Obstacles to the Assessment and Treatment of Structural Leg Length Discrepancy
There are three obstacles to the assessment and treatment of structural leg length discrepancy. Firstly, medical and therapeutic practitioners do not consider it is a thing and do not examine for it. Secondly, in the rare instance they do, because the majority of conditions that arise from it relate to the inhibition of energetic Qi flow through the pelvis which they do not see or understand, it is largely dismissed. Lastly, I suspect few practitioners have the necessary skill set to competently carry out the assessment and are unable to accurately observe the minor discrepancy camouflaged by pelvic distortion and the overlaying flesh.
The initial hurdle is for the condition to be considered a possibility. Medical examination does not include assessment for minor structural leg length discrepancy. I was examined by three Medical Doctors consulted for lower limb and low back issues. Leg length was not assessed. A plethora of Allied Health practitioners also consulted did not either. My own condition of inexplicable lower limb deterioration over a five year period did not improve until commencing self treatment and inserting an adjusting 5mm heel lift under the short right leg.
The majority of the effects from a leg length discrepancy are the result of energetic blocking caused by strain on soft tissue of the pelvis and lumbro-sacral region. Energetic Qi flow is inhibited in both the fascial meridians and the six organ channels passing to the lower limbs (Stomach, Spleen, Liver, Gall Bladder, Kidney and Bladder Meridians). Abdominal vitality in the Root, Sacral and Plexus Chakras is reduced. Long term acute effects to mobility and internal health result and are not recognised by conventional therapists because energetic Qi flow is not considered in their training and practice. They have not undertaken exercises for developing the ability to sense, cultivate and control Qi. Biomechanical and neurological effects from a minor leg length discrepancy are minimal. So even when it is identified, they are inclined to dismiss it making the assumption we will adjust and manage the condition.
The ability of most practitioners to accurately judge minor postural variations of this nature is questionable. Observing differences across the Pelvis or from Greater Trocanter to Greater Trocanter or Malleolus to Malleolus in supine or standing to the accuracy of a few millimetres by eye is the task. Being able to do so locating boney landmarks and seeing through the bulk of overlying flesh. After the unconscious anatomic adjustment of anterior rotation at left hip, pelvic tilt standing is typically 5mm or LESS at the ASIS. The actual discrepancy is bigger but it is masked. Inexperienced individuals can overlook this small variation.
I might trust the local handyman or carpenter more than the university trained therapist. The skill set necessary for making an accurate assessment of structural leg length is not acquired in therapeutic training. Yes, the therapist can identify boney landmarks and make general postural assessment but they typically have little experience measuring and surveying in construction and assembly. It takes time and practice to develop these skills. Spend months and years lining up roof lines, gutters and downpipes, you become a hot shot billiards player because the eye is dialled in and you will know what is straight, crooked, level and vertical. Knowing basic geometry and having good spatial awareness is necessary for assessing the three dimensional structure supine on table, knees flexed and raised, feet flat, but with hips that are all over the place. Some might be confident about what they think they are seeing but it is very likely they have not developed the necessary perception skills to do so. When other practitioners make off the cuff claims they see few cases of leg length discrepancy amongst their clients, I have doubts about their assessment ability. Particularly where they are not prepared to describe their assessment protocol or enter into discussion.
SRLS is a complex condition. Cases vary widely affecting mobility and internal health. Close study is required. This took me 55 years to come to grips with. Since the age of ten measuring, cutting and constructing both as a hobby and professionally, tertiary scientific study (Multi-Disciplinary Systems Engineering, ANU), martial arts and meditative practices for ten years in the dojo of a Grand Master, training and developing four times in my 60+ years to a level of physical development exceeding my peers, and sixteen years as a Remedial Therapist.