Subject: Simon Crittenden - Leg Length Discrepancy Assessment, 21mm (+/-2mm)

Until now observations demonstrating I have a leg length discrepancy have largely been indirect. Self-assessment for this condition is difficult. As stated previously, nine Medical Doctors and Allied Health professionals have been consulted and none thought to examine leg length. I am forced to self-assess.

The Three Cardinal Signs of SRLS have been present. The first of these making itself known in my early teens. Flexed knee height in supine supports the roughly palpated self-examination of hip and pelvis alignment indicating a structurally short right leg is present. However, it has recently come to light there is contradictory x-ray evidence.

It is fundamental to Chiropractic practice to ensure the spine's foundation is level. The practitioner I consulted assesses this through examination of pelvic x-ray in the Frontal plane. Direct examination of leg length is not attempted. Pelvic x-rays taken in 2015 and 2018 both show an elevated right hip and assessment was for a LONG right leg. The spectacular therapeutic response to heel lift treatment for SRLS was attributed by the Chiropractor to a neurological contra-lateral activation mechanism...the theory, putting a heel lift under the LONGER right leg spontaneous stimulated the body to heal itself. This conclusion is questionable. Direct examination yields an entirely different outcome.

 

In response to the unexpected assessment of a structurally long right leg, I have directly measured the structural leg length discrepancy. It confirmed a discrepancy exists with the right leg being shorter than the left. Standing barefoot on the flat concrete floor of the workshop next to a large upright structural post. Knees locked out. Limb parallel to the post. Using a carpenter's square with thumb pressed firmly onto the short edge, thumb tip protruding. Notch it on top of the Greater Trochanter both left and right sides. I am familiar with the Greater Trochanter. I have checked the position of hundreds in clinical examination. Mark position on post. I repeated this several times. The difference measures 21mm. Left higher than right. The right leg is SHORT. The error factor is +/-2mm.

Poor alignment may account for the contradictory x-ray evidence. My recollection is the radiographer made no attempt to ensure stance above the feet was centred. Examination of leg length discrepancy is not included in medical practice so why would a radiographer be particular about stance in their x-ray procedure. I observe that shifting weight slightly from side to side elevates each respective lateral hip and drops the opposite hip. It is basic geometry...try it with two chopsticks and a short bar (say a quarter the length) across the top. The smaller angle sighted at the juncture of Femur and Pubic Ramus on the right of my x-rays indicates a right leaning stance and an elevated right hip is expected.

In relation to a "neurological contra-lateral activation mechanism" stimulating healing, I have seen several instances where an orthotic device was fitted under the longer left leg to address symptoms in the backline of that leg and foot. Lumbar tilt and hip rotation symptoms were amplified. Typically this leads to acute pain in lumbar spine and increases anterior hip rotation on the left side, aggravating symptomatic effect down the backline of the left lower limb. It has not stimulated spontaneous healing.

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In one instance, an Australian track and field athlete competing at international level was fitted with a heel lift under the left foot by a Physiotherapist to relieve a left Achilles strain. Mechanically, when viewed in isolation, this makes sense. However, when taking into account the full structure in the presence of a short right leg, increasing left leg length further increases left hip rotation, binding the left SIJ to a greater degree, increasing the energetic Qi flow blockage. Thickening and tightening down the backline was already a problem, escalated and recovery from Achilles strain was not possible. The Physiotherapist's treatment completely sabotaged the athlete's recovery and forced him out of sport. Clearly that practitioner was ignorant of the hip rotation mechanism at the longer leg which was the primary contributing factor for the Achilles condition in the first place. This athlete was assessed with a high range structural leg length discrepancy and a prominent Left Lower Limb Mechanism. He had a short right leg.

In my experience, placing a heel lift under a structurally longer leg does not stimulate healing and recovery. It increases pelvic tilt in the Frontal plane jeopardising lumbar integrity and aggravating existing scoliosis. Unconscious anatomic adjusting rotation at the left hip increases binding at the left SIJ.  Left and Right Lower Limb Mechanisms are amplified and it only serves to escalate associated symptoms.

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Under the Mechanism tab of this website find articles describing "Left Lower Limb Mechanism" and "Examining Anterior Hip Rotation".