Have you ever been told that you have one leg shorter than another? It's definitely a question and conversation that comes up frequently here at Pain Free Posture MN. Many clients I've worked with over the years who are suffering from a variety of chronic pain have been told they have one leg shorter than the other. Most think they were born this way and there's nothing they can do about it.
This is always a red flag for me as a Corrective Exercise Specialist, because there are two different types of what's called Short Leg Syndrome. Most were not born this way and therefore, you can actively do something to alleviate the pain AND correct the problem..
My goal is that this blog post will help guide you to better understand the difference between the two, and then identify the best treatment plan to help help you care for the issue.
What is Short Leg Syndrome?
Unfortunately, Short Leg Syndrome can be used as a "catch-all" explanation for TWO very distinct types of limb length difference that are rarely explained to the patient - Structural Shortages and Postural Shortages.
The symptoms may present identically but there SHOULD be a variation in the treatment options based on whether the shortage is structural or postural.
A. Structural Short Leg Syndrome refers to a condition where a person actually has one leg that shorter than the other. The difference in length may be found in the femur or tibia, and in some cases, both bones.
B. Postural or Functional Short Leg Syndrome refers to a condition where the two limbs are actually the SAME length, but due to postural changes at the hip and pelvis, one leg "appears" to be shorter than the other.
Both types of SLS can bring about different combinations of symptoms that can be traced back to this condition.
What causes Short Leg Syndrome?
There are several reasons why you may have developed this condition while you were a child or as an adult. Some common causes are:
- Congenital defects during fetal development, including position of the fetus
- Injuries sustained during delivery, including a dislocated hip
- Childhood injuries or infections to growth plates
- Poor posture by unevenly tilting the pelvis, causing it to treat one leg as shorter than the other
- Hip or knee surgery that has caused the affected leg to shrink
- Dislocations or fractures of the lower limb as an adult
In my experience, the vast majority of what is diagnosed overall as short leg syndrome is the Postural or Functional type. The bone length is actually normal, however the joint position and muscle balance in the limbs is completely out of whack. The body has no choice but to compensate for the discrepancy between the halves of the body in order to accomplish life tasks.
What are symptoms of Short Leg Syndrome?
Because of your body’s attempt to compensate for this problem, various symptoms may occur, including:
- Hip and lower back pain
- Foot and ankle pain
- Knee pain in both legs
- Poor balance while walking or running
In my experience, the most common cause of is due to the disparity in the hips and pelvis due to faulty foot, ankle and knee mechanics. Very frequently you will find one (or both feet) over pronating and plantar-flexing which causes the knee to experience side-to-side tracking instability. This deficit in the kinetic chain is forced to travel upward causing the femur to press the hip socket back, and the pelvis to tilt forward. And this is just one example of how the resulting change in the pelvis can make one leg appear shorter than the other.
How is Short Leg Syndrome treated?
If you've been diagnosed with this condition, you may tried or considered surgery, manipulation or pain medication to find pain relief. However, these methods are not always effective or safe, particularly if your Short Leg Syndrome is simply Postural in nature. In my experience, and in many cases, these modalities do not resolve the pain simply because they do not address the root cause of what is causing the hip and pelvic imbalance. Most often the best and longest lasting relief is obtained through corrective exercise combined with other non-invasive therapies such as self-myofascial release, Pilates, yoga, acupuncture and therapeutic massage.
Recently one of my recent Egoscue University Posture Alignment Specialist Certification students posted this on her Facebook page:
I've been having discussions with my chiropractor. Based on all I've learned with posture therapy I don't believe the whole "one leg is just shorter" theory. I also think that putting a wedge in your shoe will only fix the symptom not the problem. Today we took x-rays of my hip and spine and compared them to the ones we took back in 2006. My hip is almost completely level where in 2006 there was about a 1.5 cm height difference between the left and right. He said that is something he does not usually see. Most people get worse as they age. Lumbar vertebrae also have perfect space in between them. Ha! No quick fixes for me. Just gonna keep working out including lots of posture exercises. #egoscue #painfree
And I received this email with a similar experience.
I saw your Facebook post about whether anyone has been told they have one leg longer than the other. I certainly have! I wanted to share my story with you.
I saw an orthopedist when I was younger regarding scoliosis. He told me one of my legs was longer than the other when I was about 12-13, and said that was one of the reasons why I had scoliosis. He did not take the measurement from an x-ray, he just said this from observation and assumed that one leg was about 1 inch longer due to the hip height displacement.
So I went back to this same orthopedist about 16 years later for a general check-up since I hadn't had x-rays since I was about 13. Before I saw him, his back office assistant took some rough measurements while I was lying down and the assistant said my legs were actually the same length when he measured them. I couldn't believe it! I asked if he was certain and he measured again and said they were within 1/4" of each other, which is considered "normal" clinically and he said many people have slight discrepancies.
When I saw the orthopedist, he again tried telling me that there was nothing I could do about scoliosis since one of my legs was longer than the other. I asked for the exact difference in leg lengths and how he was calculating the measurement. He said the only accurate measurement is taken from a lying down x-ray. I asked if we could do that and he said it wasn't needed since it was obvious one hip was higher than the other and that was causing the difference. Again, he based the leg length difference on the difference in hip elevation.
Needless to say I haven't gone back to that orthopedist. I think I was lucky that I was not fused as a teenager (I really have no idea how I escaped that one!). I still haven't had my legs officially measured via x-ray as the doctors think it would be unnecessary radiation, but until I do I choose to believe the assistant. My hip elevation has improved a lot with Egoscue, they are not level yet but they are definitely getting closer!
Personally, I think it is borderline reckless for a doctor to tell a patient that one leg is notably longer than the other without taking an official measurement. For anyone, I would really recommend asking for a measurement before accepting the statement "one of your legs is longer than the other."
If you've been diagnosed as having Short Leg Syndrome, I hope you've gleaned some insight into identifying the root cause of your pain problem and questions you should be asking your health care provider. The healing plan will be very different depending on which category your short leg syndrome falls into.
If you are one of the majority that falls into the Postural category, REMEMBER this! Treating the symptom (pain) will rarely provide the lasting pain relief you are seeking if the treatment does not address the body as a unit. The most successful programs include a combination corrective exercise programming that addresses the joint mechanic problems and helps restore the muscle-length tension relationships to the four major load joints.
If you have questions or comments about this article, we'd love your feedback.
1. Short Leg Syndrome | Our Health Network
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Author: Deb Preachuk is a Corrective Exercise Specialist and the founder/owner of Pain Free Posture MN. Follow Deb on Facebook, Twitter, Google+, and LinkedIn, or subscribe to her YouTube, Pinterest or Instagram pages.
With over 25 years in the health and wellness field, Deb helps real people transform real-world chronic pain challenges into achievable results. Deb infuses her teaching with an honest, open and down-to-earth mix of chronic pain relief therapeutic modalities training techniques to make the concepts of pain relief and body/mind transformation accessible and achievable!