Leg Length Discrepancy and Short Right Leg Syndrome
in the context of Remedial Therapy
Determining Size of Heel Lift Adjustment
There is no formula for determining the size of the Heel Lift Adjustment...it is not a Function of Leg Length Discrepancy...it is more a matter of what adjustment the body will accept.
There is no expectation the body's asymmetry caused by a structural leg length discrepancy will realign into perfect symmetry from the treatment of Short Right Leg Syndrome. Bones and joints have been permanently changed. The pelvis is tilted and mild scoliosis of the spine has distorted the shape of the vertebrae. When placing an adjusting heel lift under the short leg, we are only trying to incrementally back off stress and strain on the soft tissue sufficiently to release tightness and allow the flow of energy/Qi to resume. To go further over compensates, causing pain and injury.
There is no formula to calculate the size of this adjustment. It is not a function of the leg length discrepancy. It is about what adjustment will the body accept. Typically it is between 3mm and 5mm. Two vastly different cases can have the same adjusting heel lift.
I do not measure structural leg length to the accuracy of a tenth of a millimetre or even a millimetre for that matter. It is not necessary to determine the magnitude of the adjustment. Examining for the Signature Traits and Cardinal Signs indicates a discrepancy exists. A comparative assessment of the limbs verifies the bones of one leg are longer than the other. We are able to estimate whether it is low, medium or high range case...5mm, 10mm or 15mm and greater. Considered in conjunction with the symptomatic nature of the condition, guides fitting of the heel lift. Can the subject feel the thinner heel lift pushing their hip up? If so, go with that one before progressing to anything thicker. Yet, it comes down to trial and error to determine how the subject's body responds to adjustment.
Should uncomfortable niggles or low back pain occur, the subject must reduce the thickness of the heel lift or remove it altogether. This will generally be apparent soon after commencing use (hours/days). A negative outcome is uncommon.
Longer term monitoring is necessary. In addition to an adjusting heel lift, rehab exercises may be prescribed. Where the adjusting heel lift is too thin, the body may not respond despite the exercise. I am not really sure if this is the true nature or they are just not really doing their rehab exercises. In any event, a 3mm heel lift may have little effect in some cases. After two to four weeks with no improvement, progressing to a larger 5mm heel lift can see major change occur in one week. Apart from reduced discomfort and pain, and increased mobility, a key indicator is the First Cardinal sign of anterior hip rotation begins to normalise.