Most of us have a dominant side of our body, and we use that side in different ways than we do our non-dominant side. I also had the habit of standing with all my weight on my left leg. In photos of me as a teenager you can see my right hip hiked up higher than my left, and this posture stayed with me into adulthood. I remember stepping on and wearing away the bottom hem on the left leg of my pants, while the right hem stayed perfect. If I had ever sought out a diagnosis, undoubtedly the answer would have been unequal leg length functional leg length discrepancy.
When I began training in Clinical Somatic Education and learned how to release the chronic tightness in my obliques and my iliopsoas, my hips evened out, and all of a sudden my legs were miraculously the same length. The pain in my left hip went away too! I was left with a small leg length discrepancy that I barely noticed. The chiropractor gave me a shoe insert to wear and so I did.
Not even a year later, Somatic Movement Center started sending info to me about their courses that could fix leg length discrepancy. I practiced every day. The pain stopped and I was able to stop wearing the insert completely!
It was a miracle! Functional leg length discrepancy may also be diagnosed as lateral pelvic tilt or pelvic torsion. At the root of functional leg length discrepancy is chronic tightness in the quadratus lumborum, internal and external obliques, and iliopsoas. These are all strong core muscles that laterally tilt the pelvis and provide essential core stability in full-body movements.
When you have functional leg length discrepancy, other back muscles that laterally flex the spine bend the spine to one side will likely be tight as well, including the longissimus, iliocostalis, and latissimus dorsi.
If your lateral flexion progresses to more than 11 degrees, it may be diagnosed as scoliosis. Our entire body is connected like a pulley system. When one part moves out of alignment, the rest of our body will adjust to balance us out. So, the muscles on the left side of your waist and lower back and in your left hip will be tight too—just in a different pattern than on your right side. Another way we compensate for lateral pelvic tilt is by rotating our body in various ways.
Your gluteal muscles will likely become tight on both sides as a result of this rotation, because different parts of the gluteal muscles rotate the hips both inward and outward. These muscles attach to the bottom of the pelvis, so they can pull your pelvis downward on that side, exacerbating your overall pattern. If your lower hip is inwardly rotated, your tensor fascia latae on that side will become tight, creating tension in your iliotibial band.
This tension, along with increased body weight being put on this side, can easily lead to knee problems. Pelvic torsion also commonly occurs with functional leg length discrepancy. This describes the misalignment of the pelvis when one side is tilted forward and the other is tilted backward.
The pelvis can also be rotated on the transverse plane imagine a Lazy Susan. So, one hip might be pulled forward while the other is pulled backward. In some cases, exercise can contribute to functional LLD. If an athlete trains in a way that causes muscle imbalances or weaknesses, they may temporarily experience functional LLD. Structural LLD occurs when either the thigh bone femur or the shin bone tibia is shorter in one leg than in the other.
The condition typically presents at birth, but it can also happen as a child grows. The main symptom of LLD is having one leg longer than the other. If the discrepancy is very small, there may not be any other symptoms.
However, a study notes that a discrepancy as small as 2 centimeters cm can cause the pelvis to compensate for imbalances in posture. People who suspect that they have one leg longer than the other should see a doctor for a diagnosis. While waiting for an appointment, a person could try the following home test to see whether there is a possibility of LLD.
Ankles that are not aligned could indicate LLD. It will be necessary to see a doctor to confirm LLD and to determine whether it is a functional or structural issue. The treatment for functional LLD typically involves physical therapy, massage, and specific exercises to correct areas of imbalance and weakness.
It is also important to correct poor posture. The exact type and number of interventions that a person needs will depend on the underlying cause and severity of the LLD.
Exercises may help correct some functional LLDs. However, it is important that people use the correct stretching and strengthening techniques. They should also take care to exercise the side of the body that will help correct the LLD. To avoid causing further issues, it may be sensible to seek the help of a physical therapist.
We hope you found this article informative and it helped answer many of the questions you may have surrounding your leg length discrepancy, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and walking difficulties challenges. If you would like to get more information specific to your challenges please email us: Get help and information from our Caring Medical staff. Subscribe to our newsletter. The effect of simulating a leg-length discrepancy on pelvic position and spinal posture.
Journal of physical therapy science. Pre-operative pelvic incidence minus lumbar lordosis mismatch in repeat posterior lumbar interbody fusion induces subsequent corrective long fusion.
World Neurosurgery. Journal of Manipulative and Physiological Therapeutics. Is a long leg a risk for hip or knee osteoarthritis? A year follow-up study of individuals. Acta Orthopaedica.
The Spine Journal. Toward understanding the underlying mechanisms of pelvic tilt reserve in adult spinal deformity: the role of the 3D hip orientation. European Spine Journal. Diagnosis and interventional pain management options for sacroiliac joint pain.
Tzu-Chi Medical Journal. When should I involve a Prolotherapist in my care? Call Us: Email Us. Email Us Subscribe. Home » Prolotherapy News » Back Pain » Treatments for leg length discrepancy, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and walking difficulties. Treatments for leg length discrepancy, pelvic tilt, pelvic incidence-lumbar lordosis mismatch, and walking difficulties Ross A. What are we seeing in this image? If your pelvis is tilted, it can disrupt the natural curvature of the lower spine.
An understanding of the symptoms of pelvic tilting and lumbar lordosis mismatch causing muscle spasms and low back pain and hip pain As you will read below, some of the people that contact us report that one of their symptoms is stiffness and pain when they stand after sitting for some time. In this image we see: Anterior the front and posterior the back tilting of the pelvis and its effect on the kinematics movement of the lumbar spine. This image is divided into an A, B, C, D segment In the A image anterior pelvic tilt with lumbar extension and the B image a close-up image of the vertebrae and intervertebral lumbar extension the anterior or frontal tilt of the pelvis when the person is sitting puts pressure on the lumbar spine by increasing Lordosis or spinal curve you start bending backward.
In the B closeup we see that when the lower spine is bending backward, it increased pressure on the front of the vertebrae causing the disc innards, the nucleus pulposus to bulge the disc outward. To the rear of the vertebrae, this pressure causes a narrowing of the intervertebral foramen. We have a situation where the disc is bulging in the front and possibly pinching nerves in the rear.
When this happens you get stories that go something like this: Hip arthritis, leg length discrepancy I have hip arthritis, low back problems, and leg length discrepancy. My x-ray and MRI are bad. My main problems are I am walking with an uneven gait, I have stiffness when I stand after sitting. Fortunately, I can still function and perform daily normal movements.
Sciatica, hip, difficulty walking I am a former athlete, I have issues with the same side sciatica, hip, and leg pain. One leg is slightly shorter with some pelvic tilt. My doctors tell me that my pain is coming from degenerative disc disease and spinal compression on the nerves. I have walking issues. X-ray shows bone on bone knee and pelvic tilt. Physical therapy helps a little. Sacroiliac joint dysfunction I have been diagnosed with Sacroiliac joint dysfunction , leg length discrepancy, and my foot pronates.
I would like to stay that way without surgery. Which came first, developing lower spine curve deformity or leg length discrepancy and pelvic tilt?
Increasing leg length discrepancy was not translating into increasing spinal deformity Pelvic tilt is an indicator for observing pelvic changes in the coronal plane looking at the body straight on from the front and observing if the left side pelvis is higher than the right side pelvis or vice versa, the tilt to one side to another.
So what does this mean? Alleviation of symptoms related to leg length discrepancy may not be solved by spinal surgery. Doctors recommend the long fusion surgery as a means to prevent reoperations because of adjacent segment disease.
Leg length discrepancy and degenerative joint forces straining the hip. If one leg is shorter than the other, the hip joints will be stressed as the leg-length discrepancy will cause an abnormal gait or walking motion.
This is evidenced by the waddling gait of someone with a hip problem. This waddling gait helps remove pressure on the painful hip.
The gait cycle is most efficient when the iliac crests are level, you have a straight pelvis, not a tilted pelvis. Unequal leg lengths cause the pelvis to move abnormally, this will cause stress on the pelvis and can include problems of Pelvic Floor Dysfunction, Pubic symphysis in Men , and Pelvic Girdle Pain. Many people come in with a tilted pelvis. However, for many of these patients, that is not what is causing their pain.
The summary transcript: What is interesting about the diagnosis of tilted pelvis is that we see a lot of patients without that diagnosis and they in fact do have a tilted pelvis. So the question is, is the tilted pelvis the cause of their hip and back pain or not? This seemingly obvious connection between leg length discrepancy, walking problems and hip and back pain is still a controversial subject.
The first thing the researchers noted was that controversy still exists as to the clinical significance of leg length discrepancy in spite of the fact that further evidence has been emerging regarding the relationship between several clinical conditions and leg length discrepancy. Despite the controversy, the researchers found a significant relationship between anatomic leg length discrepancy and gait deviation.
The evidence suggests something of the obvious that gait deviations cause more pain and instability in the joints as the discrepancy increases. Even a small deviation in leg length could impact joint stability and degenerative disc and joint disease University researchers in Australia and Spain combined to publish research in the Journal of Manipulative and Physiological Therapeutics 5 that evaluated the correlation between mild leg length discrepancy and degenerative joint disease or osteoarthritis.
The Finnish team followed the records of individuals for 29 years. They all started with no leg-length discrepancy. When the patients were first observed they had no clinical histories or signs of leg symptoms.
The initial standing radiographs of their hips revealed no signs of osteoarthritis. Half of the group had both hip and knee replacements. Another note: 10 individuals had undergone a joint replacement of the longer leg and only 3 of the shorter leg. In the group of equal leg length, 3 had had an arthroplasty of hip or knee.
Interpretation — Hip or knee arthroplasty due to primary osteoarthritis had been done 3 times more often to the longer leg than to the shorter. Treatment of pelvic tilt and leg length discrepancy As mentioned above the diagnosis and treatment options for pelvic tilt, leg length discrepancy and a possible connection to adult spinal deformity can be challenging. Understanding and treating pelvic incidence-lumbar lordosis mismatch — Muscle spasms and low back pain Many patients we see have terrible back pain and muscle spasms because of the struggles their musculoskeletal frame goes through trying to keep their body balanced and their head in its correct position.
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