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Back Pain & the short right leg syndrome

An exceptionally significant postural issue begging for a logical explanation is the ‘short right leg syndrome’. Although an inferred awareness of right-sided limb length shortness has existed for thousands of years with decades of published research available, no one has yet to produce a universally acceptable answer to these two basic questions:

1. Why the unusual frequency of short right legs seen in clinic?

2. How does this common limb length discrepancy relate to chronic pain and somatic dysfunction?

How do you measure leg length...supine or prone and what's the difference?

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Comment by Jerry Hesch, MHS, PT on September 27, 2009 at 12:26am: A compare and contrast of his model and mine will demonstrate profound differences.
I recognize it in its simplicity and in its complexity, with armament to deal with either.
Yes to Torsions About an Oblique Axis, though pure rotations about a vertical axis are more common, but strange that this pattern is not being taught, or it is trivialized. Even if a side bending fixation is present it is NOT the same axis and is NOT the same as the torsions about an oblique axis.
Re the description of a unilateral flexion (UF), or unilateral extension (UE) per Greenman and others, reveals that these cannot be the same as any one of the 4 torsions about an oblique axis, or the vertical axis rotation, even when coupled with side bending. What he is describing is a non-existent pattern in which it would/could be a torsion about an oblique axis, EXCEPT that side bending fixation occurs on the OPPOSITE side. With deep respect and faithfulness to their profession, in 30 years I have used MORE palpation, MORE "springing with awareness" in all body positions: it is as tangible as outer space aliens. Will; again try to get hands on Bayliss' work, no luck previous.
Erik, I am new to this web site, kis there a way to know when I have a reply, so I know when to post?
Thank you very much. I hope the above information yields a deep sigh in many who accept that they always knew it was a crazy concept, but blamed their own inadequacies. Rote memorization has always failed my belief system. Love Gregory Grieve's quote on Dogma dulls the wits.....in my workboook. Can post it later.
If I did not answer your question we can chat it out with Greenmans book open. Forgive me, i don't fully comprehend your paragraph.
keep up the push the limits thinking and grasping, sometimes the branch fails my grasp
Jerry hesch
702-558-6011 Pacific 10am-8pm any day.

Comment by Erik Dalton on August 18, 2009 at 3:23pm: Hey Jerry:
Have to leave town to teach but will be back in the office on Tuesday. Need to give you a call and catch up on all your new projects. Like the 'Springing with Awareness' title.

I forgot you told me you worked with Tigney, that must have been a rewarding experience. He's been studying and refining that SI joint stuff since 1964...should have it down by now.

Are you still griping about the unilateral flexed sacrum? I slightly remember your argument against Mitchell and Greenman's take on that SI dysfunction. You say it is physically impossible for the sacrum to go anterior and inferior on the ipsilateral ilium and get stuck there (without luxation). Therefore, you also don't believe the ipsilateral L5-S1 joint is fixated in people presenting with this condition?

I know Mitchell's been getting a lot of slack the past few years but, nonetheless, I have seen some good results with muscle enegry techniques....in my own body too. Greenman fixed a bad backward torsion on me in class in the early 90's and it made me a believer. However, I use very few true muscle energy techniques in my practice.
After studying Tigney, you and Bayliss, I began altering my deep tissue/joint stretching approach to SI joint work. Gotta go...the driver's here. Will get back to you when I return. Bayliss's self-published "The Theory of Synergetic Spinal Mechanics and PPT Manipulation" can be purchased on Amazon (I think) but you have to buy the DVDs from him. I think his e-mail address is jrb5870@dcccd.edu Be well...talk soon ~Erik

Comment by Jerry Hesch, MHS, PT on August 17, 2009 at 3:04pm: Hi Erik,
No, not familiar but it looks good. I revised my workbook and screen pelvic side glide before and SIJ screen and do same for hip extension. re pelvic side glide I think Bayliss has important things to say. My early papers 1990 1992 and presentations at World congress on LBP/SIJ and National APTA conference were directed at discounting much of Fred Mitchell Sr's work that has permeated SIJD since. I worked with Dontigny in 1981, my fiorst job, that was where the seminal Hesch ,method started as I started to question things, started doing spring tests now named "SPRINGING WITH AWARENESS". I feel very strongly that the injection methods are flawed in terms of being the gold standard for SIJD, have written on that. So I am glad to hear that others feel similarly.
Please reference the work specifically (Richardson).
I would like to read Bayliss' book and see viodeo, any suggestions re source?
Thank you. Keep up the good work.
Jerry hesch
PS let's gently debate "unilateral flexion/extension". I submit it does not exist when using additional palpatory and springing with awareness. the Osteopaths have only 14 different terms for Rotation about an oblique axis!

Comment by Erik Dalton on August 10, 2009 at 1:05pm: Glad to hear from you again Jerry..hope all is well. Still working with some of your joint springing techniques with much success. Also am getting good results with some of Don Tigney's SI joint stuff.
SI joint research has always been a hotly debated topic with much confusion. Richardson's new studies are questioning long-held beliefs about SI mobility and how or if it is a pain-generator.

Are you familiar with John Bayliss's work? His book and DVD "Spinal Mechanics and Bony Locking" refutes almost all of Fred Mitchell's teachings...very interesting concepts.

Best to you. Hope your feeling better and back to teaching..ERIK

Comment by Jerry Hesch, MHS, PT on August 10, 2009 at 12:51pm: Erik et al,
RE: RADIOGRAPHS AND THE ILIUM, SACRUM
It is difficult to accept radiographs as being able to determine rotation of the ilium on the sacrum. radiographs cannot determine intra-articular mobility of the sacroiliac joint. The illia can move in 3-dimensional space being connected to the sacrum. "By comparing sagittal-plane femoral-head height and sacral base angulation, the authors concluded that innominate bones rotate around the sacrum (iliosacral tilt)." A person with a fused sacroiliac joint could still present in the same manner as the study population. One must always give consideration to the biomechanics of the pelvis and a unit when considering mechanics of the sacroiliac. Research has invalidated some of the sacred dogma regarding the sacroiliac. Most of the Osteopathic's belief system regarding the mechanics of the SIJ go back to Fred Mitchells SR's 1958 article. The use of radiographs for looking for leg length inequality cannot always distinguish between true and functional leg length differences. In addition to the testing you describe for functional leg length asymmetry, it is also worthwhile to check articular mechanics of the subtalar joint, the talocrural and the tibio-fibular articulation. These can be treatable dysfunctions that also influence leg length inequality. this is a rather brief reply to a complex topic. Will post more current scientific references in the near future.
Best Regards
Jerry Hesch, MHS, PT
The Hesch Method, Hesch Manual Therapy

Comment by Erik Dalton on July 27, 2009 at 6:27pm: Just finished writing a post on the difference in prone and supine leg length assessments and accidentally deleted the whole thing...don't you hate that!

Anyway, I picked up a bug in Costa Rica or in a dirty airplane and am too beat to redo the thing so I'll offer a quote from a Short Leg article I wrote a couple years ago that may have some relevance...or not. It's important to realize we can't always rely on eyeball evaluations to determine dysfunction. Often I refer my clients for radiologic postural exams if I can't unravel the "key" lesion causing their pain....and sometimes that doesn't work either.

Here are some thoughts from my article @ http://erikdalton.com/article_shortlegsyndrome_part2.htm:

"Although leg, hip and pelvic corrections shouldn’t be based solely on supine test results, helpful information is derived by combining it with other exams such as prone leg-length tests. These oft-neglected prone assessments offer therapists additional clues for solving the limb- length puzzle. When prone, both ASISs are “pinned” to the table, thus preventing ilial rotation and allowing the therapist to isolate sacroiliac and axial skeletal joint dysfunction. Here’s a quick reference for differentiating supine from prone limb-length assessment:

Supine: Tests leg-length differences resulting from iliosacral rotation, typically due to muscle imbalance.
Prone: Tests leg-length inequality as the lumbar spine attempts to adapt to sacral-base unleveling in the presence of SI joint dysfunction.

Depending on the degree of leg-length shortness, compensations may travel all the way up through the cervical spine and into the cranium (Ascending Syndrome). Conversely, “key” restrictions sometimes begin in the head or neck and travel down the kinetic chain (Descending Syndrome), causing pelvic obliquity and adaptive leg-shortening.
During the course of an examination, several simple tests help uncover the biomechanical root of the shortened leg. However, none are adequate to fully assess all possible causes." Thx Y'all!

Comment by Erik Dalton on July 23, 2009 at 12:48pm: I'm back and have a few comments to make on supine vs prone length measurements after I 'wade through' a 162 e-mails. Talk soon...

P.S. Look forward to seeing some old friends and having a great workshop in Panama City, Florida next weekend. Hope the 60+ participants will fit in that 3,000 sq foot ballroom.

Comment by Erik Dalton on July 23, 2009 at 7:49am: Back from Costa Rica and will be posting comments about this topic when I catch up with all these e-mails...thx..>ERIK

Comment by Katie Stewart on July 23, 2009 at 7:34am: What about isssues related to birth lie? Tensile compression forces as we exit the birth canal can set up patterns of fascial organization leading to issues showing up on one side or the other. Has anyone looked at patterns of C-section children versus vaginal births??

Comment by Erik Dalton on July 16, 2009 at 2:19pm: Thanks to all of you who've posted on this question. Limb length discrepance has long held a major fascination for me. The D.O. I work with here in town and I go back and forth on this issue. Just as I think I've got a handle on it, someone comes in the office and after performing the 10-step screening process, all the theories go out the window. The body is so marvelously complex and that's what makes our jobs so enjoyable.

I'm off to Costa Rica so I'll not be posting for a while but please keep the discussion going. Love mulling over your thoughts...I'll steal some of em and claim they're mine...Namaste