the heel lift in the first place. I reverted to the smaller size immediately.

At the three month mark digestion became turbo charged and energy levels increased. 

At the six month mark, rheumatic like knee pain that had been causing discomfort with every step...particularly walking downhill or with any sudden movement...disappeared. 

At the 10 month mark, the neck which had been painful on the right and would stretch out and on the left was stiff and unyielding, became balanced. A torque like sensation through the skull in the Transverse plane disappeared and release was felt right through to the temples and forehead. As a therapist I self-treat using massage, acupressure, Craniosacral/Fascial Release so it may be I am aware of subtleties in my own condition that might not be generally experienced or known by the public.

 

Interestingly, since suffering back injury in 2016, I have been examined and treated by two GP's, one Osteopath, two Chiropractor, two Remedial Massage Therapists, and two Traditional Chinese Medical practitioners for low back and lower limb issues. Not one assessed me for leg length discrepancy nor thought anterior rotation of the left hip was of any consequence.

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