Back Pain…& the short right leg syndrome
July 15, 2009 – 8:04 amAn exceptionally significant postural issue begging for a logical explanation is the ‘short right leg syndrome’. Although an inferred awareness of right-sided limb length shortness has existed for thousands of years with decades of published research available, no one has yet to produce a universally acceptable answer to these two basic questions:
1. Why the unusual frequency of short right legs seen in clinic?
2. How does this common limb length discrepancy relate to chronic pain and somatic dysfunction?
How do you measure leg length…supine or prone and what’s the difference?
24 Responses to “Back Pain…& the short right leg syndrome”
Hello, I’ve never done this before! First, I don’t know, but I wonder….is there a correlation with right handedness (and does this have a correlation with pelvic rotation and then you may get a functional short leg??) Also, this is a little out there, is there a leg usually crossed over the other one in utero?? Is there a observable pattern of that? And doesn’t connective tissue spiral through our bodies? Does it go in a certain direction? (and is it the opposite south of the equator? Ha!) Can’t wait to try one of your workshops once I get the $$ and the time at the same time. Thanks for your inspiration! Julie
By Julie Smith on Jul 15, 2009
Hello Julie:
You’ve made some very good observations that have been floating around the research community for some time. Cerebral lateralization is one of my pet theories. First proposed by Previc and Geschwind, their studies explain how motor and vestibular (balance) dominance affect patterns we see daily in our practices. J Gordon Zink called them “Common Compensatory Patterns”.
Therapeutically, I find this research very helpful in getting to the “key” lesion in many chronic back pain cases. To read a very compresensive article on the subject, visit http://erikdalton.com/articleCCPThesis.pdf
Anyone want to address the question about the importance of testing leg length supine vs prone? What is the big deal…how do the results from these tests differ?
Thanks Julie for the post….ERIK
By Erik Dalton on Jul 15, 2009
Hello Mr Dalton,
My name is Michael Ewell and I have taking your courses. The Myoskeletal Zone Therapy procedures you have taught me( after a supine leg test)has become the first treatment I do with clients. Going through the zones( the client still dressed)has increased mobility and helped when I then do deep tissue especially on the elevated ilium on the short side, most of the time it’s not! I get more issues with the 3rd zone, the thoracolumbar fascia, perhaps there’s the place to consider also. Clients with erector pain say T10 to L1 on one side benefit from your piriformis and glute fascia release on the other. I really believe in your work! I am saving for your new DVD set to add to my work. Thanks for everything!
Michael Ewell
By Michael Ewell on Jul 15, 2009
When assessing for leg length difference I’ve found the most accurate results standing and supine (sitting for a hemi-pelvis test).
Standing is important when thinking about how the body responds to gravitational pull. Supine is important to see how the bodies response translates into muscular fixations as rest. Together yields an more accurate portrayal.
I find the landmarks prone (minus sacrum measurements) to be a bit harder to read. Perhaps that is just me. Thoughts?
By Justin Kobbe on Jul 15, 2009
The only accurate way to access a leg length dsicrepancy is with an “scanogram xray”. This is the only way to get appropriate measurements to see if the bone’s are longer or shorter. Then, one can compare the tibia’s and femur’s. Also, the pelvis needs to be examined as well. It sure will make treatment easier and determination if a heel or full foot lift is needed accurately. Otherwise, a person may actual develop ,more symptoms if the wrong lift is suggested.
Treat the whole person.
My 50 cents,,,,,,Cant beleive no one mentions this fact. Sad so many speculate with incorrect advise.
By Dan on Jul 18, 2009
Erik, your articles talk about the right short leg. i have a short left leg with some mild left lumbar scoliosis. my left hip is lower and the left side looks flat. the left shoulder and clavcle are lower than the right. i may have a slightly smaller left hemi-pelvis.
the right hip is higher than the left, and the right scapula and shoulder are higher. head tilts forward and to the right.
i supinate on short left side by the way, have medium-high flexible arches.
the upper crossed and lower crossed pictures do not show my pattern. is there a “dalton” pattern i fit into?
thanks in advance, linda
By LINDA on Aug 3, 2009
Cool, I just discovered this blog.
1. As you stated above, l generally find the average 1/2 inch imbalances of all ages to be brain hemisphere dominance related. Neurologically related systemically, to say the least.
My answer to Erik’s #1 would be due to the majority of people being left brain dominant. Although, I am finding more and more short left legs here in CA with my creative industry right brainers
A. There’s the usual 1/2 inch imbalance, with muscle testing showing strength on the short leg side in both hip flexor and arm/finger tests, as well as more tension in same side occipitals.
B. During more stressful times, a person can be opposite arm and leg, or both legs are strong with both arms weak, or vice-versa.
C. Someone with an extremely stressful life, and/or locked in victim mode, they will actually be weak all the way around, with the legs showing even. Rarely are the legs even, so if you see this, muscle test both legs and arms. If all weak, they are not ready for deep bodywork, due to deep emotional involvement; of which is almost always traumatic abuse.
Wanting to avoid occipital-lift brain-reboot techniques, I developed a two-finger bio-energetic balancing technique that I assume is perhaps a temporary reboot of the ANS, as it equalizes leg lengths, and strength comes back all around from testing before and after.
When the short leg does not drop all the way, then it generally means there is something stuck; wether it be S/I, facets, ribs, A/O, etc.
If the imbalance is pushing 1″, and always comes back, then I’ll also consider shifted S/I, or anatomical discrepancies. And of course major scoliotic patterns.
Regardless of the cause, the imbalance has generally been there for years, and thus developed muscular and fascial restrictions and patterns for us to have fun with. MAT is a very useful set of tools.
My answer to Erik’s #2 would be that the ongoing imbalance is from (stress-related hemisphere sub-dominance) weak muscles preceding and thus allowing the opposing strong muscles to shorten. Along with the righting reflex equilibrium balancing act the body has, to keep the center of the head over the center of the pelvis with eyes and ears level to gravity. Now, over time, you get into the pain generating abnormal joint pressures and angles, overworked weak eccentric muscles, nerve impingement, etc. etc.
Don’t forget, the imbalances are a combination of left/right, anterior/posterior, and rotational torquing, altogether at the same time. ie: an ilium can be hiked, rotated, and torqued. And you are left scratching your head talking to yourself while the client has a funny look on their face watching you. Oh wait, that’s what I do =)
2. I always test supine, then standing and prone if things are slow to change. Prone testing can be useful for rect.fem., tfl, A/O, and hip flexor involvement with the legs bent while testing. Given the short amount of time, I do a quick check supine, and go from there.
Robert Fisher
By Robert Fisher on Aug 13, 2009
You’re one of the first to comment on my Myoskeletal Zone class Michael. I’ve only taught that program three times but I absolutely love it. Appreciate you bringing that up and thanks input about the relationship of T10 to L1 to the thoracolumbar junction (3rd zone).
By Erik Dalton on Aug 14, 2009
Prone is a bit harder particularly if you include knee-flexion tests such as the Dierefield Maneuver into the assessment. However, it is still one of my favorite ways of discerning possible SI joint dysfunction…thx.
By Erik Dalton on Aug 14, 2009
Yes Dan, improvements over the past few years have made distinguished the scanogram as one of the best tools for accurate limb length measurement. However, most manual therapist’s offices are not set up to include this type of technology. Furthermore, CT scanograms expose the client to too much radiation for my purposes. Although MRI scanograms eliminate this problem, the costs are often prohibitive and in some of the population, there is the claustrophobia issue to deal with.
In ankle, knee and hip replacement cases, scanograms are the perfect tool. But for most skilled manual therapists, the use of anatomical landmark testing has proven (over the past 100 years) to provide adequate information to allow restoration of function and alignment to most bodies.
If my client’s evaluations point toward anatomical limb length shortening, I’ll refer them out for scanograms or other high-quality radiographic testing. But really, in my opinion…the ‘proof’s in the pudding’. Are your assessments and corrections alleviating their problems using the skills you’ve honed over the years…or not? If not, admit it and move to the next level.
Thx for the fine input on this extremely important topic.
By Erik Dalton on Aug 14, 2009
You might begin by corecting sagittal plane upper and lower crossed muscle imbalance patterns and then re-evaluate to see is some of the strain has been resolved. In the presence of a possible hemi-pelvis, you need more accurate measurement tools such as radiographic studies as discussed by Dan above.
By Erik Dalton on Aug 14, 2009
Some interesting points being made here. I’d like to hear what you think of Robert’s proposals…please!
By Erik Dalton on Aug 14, 2009
I find the brain dominance information fascinating. But I look at things a little more simplistically. Here’s my theory, based on years of observation and no science whatsoever:
1) The right leg is not only more often shorter, but also more often laterally rotated.
2) The left leg is more often medially rotated.
3) When driving, most people have their right leg and knee flexed a bit more than the left, with the right leg slightly laterally rotated, ready for the foot to press on the accelerator and move to the brake when needed – all with consistent tension going up through the leg to the deep 6 rotators, as well as gluteus medius.
4) Also when driving, the left leg tends to extend a bit further forward, with a slight medial rotation due to the placement of the wheel well in most cars.
5) Hence the tendency for shorter and laterally rotated right leg and medially rotated left leg, with pain due to persistent hypertonic muscle patterns, particularly in the piriformis and gluteus medius.
6) Short leg presentations are more often due to these hypertonic muscle patterns and pelvic imbalance than actual femur/tibia length discrepancies. Lifts/orthotics, etc., may help sometimes short-term, but used indefinitely they can encourage the musculoskeletal dysfunction.
I use different forms of myofascial release and other techniques to break up the patterns. But modifying driving habits is hard, though not impossible, to do – i.e. adjusting the seat position periodically…
By John J. Ray on Aug 15, 2009
I like the driving posture observation. Good catch. And it makes a lot of sense. Depending on the amount of driving one does, this will undoubtedly be an ongoing additional factor affecting the muscles you mentioned.
Question is….. why do children, who do not drive, also have the same patterns????
By Robert Fisher on Aug 16, 2009
You guys are coming up with some interesting observations…keep up the chatter.
By Erik Dalton on Aug 16, 2009
I haven’t noticed the same patterns in children. I work on kids with ADHD and other issues periodically.
By John J. Ray on Aug 16, 2009
Yeah, the pattern is there amongst all ages. You can do the muscle testing with them as well. It’s a fun way to get them involved and comfortable too.
As I mentioned earlier, my creative CA clients actually pull up short on the left leg. So I’ll have to see if the rotations you mentioned are along the leg discrepancy, or more right rotated, the same as the others.
By Robert Fisher on Aug 17, 2009
I have noticed the link to driving as well. In older clients, especially women, who rarely or never drive, I do not see such a prevelance of short right leg syndrome. The pelvis tends to be bilaterally roated, or the left leg is just as likely as the right to be short. I also fail to find the strong prevelance of short right legs in children and adolescents. This indicates to me a strong link to driving posture.
By Joel Romig on Aug 19, 2009
Early in my practice, my wife went fairly often to the chiropractor for pain in the mid thoracic. I was studying about the effects of hip rotation and short/long leg syndrome. This was exactly the situation my wife was experiencing. She did not have facets that were stuck. I follow your assessment and treatment protocol. she has now been without back pain since then. Like all of us, I have a number of clients with back pain. I first assess all clients for short leg and hip rotation. I treat as protol. I also instruct my clients how to check themselves daily for balance: head, shoulders, elbows, hips, knees while looking in a mirror. I instruct them how to check their ASIS prone and how to perform self NMT for muscle shortness and tension. Most clients just come in for a quick mobilization. They feel much better, more active and have fewer insidences of back pain and stress.
By Ken Nelson on Aug 30, 2009
So far I have not heard any mention of checking the height of knees when patient is laying down and knees are bent for short leg syndrome.
If when laying down and legs are straight the patient is level, but bending the knees shows the left knee higher, what does this mean?
Is this test valid? Thanks in advance, Linda
By LINDA on Aug 30, 2009
Hey Ken…I like the idea of having them check their own anatomical landmarks between sessions and offering specific home-retraining exercises that can be done to help keep them in a balanced state…nice!
By Erik Dalton on Aug 31, 2009
I just assessed a new client. She had a fall ten years ago and has been in high chronic pain since the accident. There is no structural damage. Left ilium anteriorly rotated approx. 11/2″. Standard muscle,fascia and joint involvement.
Question? She is in postpartum, delivering 2 weeks ago. Is it appropriate to work with the pelvis for sacral base decompression,sacral roll or is it contraindicated for a period of time until tissues normalize?
Thankyou
Ken
ps
I just received the video series a few days ago. Incredible!! the above client called for an appointment a few days earlier with sciatic pain. I spent four hours on disk 1 and 4. Perfect timing–first client! But it is amazing what knowledge can provide. A month ago, I would not have recognized the problem in the prone position and would not have assessed by landmarks on sacrum. Blessings
By Ken Nelson on Sep 15, 2009
Blessings to you Ken…thx for the interesting post.
I’m headed out the door for an Atlanta Myoskeletal workshop and then on to Orlando for the AMTA National Convention so I’ll respond when I return….keep the passion my friend!
By Erik Dalton on Sep 16, 2009
Is this the same Bob Fisher that practiced in Northwest Washington, D. C.? If so I’m a former patient and would enjoy hearing from you. My email is: pidgegoddess@aol.com. Glad you’re still into bioenergetics!
By Pam Richards on Jun 14, 2010