Leg Length Discrepancy and Short Right Leg Syndrome
in the context of Remedial Therapy
Case Notes 4, Part 4 - Simon Crittenden, Could I Have Done This Better and What Was the Lesson
In June 2016 I suffered a catastrophic lumbro-sacral injury as a result of a short right leg and intensive athletic training. A previously injured knee mysteriously became unstable and thwarted attempts to re-enter sport once the back healed. Leg function gradually deteriorated over the next five years despite consulting nine medico's and therapists. While giving minimal short term relief, treatment did not change the status quo. Twice in the latter stages I considered retirement due to pain and disability. Could I have avoided this situation? Yes, possibly but that did not happen and, as a result, I went through a long, difficult and painful process of discovery attempting to overcome the disability. This has effectively been a first hand tutorial identifying the condition, experiencing the effects and learning to treat Short Right Leg Syndrome. I had already identified the condition in clients, this personal experience gave me greater insight.
I might have avoided breakdown and missed out on this extraordinary educational experience in several ways. Firstly, had I done more cross training the catastrophic outcome may have been avoided. Maintaining flexibility about the waist and pelvis is key to managing SRLS. Work pressure and an increasingly obsessive addiction to high intensity athletic efforts was my undoing.
Secondly, had I gone to the one guy in town...a Physiotherapist in Kensington VIC who did bike fits taking into account leg length discrepancies...it might have averted injury. His procedure included insertion of a 3mm to 5mm chock between the sole of the cycling shoe and pedal under the short leg. It is always the right leg. The vast majority of the therapeutic industry do not consider it and do not assess for it.
Thirdly, once injured and knocked out of sport, had I re-commenced other physical training activities, the deteriorating condition that had me in pain and walking like Frankenstein three years later might have been averted. However, with hindsight, I had withdrawal issues and was not coping well with the situation. Unless I had the wind in my hair and a mad look in the eye hammering at maximum effort with snot and drool coming out of every orifice of the face, I was not interested. I trained 10 to 15 hours weekly riding 50, 70, 90 or 150km distances to perform two high intensity 20 minute efforts each week.
I will never know the truth of how large an impediment the combined forces of SRLS compounded by lumbro-sacral injury and advancing age amounted to and whether I could have avoided it. It was big and I hypothesise about the potential for various exercises to avert the breakdown and deterioration I experienced. It required ten months for the corrective effect of a heel lift to make its way through the spine and, even then, the right sided hip rigidity from the Second Cardinal Sign was still making itself evident and causing acute pain and dysfunction to the right leg. Even now, I continue with occasional Chiropractic adjustments, daily TCM herbal medicine and regular Thai Massage. Huge advances in my condition came about addressing SRLS but it was a long, long downward journey prior to that. I am near being able to spring onto a racing or mountain bike again. This is contingent on recovery and improved flexion of the right knee never previously injured but now kyboshed by that Second Cardinal Sign. It is likely the instability suffered at the head of the fibula in the left knee will prove to be an ongoing limitation preventing high intensity output...I will have to ride like an old man...Sheesh.
The positive lesson to take away from this is I have gone through some of the worst that can occur as a result of SRLS over a five year period and learned first hand what many others are subjected to. My experience is not unique. Similar symptoms are sighted in my clients. I have vast experience in physical training and know my body well. I am observant and now have 16 years experience as a physical therapist. I have experience and knowledge in both Western scientific method and Eastern energetic/Qi philosophy. I am able to sense, cultivate and control Qi. So where the medico's and therapists failed, I eventually recognised the need to treat SRLS and inserted a 5mm heel lift in my right shoe. The smallest of changes to the biomechanics has an enormous effect on energetic flow through the body. I have described elsewhere the dramatic changes and improvements that occurred over the following ten month period. While many aspects of the condition did improve, I was still left with a right sided issue affecting the Bladder meridian causing thickening, tightening, pain and a knee injury through the right leg. This dogged me for nearly two years despite intensive treatment before I realised the right Kidney had been weakened by the Bladder meridian being strangled over a lifetime passing through the right lumbro-sacral region under the influence of the Second Cardinal Sign. There is a sidedness to SRLS. I experimented with releasing tightness in the right lower back and stimulating the right kidney. This looks like fundamental fascial release work, acupressure, energetic focus directing Qi, and self-Reiki. The pain cleared and condition vastly improved in the first 20 minutes of this revised approach. If I did not know better I would say it was a miracle. The less informed would be sceptical. The superstitious would say it is magic.
All in all, this experience has given me insights to the effects of SRLS not previously described. I have identified biomechanical effects, First Order energetic effects and Second Order energetic effects. First Order energetics relate to mobility issues and are the subject of my practice. Second Order energetics relate to metabolic effect on digestive and reproductive organs and are not within my scope of practice. However, I have evidence demonstrating the work I do treating SRLS would appear to have beneficial side effects on metabolic function. I am expecting to find a branch of alternative medicine recognising the effects of pelvic energetic blocks affecting digestive and reproductive function. It may be aware of the problem but not have the detailed anatomic and treatment knowledge I describe.
Importantly, it is a condition that can easily be screened in juveniles and young adults before they experience the catastrophic effects sighted in mature adults. Use of adjusting heel lifts and/or appropriate physical training to manage the condition can be undertaken. Large numbers of people suffer from SRLS and receive endless therapeutic treatment that provides little more than temporary relief. For some the condition deteriorates to an acute level of constant pain, they are no longer able to work and need a mobility scooter to get to the supermarket. I had a taste of that.