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Leg Length // Pelvic Unleveling // InjuryDiagnosis

Posted By: KP
Date: Tuesday, 5 February 2008, at 2:50 p.m.

From an earlier conversation regarding pelvic unleveling and possible resultant injury ==>

:?? << My chiropractor told me that my right hip is rotated forward, effectively shortening my right leg by about half an inch. This explains why I can never seem to dial in my seat for both my left and right legs to be pain free. I was wondering if anyone has tried any remedies outside of going to the chiropractor. >>

:wave Dr. KP: You will be able to manage the situation most effectively and with additional certainty if you can label leg length difference as (1) functional (due to spasm and/or rotation at the sacral illiac joint), (2) anatomical (actual boney length differences of the femur or tibia) or (3) a combination of the two. X-Ray of both femurs and both tibia allows you to measure bone length. If you have anatomical differences, you may place a lift in one shoe, shim one pedal, move cleat position on one shoe, etc. A short leg on the bike can create significant problems for you as the short leg reaches for the pedal. Your pelvis rocks as you reach and your taint can get rubbed raw and low back may get pretty sore. You'll often have chronic saddle sores on the short leg side due to rocking/chaffing.

:?( << are you disputing that my chiropractor is able to make a leg length discrepancy assessment? The way she explained it to me was that my right hip was rotated forward (top of hip pushed forward, bottom of hip pushed back) which was creating the length difference. I really want to be careful implementing a shim or lift if I'm only going to be reinforcing a problem I should in fact be correcting.

:spin Dr. KP: I specifically didn't comment on your doctor's assessment. That would be easy, but unfair. I don't know what she did. I am a chiropractor of 25 years // and I have an anatomical short left leg (14mm). I know what I need to do to properly differentially diagnose anatomical short leg vs functional short leg. One is actual boney length difference from side to side (femur vs femur // tibia vs tibia). Functional or 'apparent' short leg can be due to muscle spasm, guarding, scoliosis and a host of other things. Sounds like you'll need to dig a little deeper to see how your doc came to her conclusion and then decide whether that is enough for you.

:?( << Can a problem such as described be dealt with using orthotics? >>

:) Dr. KP: It depends. What is the purpose of the orthotic? If you have sh*t for feet, like me, you might use orthotics effectively. If you also have an anatomical short leg you could build a heel lift into one orthotic. I generally go about half the difference. My lift is 7mm.

:\ << My feet are in good shape (wide w/ high arch) but I have continually had an issue with my right hip (behind the top of the femur). I've been to a local chiro guy who always says that hip is misaligned. He set me straight (he says) last week but it's still a problem. He believes the solution is orthotics and he's now in the orthotic business (as of last year). He may be right on and very competent but I'm pretty sure I'm his only runner client. I just don't know if I'm heading in the right direction with this. Wish you were up here. If I still don't have a solution by March I'll make an appointment with you when I'm in town for O'side. Each time I get a breakthrough I'll get a 2 month reprieve and then it hits again. Pain starts at mile 2 and I can actually push behind the femur and run pain free for another mile. This continues with greater frequency as I run until it kinda just goes numb and I run through it. Probably not a good thing. >>

:ok Dr. KP: Your man may be right. I can' tell. Often there is an array of things going on. That's why it can be so darn hard to clear everything up and we suffer frequent recurrence. Think about what other structures may be part in parcel to your problem that are in that area (an area that usually has some soft tissue component involved) that might be treated with ART, deep massage or strengthened with specific rehab. The vastus lateralis inserts way up in there. Tensor Fascia Latae could be a player. The major muscles of the posterior hip are the gluteals, piriformis, gamelli, obturators and quadratus femoris. They work together and in similar directions. However, they should be treated in isolation and individually. Interestingly, these muscles change function based on how much the hip is flexed. When you leg is straight they are "external" rotators of the hip. When your hip is flexed past 90 degrees they are internal hip rotators and do some abduction. These muscles are all deep in your butt, behind your "hip" or femur. The fact that you can reach back and dig into the area for relief is a sign they may be involved. Have a look at an anatomy book and see if these muscles are in the area of your symptoms. Itís hard for me to tell by your description. These structures can also influence the sciatic nerve that exits down the leg near there. They are also frequently irritated in patients with LBP as they are recruited to do a lot of compensatory motion in those cases (disc, facet pain, etc).

:?? << is this the sort of thing that might happen over time with, say, misaligned shoe cleats or running on canted surfaces? I've been experiencing hip pain and subsequent sorts of compensation issues over the last year or so. I can't seem to find a good alignment for my cycling cleats, especially on the right...and this is after a few years of running on significantly canted roads. I've got an appointment w/phys therapy tomorrow for hip pain issues...maybe they can check for this type of situation? >>

:ok Dr. KP: One of the key points to take from my previous answers is that often, there are several contributing factors that support chronic recurring sports injury. You need to consider equipment, terrain, protocols, genetic predisposition, past wear and tear, anatomical anomalies, structural irregularities, tendons, fascia, nerves, repetitive strains, adhesions joint dysfunction, etc, etc. The best folks at differentially diagnosing these types of issues are the guys that have spent 20 years working to dig out answers while considering all possible combinations of issues. They are not MDs, DCs, PTs -- but they may be MDs, DCs or PTs -- or they may be a very experienced team trainer at the Olympic Training Center. Lets remember, this is not about egos, it's about who can give you _correct_ answers. Nobody is right all the time, but some guys get it right more often and more quickly. As athletes, these are guys we want to see. Sometimes it takes a team to find the answers. I am not sure if your practitioner will be able to help you. Lets hope he is willing to listen and remain open minded.

coach KP

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