Case 3 - Paramedic, Left Sided Mechanism and Low Back Pain

 

This is a high range case of Short Right Leg Syndrome with a 21.6mm structural leg length discrepancy confirmed by frontal x-ray of the hips…the right leg shorter than the left. The Chiropractor making the x-ray examination pointedly stated the hip elevation was coming from higher up the torso, working its way down, distortion pulling up the left hip. It is possible there is a component from that effect. However, I subsequently put the tape measure on him and confirmed a structural difference of 15mm +/-5mm exists putting it in the ballpark of the x-ray outcome. 

 

I had already sighted the two Signature Traits and three Cardinal Signs of SRLS in this case. Rudimentary leg length examination indicated a high range leg length discrepancy existed. This was later confirmed by the x-ray examination and tape measure. I can only think the Chiropractor's statement of distortion through the torso was lifting the left hip rather than a longer leg pushing it up was made without examining structural leg length. I now know medical examinations in this country rarely assess structural leg length. None of the many medico’s and therapists I have consulted for low back and lower limb issues since 2016 have conducted a structural leg length assessment. This is typical. The majority of my clients when advised they have a leg length difference contributing to their condition do not know they have a short right leg.

 

Sorry, I digress…returning to this case…he was experiencing the typical thickening and tightening down the back line of the left lower limb due to anterior rotation of the left hip in the Sagittal plane (First Cardinal Sign). I describe this as the Left Sided Mechanism. In his case it was the underlying cause for a chronic painful spasm in the lateral gastroc head that would not respond to stretching, needling and treatment of any sort. I know this because he was reluctant to trial heel lift treatment for the short leg for the first twelve months he was a client of mine. Additionally, he suffered significant low back pain he believed to be the result of injuries sustained catching patients falling off the ambulance gurney…he is a paramedic. 

 

After twelve months of largely ineffective treatment on my table that only gave partial temporary relief, he took my suggestion and inserted a 5mm heel lift under the right foot. He experienced immediate relief from the low back pain condition. The Gastroc spasm and discomfort was rapidly alleviated. He tells the story how he was subsequently hiking the Warburton Trail and the heel lift was pushing his foot upwards in the high top hiking boots. Finding this uncomfortable he stopped and removed the heel lift. Resuming hiking he stopped again literally 10 metres down the trail to reinsert the heel lift. On removal, his left hip immediately defaulted to the anteriorly rotated position, binding his left SIJ, blocking energetic flow down the backline of the left lower limb and triggering painful spasms in the left Gastroc again…anterior rotation of the hip in the Sagittal plane is an anatomic adjustment functionally shortening the leg to reduce pelvic tilt, making it more comfortable to stand and protect the spine in the presence of a leg length discrepancy. However, it does so at the expense of twisting the SIJ, affecting lower limb function and potentially injuring the joint.