Leg Length Discrepancy and Short Right Leg Syndrome
in the context of Remedial Therapy
Short Right Leg Syndrome Treatment Protocol
Driving to the core of treatment for Short Right Leg Syndrome:
➤ Heel Lift Treatment - Incremental adjustment lengthening structurally short leg.
https://critsvcs.wixsite.com/shortrightleg/determing-heel-lift-size
https://critsvcs.wixsite.com/shortrightleg/considering-incremental-adjustment
https://critsvcs.wixsite.com/shortrightleg/heel-lift-instructions
➤ Normalise left hip alignment - Rehab where anterior rotation of hip in Sagittal plane (First Cardinal Sign) binding left SIJ is generating acute symptoms at SIJ and/or down backline of lower limb. In the absence of acute symptoms, accelerating this process is unnecessary. It will happen naturally with Heel Lift Treatment (weeks/months). Stretch hip flexors, strengthen abs, activate glutes.
https://critsvcs.wixsite.com/shortrightleg/first-cardinal-sign
https://critsvcs.wixsite.com/shortrightleg/examining-anterior-hip-rotation
https://critsvcs.wixsite.com/shortrightleg/left-lower-limb-mechanism
https://critsvcs.wixsite.com/shortrightleg/rehab-correcting-anterior-hip-rotation
➤ Clear rigidity at the right hip (Second Cardinal Sign) and associated Bladder meridian choke points at Iliac Crest and Sacrum - Indirect Facial Release, Deep Tissue Massage, Cupping, Stretching, Reclining Windshield Wiper Exercise. There will be an ongoing requirement to do this despite Heel Lift Treatment which only partially corrects leg length discrepancy. Gait effects still exist and effects from the Second Cardinal Sign at the right hip are not fully eliminated.
https://critsvcs.wixsite.com/shortrightleg/second-cardinal-sign
https://critsvcs.wixsite.com/shortrightleg/right-lower-limb-mechanism
https://critsvcs.wixsite.com/shortrightleg/right-lower-limb-mechanism-and-fascial-release
https://critsvcs.wixsite.com/shortrightleg/bladder-meridian-choke-points
https://critsvcs.wixsite.com/shortrightleg/bladder-and-kidney-meridian-effects
➤ Spinal Rotation Exercise
https://critsvcs.wixsite.com/shortrightleg/spinal-rotation-exercise
➤ Sacral Mobility Exercise
https://critsvcs.wixsite.com/shortrightleg/sacral-mobilisation-exercise
➤ Manage the effects of mild scoliosis through thoracic and cervical spine - Massage, stretching and mobility generally. It is now time to take up yoga, pilates or callisthenics. If you are a good swimmer, start doing laps again.
https://critsvcs.wixsite.com/shortrightleg/observations-on-mild-scoliosis
➤ I practice a range of floor exercises helpful rehabilitating my own condition of advanced Short Right Leg Syndrome following major lumbro-sacral injury to open hips, stretch and lengthen hip flexors, adductors, medial and lateral rotators of the femur, backline of the lower limb and strengthen abdominals. It is starting to look like yoga. Owing to injury, knee flexion is limited preventing full yoga practice. I do the best I can.
Stretching medial rotators of the femur has been particularly helpful for me. Lateral rotation of the femur lengthens the medial rotators. The actual practice that does this for me is a Dao seated meditative exercise to improve kidney energy which suffers from SRLS due to Bladder meridian blockage at choke points in the lumbro-sacral region. I commenced this for the kidney benefit and discovered the side effect of improved mobility from lengthening the medial rotators. A video presentation can be viewed on the Massage Works Dandenong Ranges facebook page.
https://www.facebook.com/share/v/1XykNBjCda/
Cautions
Spinal rotation and sacral mobility exercises may not be advisable until anterior rotation of the left hip has been resolved. There is the possibility of unforeseen damage from attempting to mobilise an SIJ which is forcibly rotated many times past its normal range of motion. I have not tested this. It may be better to wait until through rehab or heel lift treatment, the left hip position is improved and normalised before attempting to actively mobilise the left SIJ. This can be achieved quickly (days/weeks) with rehab exercise and dedicated use of a heel lift.
Another caution is the presence of potential left sided disk bulging indicated by high degree of tenderness and tightness in the left QL’s. In the absence of definitive scan reports giving precise description of bone, neural and disk condition there is a degree of trial and error to the process. Basically, the elevation of the right hip by insertion of an adjusting heel lift under the right foot, incrementally closes right disk spacing and opens left disk spacing. Where disk bulges are right sided this is beneficial and helps push a bulge back in. Where it is left sided it has been known to aggravate the condition. Should that occur, it is necessary to remove the right sided heel lift and focus on treatment to resolve the left side injury.
Similarly, attempting to start with too large a heel lift can cause discomfort. There is a limit to the amount of adjustment the body will accept. There is no formula based on leg length discrepancy measurement that gives a calculated adjustment amount. It is more a matter of what will the chronically bound lumbro-sacral region accept. It is better to start small and gradually increase size in response to symptomatic outcome or lack thereof. This is usually in the range of 4mm or 5mm regardless of discrepancy size. Occasionally this proves to be too great causing pain and discomfort where a smaller 3mm size works well. I have treated one case which I categorise as a “super sensitive” with a nervous system more finely tuned than average where 5mm made him feel like he was falling off a cliff, 3mm seemed OK but within a few hours he reduced it to 1.5mm.
Do expect there to be some discomfort mobilising joints, structures and musculature that has become dysfunctional. Much of this may be alleviated within days or weeks. My own advanced case with a five decade history prior to treatment commencing has taken four years to plumb the full depths of the condition. The right SIJ would seem to have some degree of arthritic degeneration that resists full recovery at this stage. Use of medicinal dosage of Hydrolised Collagen Protein does improve joint condition, accelerating recovery from injury.
https://www.massageworksdandenongranges.com.au/collagen-supplementation-for-injury
It is preferable to allow normalisation of the left hip’s anterior rotation to occur slowly under influence of the heel lift only. This can be accelerated with rehab exercise if acute symptoms at the SIJ or down the back line of the lower limb are being experienced. However, owing to the fact twisted and stretched ligamental structure about the SIJ loosens as the hip returns to normal alignment, the joint becomes unstable and prone to injury. It can take considerable time (months/year) for the ligaments to retighten and improve joint stability. Cases with high range anterior rotation at the left hip should be cognisant of this and avoid heavy lifting in the early stages of treatment. This is particularly pertinent to cases who have experienced pain and dysfunction at the left SIJ prior to commencing treatment.
Discussion
The postural anomaly from a structurally short right leg can be managed through physical activity without the use of Heel LIft Treatment. Martial arts, dance or yoga promote flexibility in the pelvis, good posture and muscle tone. These practices do not eliminate the structural anomaly but do resolve strain that otherwise causes thickening and tightening through the heavily fortified construct of the pelvis restricting energetic Qi flow. This requires the dedication and ability of a master or guru. Many do not have the time, motivation or ability and may now be aged and injured preventing them from doing so. Females with hypermobile joints that do not work on their feet or do heavy lifting have an advantage over males who do these things. Where an individual chooses to manage their condition through exercise only and not insert an adjusting heel lift in their footwear still run an increased risk of lumbar injury due to the influence of pelvic tilt across the frontal plane. Particularly, should anterior rotation of the left hip need correction in the presence of symptoms resulting from the twisted and bound left Sacro-Iliac Joint. Unwinding the rotated hip with rehab exercise functionally increases pelvic tilt, further straining the lumbar spine.
Most do not manage the condition well and, if not as a young adult, by the time they have exceeded the life expectancy of our prehistoric ancestors they begin to exhibit symptoms. These can escalate under loading and other influencing factors and generate acute symptomatic effect which is typically not attributed to the pelvic postural anomaly. Structural leg length discrepancy is not included in medical examination. Symptoms primarily attributed to energetic Qi flow principles and effects are not understood by conventional medico’s and therapists. Once acute symptoms have developed, it is like we always have to insert a thin adjusting heel lift under the short leg.
The first thing to understand in the treatment of Short Right Leg Syndrome, there is no expectation perfect structural symmetry will be achieved. After several decades on the planet under the influence of gravity, there is a certain amount of permanent change to the skeletal structure that will not be undone.
Another fundamental concept is that in the presence of structural anomalies imposing permanent distortion and strain blocking energetic Qi flow, no amount of energetic, spiritual, neuroscience or psycho-social action will lead to resolution. Healing practices such as Reiki, Acupuncture, Bowen Therapy, Pranic Healing, Homeopathy and Aura Soma, etc., can only provide limited temporary relief. The same statement applies to conventional medical treatment outcomes. I do not deny that in some instances dramatic and what might be considered miraculous improvement can occur. However, in the presence of the Pelvic Block, these effects are temporary and the condition will once again deteriorate in days or weeks unless ongoing treatment is maintained. Even then, the weight of constant energetic impingement by the Pelvic Block does have an overwhelming effect in the longer term despite other treatment efforts. This has been my experience.
A characteristic of SRLS not understood by conventional medico’s and therapists is the principle where a proximal block to energetic Qi flow at hip or shoulder has a distal effect in the limb. Distortion and strain at the pelvis blocking energetic Qi flow to the lower limb generates a subtle thickening and tightening through the connective tissue of the limb. Under the influence of loading and other factors this can escalate to acute pain, dysfunction and injury. Direct treatment at the affected area of the limb will have limited temporary effect until the condition at the pelvis is resolved.
Age does lengthen response time. A juvenile responded rapidly and within two weeks acute symptoms were completely resolved. Whereas, the 70 year old case with a 20 year history of acute lower limb symptoms required six months to recover from the prominent aspect of the condition but continued to report beneficial changes for another two years. In my own advanced case with a 50 year history of symptomatic effects, it is now four years since commencing self treatment for SRLS as I plumb the full depth of the condition. This might have been accelerated had I known what I do now and had the treatment protocol outlined above.
Resolution of the effects from SRLS requires more than the insertion of a small adjusting heel lift under the short leg. Unwinding the distortion and strain through the pelvis from chronic pelvic tilt in the frontal plane, a rotated left hip with twisted and bound SIJ, short and tight left hip flexors, releasing a rigid and stuck right SIJ, short and tight right adductors, rigidity along the right Iliac Crest, a strained right leaning lumbar spine encouraging disk bulging, with mild scoliosis through the thoracic and all that does to upper back, neck and shoulders, requires both an adjustment to incrementally back off distortion and strain through the pelvis, as well as, active mobility exercise to clear chronic tightness developed over decades. Particularly, drilling to the structural core where the sacrum at the foundation of the spine has been chronically twisted and tilted in a highly fortified matrix of heavy ligamental and connective tissue.
The Remedial Massage Therapy I practice assists this process. Massage, mobilising, stretching, Indirect Fascial Release, Chinese Cupping techniques targeting spine, lumbro-sacral region, hips, musculature of the lower limbs, energetic choke points and activation points does give relief and accelerates recovery.
Dedicated use of an adjusting heel lift can have dramatic effects reducing lumbar pain, correcting anterior rotation of the left hip, releasing the bound left SIJ, improving energetic Qi flow down the backline of the lower limbs and up through the thoracic spine improving mobility. This is frequently accompanied by internal health changes with reports of improved digestion, kidney function and reproductive health. What it generally does not do is eliminate gait effects responsible for rigidity at the right hip and the primary Bladder meridian choke point at the iliac crest. It does not fully resolve chronic binding of the sacrum contributing to deep energetic blockage of the Chong Mai, Du Mai and Ren Mai meridians.
There is a limit to the amount of adjustment the body will accept. Heel Lift Treatment typically adjusts for only one quarter to one half of the leg length discrepancy. Hence, gait effects continue to impact the right hip and lower limb. In addition to Heel Lift Treatment, there will be an ongoing requirement for supplementary exercise and stretching activity to achieve and maintain flexibility through the pelvis and spine.
In the longer term, as the body responds to the influence of the heel lift and begins to unwind and release through pelvis, sacrum and spine, it may be possible to increase the height of heel lift adjustment to improve symptomatic response. Particularly in relation to the right sided rigidity and Bladder meridian choke points.
The sacrum is structural ground zero. Heavily supported by ligamental and connective fascial material where it is the focal point connecting lower limbs and spine. It is the foundation for the spine and torso. Distortion from structural leg length discrepancy imposes constant strain over a period of decades. While we are young and active, lighter weight and have been under the influence of this structural strain for a short while only, we generally manage the condition well.
I am convinced the underlying purpose for Belly Dancing and Hula is to ensure fertility in prospective mothers by improving pelvic mobility to resolve the Pelvic Block, as well as, conditioning to support pregnancy and birthing. From another perspective, sexual intercourse is a beneficial physical exercise for mobilising the pelvis. As young adults we have frequent and abundant practice. However, with the passage of time we may lose opportunity, ability or interest…many do not have the physical development of trained athletes able to manage the rigours of life with zest and gusto…and our sexual appetite wanes and it becomes an occasional event that may eventually cease altogether. Apart from the mounting pressures of adult life, internal health effects from SRLS can be partly to blame. If we do not substitute a suitable regular alternative to maintain pelvic mobility under the strain of structural leg length discrepancy, the lumbro-sacral region gradually begins to thicken and tighten. Energetic Qi flow becomes blocked adversely affecting mobility and internal health.
Driving to the core of treatment for Short Right Leg Syndrome are exercises to improve spinal and sacral mobility. I describe examples I have had some success with. They are simple and readily achievable. Whereas, many other practices may require a degree of motivation and dedication that we do not all have. Also too, age, injury and physical degeneration can prevent many from successfully practicing more vigorous methods.
There is a vast range of physical activities and exercise regimes helpful in the longer term, such as; walking, swimming, dance, Yoga, Pilates, and Dao Yin Chi Gong Therapy. The last actually having a large selection of exercises specifically targeting the effects of this structural anomaly. Yoga practice is generalised and may need to be modified to manage the condition effectively. I have in mind a clinical version as practised by Physiotherapists using Pilates in their treatment. It must become a daily habit to be effective. Attending yoga class once a week is not going to do it.
Mild scoliosis is universal. The majority of cases being right convexity through the thoracic induced by right leaning pelvic tilt from the structural leg length discrepancy. This is one aspect of the condition that will not be fully undone by Heel Lift Treatment. In my own case 34 days after commencing Heel Lift Treatment, chronically tight thoracic musculature that prevented me from looking over my shoulder when reversing the car completely released and I was doing so better than I had been able to 20 years prior. However, this was due to resumption of energetic Qi flow up the spine as the lumbro-sacral block was released. The scoliotic curve with right convexity through the thoracic was still present loading the right sub-occiptals and spinal erectors and causing neck pain. Hence, subsequent development of the Spinal Rotation exercise. There are specialist exercises designed to reduce pelvic tilt and the effects of mild scoliosis which I do not have much experience with. They are probably helpful but their proponents do not understand the underlying causation is actually a structurally based postural issue to do with leg length discrepancy. None I have sighted recommend use of Heel Lift Treatment.
Where I was facing the prospect of retirement from active life at January 2021 being unable to stand and walk without considerable pain and deteriorating internal health and vitality, Heel Lift Treatment turned that around. Dramatic and enduring beneficial changes that played out over a ten month period. However, it did not eliminate rigidity about the right hip and once again at January 2022 I was facing the prospect of retirement due to overwhelming pain in the right leg that defied all treatment. Piecing together historic clues and a growing understanding of Short Right Leg Syndrome, ceasing all other treatment and focused self-treatment to release rigidity at the right hip. Once again, dramatic enduring change that within minutes cleared the crippling pain in the right leg. It did take some months to plumb the full depth of the condition at the right hip and then several years before discovering the benefit of spinal and sacral mobilisation. I expect that after my own long drawn out experience with SRLS, the recovery process for others can be accelerated.