Leg Length Discrepancy and Short Right Leg Syndrome
in the context of Remedial Therapy
Mechanism for Right Lower Limb Symptoms
Effects on the back line of the lower limbs from Short Right Leg Syndrome (SRLS) are poorly understood by the therapeutic community. Left leg cases due to the effect on the SIJ by the postural anomaly of anterior hip rotation. Right sided cases due to Lumbro-Sacral dysfunction caused by mild disk bulging through lumbar region and the Pendulum Effect on gait causing rigidity at right hip and adductors. Right sided cases are less common by a factor of ten. I consider them to be more serious as these symptoms indicate the integrity of the spine is being compromised. Right side cases may never amount to anything more than low level symptoms but under sustained pressure, loading or an event may escalate and ultimately result in catastrophic disk bulge.
Underlying the Right Lower Limb Mechanism is the Second Cardinal Sign of Short Right Leg Syndrome of rigidity at the right hip. In largely asymptomatic cases of SRLS, rigidity will still be evident on tractioning the leg from the ankle. Where the condition escalates and the Right Sided Mechanism becomes prominent, pain and dysfunction through the right Lumbro-Sacral region and back line of the right lower limb can occur. In exception cases that do not demonstrate the First Cardinal Sign of SRLS, a higher degree of Pelvic tilt across the Frontal plane will be evident and effects from the Right Lower Limb Mechanism are more likely.
Reviewing the Second Cardinal Sign...rigidity through the right hip from the QL's in the lower lumbar region through to the Ilio-Femoral Joint and Adductors readily felt by practitioner and client tractioning from the ankle in supine...right side wooden and unmoving, left side soft and giving. This rigidity is due to altered gait and the effect of pelvic tilt on the lumbar spine.
With each step taken the left foot confidently finds the ground whereas due to the Pendulum effect from the shorter right leg, there is a momentary hesitation before the right foot plants generating holding patterns through hip and adductors. Soft tissue about the right hip becomes subtly rigid and the right Adductor Magnus will be in some degree of spasm.
The other aspect of the story at the right hip is Pelvic tilt in the Frontal plane. A dropped right hip and elevated left hip geometrically distorts lumbar disk spacing (scoliosis, right convexity) creating a slight wedge shape encouraging disks to bulge slightly to the right. Rarely catastrophic but tenderness and tightness in the right QL's is part of the symptomatic pattern of SRLS.
As the Right Sided Mechanism becomes prominent, tightness and tenderness becomes evident in the right QL’s through the lumbar spine, the right glutes and back line of the lower limb begin to thicken and tighten. Even though right hip alignment in the Sagittal plane is normal, the right SIJ can be tender when palpated. The right glutes will be in spasm. Acute cases experience high degrees of pain through the right Lumbro-Sacral region and down the back line of the lower limb. Direct treatment provides limited temporary relief from these symptoms until an adjusting wedge is inserted beneath the heel of the short right leg.
The nature of the symptoms is two fold. Lumbro-Sacral dysfunction/injury directly affecting the region generating pain. Secondary to that, the proximal blockage at Lumbar Spine and SIJ to energetic flow distally down the backline of the lower limb causes thickening and tightening through the connective that can escalate to acute pain.
Pelvic tilt encourages spinal injury. Should an injury occur, this tilt continues to strain and aggravate the injury...nagging it...inhibiting recovery or facilitating re-injury. In the face of this...particularly if accompanied by other related symptoms from the mild scoliosis...adopting the use of an adjusting heel lift should be considered for at least the short term until resolved. One may choose to continue use of the heel lift indefinitely if discomfort and symptoms about the upper back and neck from mild scoliosis are similarly resolved.
A variation occurs even in the absence of Lumbro-Sacral injury whereby the postural asymmetry and resulting gait issues causes soft tissue tightness/spasm about the Iliac Crest and QL’s strangling the Bladder Meridian. Advanced cases experience pain along the Bladder Meridian in the hamstring, at the Biceps Femoris insertion to the back of the knee, the calf and lateral aspect of the heel accompanied by an inflammation like thickening and tightening of the connective tissue of the right lower limb. This has an effect on metabolic health and may be evident to TCM practitioners as a Kidney deficiency. As heel lift treatment is an incremental adjustment only and does not completely realign structure, gait will still be affected and supplementary ongoing soft tissue release work at the right hip will be necessary for these advanced cases to fully resolve. As a Remedial Therapist, diagnosis and treatment of internal health conditions is outside my scope of practice.
From early in my career I frequently observed tightness and tenderness in the right QL's accompanied by tightness in the left glutes. It is a common pattern. Eventually I worked out the cause for thickening and tightening down the backline of the left lower limb...being anterior rotation of the hip about the SIJ >>> joint tightness blocking energy flow down the limb...eg, with one exception, every left sided case of Plantar Fasciitis I have sighted is accompanied by anterior hip rotation and a common unforced football injury is a torn left hamstring and every second pro-tennis player has Rock Tape down the back of their left hami. The right QL condition remained a mystery until after a spate of cases brought it front and centre in my attention. Several had medical scans revealing right sided disk bulging. What all these cases had in common was a leg length discrepancy...the right leg shorter than the left. It then struck me the postural anomaly of a dropped right hip causing a right leaning scoliosis will open the lumber vertebrae on the right and the elevated left hip will close the lumbar vertebrae on the left. This accordion like action creates a wedge shape where the vertebral surfaces should be parallel and forces the disk out to the right. I am inclined to think this is a common cause for right sided lumbar disk bulges.
First published 5 Sept 20 https://www.facebook.com/MassageWorksDandenongRanges