Short Leg Syndrome (SLS)
Many individuals develop imbalance and pain as a result of a leg-length discrepancy. If one leg is longer, it is similar to driving around with one car tire slightly larger than the others. The center of gravity changes as weight is transferred to one side of the body. Often, one shoe heel will wear away faster than the other. Due to improper weight distribution and stresses placed upon then, one side of the posterior chain (foot, ankle, knee, and hip) will be undergo compensatory changes. Scoliosis develops with eventual premature joint degeneration on one side of the spine and wight bearing joints. The short-leg syndrome has been an enemy to athletes, Sports Therapists, and Chiropractors for many years.
Questions such as the following are asked daily: (1) Can it be an aggravation to, or cause of, low back pain in lower extremity problems? (2) Should a heel lift or orthotic be put in the shoe of the long leg or the short leg? (3) Will I always have to run on beveled road shoulder to have even lengths? The first thing that should be considered is that there are two types of short-leg syndrome:
1.Anatomical Short Leg. The measurement from the bony protuberance (the greater trochanter) of the hip joint to the lateral ankle measures shorter on one side than the other. This is seen in approximately three percent of all short-leg syndromes.
2.Functional Short Leg. The measurement from the same two points is equal on both sides, but there is still an apparent short leg. With this type, there is usually a rotation or displacement of the pelvis on one or both sides. This causes abnormal stress on all muscles, nerves, and joints that are involved. The longer a person has this type of short-leg syndrome, the greater the chance for a secondary compensatory problem somewhere else in the body, usually in the upper back, shoulders or neck. Common symptoms include muscular pains in the involved areas, headaches, numbness and/or tingling in the arms or hands.
There is a relatively simple test to determine which short-leg syndrome you may have; it is known as the Deerfield Test. With the individual lying face down, check the length by correcting any pronation or supination of the feet so that the heels are parallel and perpendicular to the plane of the legs. This is easier to visualize with shoes on than with bare feet because the shoe has a flat heel as opposed to the foot’s rounded heel. After noticing which leg is short, flex both knees to 90°. If it is anatomical shortness, the difference in leg length will be identical in positions 1 and 2. If it is a functional shortness, the short leg will either become longer as the other leg or longer when in the flex position. If it is functional shortness, the short leg will be either become as long as the other leg or longer when in the flex position. This is called cross-over. Whichever syndrome one is suffering from, the weight distribution through each leg will be uneven. As a result of the increase in poundage and stress on the body and legs during impact, the symptoms will be more pronounced in someone who is involved in more impact oriented activities, such as long distance running, soccer, rugby, etc.
What symptoms should make a person consider short-leg syndrome?
Any symptom exaggerated by impact, such as low back, hip, knee, ankle, or foot pain. Second, a tendency to repeatedly strain the same muscle even given sufficient time to heal. Shin splints and sciatic neuralgia (inflammation of the sciatic nerve that produces pain in the buttocks and down the back of the leg) are also commonly associated with SLS.
How does a functional leg-length difference develop?
Over a number of years, one side of the spine may develop stronger than the other. Sleeping on one side; carrying items on one side; running clockwise on a track; using the phone on one side; facing traffic when you run; lifting suitcases; carrying kids; acquiring injuries when as a child, or even forceps delivery at birth, for example, can result in functional imbalances. An individual with a large discrepancy in leg length will often notice postural irregularities in photographs of him or herself. One shoulder may be elevated, and the head tilted towards the side of the high shoulder. Your tailor may be the first to notice a leg-length discrepancy. Many runners with leg-length discrepancies report their cadence changes and they feel they impact one side greater than the other. Some runners state that they feel “lopsided” when running and as noted earlier, one heel usually wears away faster than the other.
After it has been determined which syndrome is evident, a correction should be considered. With an anatomical shortness, correction is made simply by placing a heel lift in the shoe of the short leg. The lift can either be inserted in the shoe itself or constructed into an orthotic. This can be done by any of the Chiropractors at Vitality Clinic. When addressing a functional shortness, the first thing to consider is the underlying cause of the short leg. A functional leg-length discrepancy is present in three out of five people and the difference may vary significantly. If the difference is minimal, the patient is often asymptomatic. Over time, however, a minimal difference always becomes greater. With individuals sustaining a greater amount of impact, the change in leg length is more rapid, due to the increased vertical impact. Gravity eventually wins if nothing is done to combat the imbalance.
Some common causes are:
- Arches are not symmetrical in both feet. (correction can be aided with the arch supports or orthotics).
- An abnormal range of motion in the joints. Each joint, including ankle, knee, hip, and low back, should be put through a full range of motion to ensure normal equal motion.
- A weakness of one or more lower extremity muscles, which allows the pelvis to rotate either anteriorly (forward) or posteriorly (backward) in relationship to the other side.
- Bad habits, such as poor posture, slouching in chairs, crossing legs while sitting, standing with all your weight on one leg, always running on the same side of a beveled roads or insufficient stretching.
- Poor quality running shoes.
Correction of functional shortness involves a number of factors.
First, correction of any structural faults has to be made to allow for normal weight distribution and normal functioning of the joints and muscle involved. This is done by correcting any muscular imbalances (right vs. left and front vs. back) that become apparent after a through examination by a Chiropractor. After correction of the muscular imbalances, adjustments of the involved joints is often performed to correct any structural imbalances. This allows all joints to functional under a proportionate weight distribution.
Second, a visual observation of the patient running is often required to determine if there are any abnormalities in the gait or stride (cadence), such as one arm held close to the body in its correct motion.
Third, correction of the short-leg syndrome is made to prevent further stress on the joints. During every Chiropractic patient’s first visit, we examine and determine potential leg-length discrepancies. Within four weeks of treatment, we re-evaluate to determine what changes have occurred.
Spinal and SLS screens are recommended for everyone, but especially school aged children. Corrections made early enough have the potential to last a lifetime.
Be proactive, not reactive when it comes to your health.
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic