Considerations for Incremental Heel Lift Adjustment and Sacro-Iliac Joint Stability on Commencing Treatment for Short Right Leg Syndrome

 

The First Cardinal Sign of a structurally short leg is anterior rotation of the opposite hip/ilium in the Sagittal plane about the Sacro-Iliac Joint. This is an unconscious anatomical adjustment pulling up the longer leg, functionally reducing pelvic tilt in the Frontal plane, making us feel more comfortable and protecting the spine to some degree. It does not entirely eliminate pelvic tilt.

 

Where an adjusting heel lift has been inserted under the structurally short leg, the rotated hip unwinds and returns to a neutral position releasing tightness in the twisted SIJ. This causes the ligamental structure about the joint to loosen as the rotational strain is released. Causing instability in the joint leaving it vulnerable to injury until ligaments re-tighten. 

 

I cannot yet speak too authoritatively about this. It is a hypothetical I had first considered based on the concept of the Spanish Windlass effect. My own experience treating an advanced short leg condition and inserting an adjusting heel lift under my right foot resulted in an unstable left SIJ that was repeatedly injured. That the SIJ had some degree of degradation from five decades of being twisted in high range rotation is part of the story. After the sixth such injury* I finally realised I could not lift heavy and avoided lifting anything greater than 10kgs. Twelve months later I was able to resume collecting, stacking and splitting firewood for the wood heater.

 

*Note: I do not give up easily and persist in pushing through, sometimes to my detriment. However, if I did not have this characteristic, I would now be retired from active life with a severely limited life expectancy and unable to walk the dog.

 

Changing thickness of the heel lift is a variable control mechanism for realigning anterior rotation of the hip in the Sagittal plane. Make a small incremental adjustment and only partial realignment occurs. This is a consideration in treatment because should the hip’s position be encouraged to change rapidly from high range anterior rotation (30 to 45 degrees) in which it has been throughout the subject’s adult life, to a neutral position, the SIJ can become unstable and vulnerable to injury.

 

Should the subject undertake high intensity athletics or heavy lifting at work, it might be prudent to commence treatment with a small adjustment and gradually increase the size incrementally over the course of some months. It does take time for the ligamental structure about the SIJ to re-tighten and take up the slack as the joint unwinds. 

 

This is more a consideration with older subjects, I would suggest from the age of 50+ where greater joint degradation might be present. Also too, this needs to be balanced against other symptomatic effects. For instance, in the event of a prominent Left Lower Limb Mechanism generated by energetic Qi flow blockage from a bound left SIJ resulting in acute Plantar Fasciitis, unwinding the bound SIJ becomes a priority. Nevertheless, some degree of incremental control can be exercised. I have observed that unwinding the SIJ halfway can release tightness sufficiently to relieve secondary symptoms distally in the limb.

Hence, in lieu of going directly to a standard 5mm heel lift size on commencing treatment, 1.5mm or 3mm will limit the adjusting effect on hip rotation and maintain some degree of stability in the joint. At a later time when that change has settled and ligamental structure has had a chance to re-tighten, heel lift size can be increased.