Back Pain & the short right leg syndrome

Comment

Comment by Erik Dalton on July 16, 2009 at 2:04pm

No, you were right Whit. Teri fell (was actually pushed by our 107 lb. Ridgeback) onto a stone floor 13 feet below. Broke her nose, all the bones around the orbit of her right eye...and femoral neck.

The face plate surgery was perfect but the three titanium nails joining the ball and acetabulum worked loose. We researched and pondered the next step to take....either a total hip or a 'dynamic hip screw' surgery. Picked the wrong option so she suffered for another 6 months. Finally, after 14 months and a successful titanium hip she is back to her old self. We're thrilled and she is so motivated...really obsessed with the gym, water aerobics, yoga and zumba.

FYI: Never heard this before but my ortho told me that femoral neck fractures heal slower (if at all) in people under 55. We know that joint capsules and ligaments thicken with age but it never occurred to me that this stiffening process would actually help stabilize the fracture and enhance osteoblast formation.

What a wild ride we've had...thanks so much for your kind words....much appreciated.

Comment by Whitney Lowe on July 16, 2009 at 12:08pm

Erik:

Thanks for all that great info and those resources. I had actually come across something on Robert's site the other day after you posted this (I was looking for something else there) and came across a mention of this short right leg phenomenon. The author (and I can't remember who it was) mentioned that he thought this was a result of right-leggedness and the right leg being worn down from greater use do to its predominance in certain activities. That brings up the question of whether this short leg phenomenon is an acquired change or if it is something genetic and developed earlier on.

I'd be curious to hear your thoughts on this.

p.s. Glad to hear that Teri is doing well after her hip replacement (which I wasn't aware of). I was actually referring to her rehab from that terrible fall she had. Sounds like she is doing better overall, so I am glad to hear it. Probably a result of spending time in the Costa Rican sun eh?

Comment by Lisa Santoro on July 15, 2009 at 8:34am

Thinking about how many people sit for inordinate amounts of time at a desk, I wonder if this issue is "fascular" fascial/muscle based. How many of the people with a leg length difference are on one of those swivel chairs with wheels? When they turn to answer a phone, the lateral side of the foot presses into the floor, the fibula rotates slightly, the lateral knee, ITB etc. all go to work to make the person swivel right to pick up the call. The phone sits in the crook of the shoulder, and the person's attention drifts to the computer as they grip the mouse and fiddle with whatever is on screen. The head is turned right, the eye focus may be to the right, the whole right side of the body is engaged.

How many of those people are elevating that right shoulder throughout the day? When those same people go home many of those same people are watching television. Which hand are they pressing the buttons of the remote? Holding a fork? Gripping a cell phone? Texting their friends on a crackberry? I wonder if the short right side is strictly an American phenomenon or is it international?

In the same thought highway, for right dominatn folks, the right leg is the first to swing anteriorly when moving, and the leg that most will lean in to when standing. Is this creating a "chronic" or more frequent flyer in a tension pattern? And does that permanently anteriorly rotate the hip, creating a "phantom" leg length difference; one that's not measurable from tib/fib length, but from ASIS to ankle? When I work with folks with lower back pain, the first thing I look at is leg length. If there is a descrepancy, (and I wish I kept a tally so I could quote a statistic of how often that is...) I look to the anterior hips. By palpating ASIS, I can feel more succinctly if there's a distortion of whatever kind. The North and South cardinal directions can be assessed from there, in looking at "what sit's on top of what?" Gravity directs this assessment first, and from there lateral aspects or anomalies can be determined. Sometimes even something as simple as looking at the initial drape on the person can point to the root cause. Frequently, the sheet will be pulled up on one side, and the folds will literally create a linear map to what's pulling on what. For me, there's no step-by-step protocal in techniques that help back pain. It's a different menu for each person based on the cardinal direction assessment. And don't we know how an injury or surgery on whichever side can toss in some interesting elements to consider as well. An accurate assessment comes first with a thorough intake.

Comment by Erik Dalton on July 15, 2009 at 6:45am

Howdy Whit:
Thanks for linking up and adding your post. Per you question about my wife Teri's rehab from her recent hip replacement....very happy to report that she's doing great. Actually teaching Zumba classes. If you know of anyone under 60 who needs a replacement, please contact me for info on a fablous prosthetic called a Magnum3.

The following is taken from one of my Shoprt Leg articles @ http://erikdalton.com/article_shortlegsyndrome_part2.htm

"In two exquisitely designed studies (1962 and 1983), Denslow and Chase measured leg-length discrepancy in 361 and 294 subjects presenting with low back pain.1 Using the most advanced radiographic technology currently available, their papers (published in the American Academy of Osteopathy) reported the following findings concerning limb-length discrepancy:

Significant incidence of short right legs (66 percent);
Lumbar convexity to the short leg side (sidebent left – rotated right); and
A high correlation depicting contralateral (left) pelvic rotation.

By comparing sagittal-plane femoral-head height and sacral base angulation, the authors concluded that innominate bones rotate around the sacrum (iliosacral tilt). Transverse plane images revealed that the pelvis also can rotate as a block around the vertical lumbar spine. Denslow and Chase’s pioneering work helped biomedical researchers understand how shortened limbs torsion the pelvis, creating painful lumbar compensations. Their data not only confirmed leg-length findings conducted by previous researchers but also prompted new, more sophisticated imaging studies. In 2004, John H. Juhl, DO, reported that 68 percent of 421 low back pain patients presented radiographically with short right legs.2

1. Denslow J, Chase I, et al. Mechanical stresses in the human lumbar spine and pelvis. In: Postural Balance and Imbalance. Peterson B, ed. Indianapolis: American Academy of Osteopathy, 1983, pp. 76-82.
2. Juhl J. Prevalence of frontal plane pelvic postural asymmetry. J Am Acad Osteopath Assoc, October 2004;104(10):411-21

References dating back to the 1930's can be found by visiting Robert Schleip's wonderful website www.somatics.de and searching for Erik Dalton. Both articles have references but I think the first has the history listed in a box. In my Advanced Myoskeletal Techniques book the box is on page 141.

Best to you and your wife...keep the passion my friend.

Comment by Whitney Lowe on July 14, 2009 at 11:19pm

Erik:

Can you share some of the published resources where you have run across this issue of short right leg syndrome. Being a research geek and interested in epidemiology, this is a fascinating thing that I'd like to look into further.

Many thanks!

Comment by Laurie L. Irlbacher LMT on July 14, 2009 at 10:09pm

The only thing I have to bring to the table is the handedness patterns. In the side you are dominent or handed that shoulder will be lower and the hip of that same side will be hiked up. As Nate said the majority of the population is right handed , so that makes sense the problem would seem to be with only right legs. As far as pain well all those muscles from QL to Traps would be shorten as well as the fascia would be restricted. Nate's info. was great and thought provoking. If I were to try to measure it on others I would aim for a plum line and have my clients in a tank and shorts to measure visually the knees to see if they were lined up with one another and all the other plum requirements that I can't remember at this hour. I was good at spotting the subtle differences in school. I myself am right handed and with my recent gym membership had my legs measured. My left leg (measured around my quads) was a full inch bigger than my right. If that isn't enough ironically my left ankle will just flare up and hurt to bare weight on it. No previous sprains or injuries to that ankle. Seemingly random or is it?

Comment by Nate Ewert on July 14, 2009 at 1:18pm

I have a hypothesis for the unusual frequency. I could be way off base, but here it goes anyway.

Generally speaking, the majority of the population is right handed. Because of this it will cause many of us to be left leg dominant as well. This in turn will allow the left leg muscles to become slightly more developed. When looking at the structure of the skeleton, we know now the bones don't hold us up. That it is a combination of tensegral structure of the muscles and bones together. Therefore if the left leg has more muscle tone it will effectivley allow the leg bones to be supported more freely and "float" if you will between the better tension of muscles. Where as the right side not being as toned may not let the bones "float" as they should creating closer joint spaces in the ankles knees and hips. This would make the right leg appear functionally shorter.

I have been under the impression the incidence of the bones actually being functionally longer on one side is a fairly rare occurrence. Therefore looking for more compression issues in the joints makes more sense to me.

As far as question two is concerned, we could spend days discussing ramifications of postural distortions and how they are perpetuated, but I think the two biggest things you will see are pes planus more on the left foot, and possibly genu recurvitum developing in the right knee.

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