When you’re talking about a
leg length discrepancy
which is different from
a short leg syndrome
again short leg syndrome is not short leg,
it’s what we call the changes
in the body mechanics that make one leg
appear longer than the other.
A true leg length discrepancy is when you have
an actual change in length
of one leg versus the other.
This is often due to trauma.
It’s got mechanical causes. It can have a
nutritional etiology from early on in life.
It’s important if you do have a true leg length
discrepancy to establish the cause,
to look for causes, and to see
what else could be going on.
Another thing that we check for in the osteopathic world
is pelvic torsion or pelvic trauma.
A leg length discrepancy could be due to a change
or an asymmetry in the pelvic mechanics
or in this case the pelvic anatomy. Again, a true
discrepancy, check the fixed points
and go from fixed point to fixed point, establish
whether or not a true discrepancy
in leg length exist, and check for
pelvic torsion, pelvic twisting
or an abnormality in the pelvic structure.
This is important stuff.
These are the tests
we have to do
to see what’s going on with the
The first is the Trendelenburg test,
the dropping of the hip,
checking for gluteus
Drop the hip.
Drop the hip.
We’re going to go through
each one of these tests separately.
Straight leg raising. Lay the person supine
and raise the leg one at a time.
Usually, if you start getting pain about
20 to 30 degrees of elevation,
you’re worried about a herniated disc.
If it’s one side versus the other,
that’s a sure sign that you
need to look further.
Yes, it could be a
It could be muscular in nature. But if you have
positive straight leg raising,
worry about radiculopathy, worry about
nerve root compression,
worry about swelling,
and take it further.
The Stinchfield test will
give you a sense of
whether or not there’s intra-articular
or extra-articular pathology.
The Stinchfield test differs
from straight leg raising.
The straight leg raising,
you do for the patient.
Stinchfield, you put some resistance to see
whether or not the pain develops.
The FABERE or Patrick Fabere test is flexion,
abduction, external rotation, extension
and you’re looking for
SI joint pathology.
If you have pain with the flexion,
abduction, external rotation,
then you’ll know that you’ve got
some pathology in the SI joint.
The Fadir test is flexion, adduction,
It’s telling you whether there are
problems with the piriformis
or more of the hip
flexors and adductors.
Thomas test will test for
Erichsen’s is when you put the patient prone
and you palpate the SI joint.
It will tell you whether there
are spondylitic changes.
Ober’s test is testing for a contracture
of the iliotibial band.
Again, we’ll go through each one of these tests
separately with a short video.
Hip drop, you can actually elevate the patient, and then
have them move their hip
on each side to assess for
The Adams forward bending test
which is a scoliosis screen
and it’s the test you do when you
have a patient bend forward
and you check for functional
versus structural scoliosis.
If the patient looks like they have a curvature
and they do the forward bend test
and the curvature goes away, then
they’ve got a functional scoliosis.
If you have the patient bend forward and you notice
a hump or a bump on one side,
then you have a structural scoliosis.
Back to the heel lift therapy.
When you have a leg length abnormality
or discrepancy, we do OMT first.
I don’t always do X-rays before I treat
for a short leg syndrome.
A heel lift is added to the heel on the side
of the lowered sacral base.
So, it’s the side where the leg looks longer
because you want to elevate it.
You want to acknowledge the posture
realignment and reeducate the patient
and the patient’s body so that they can help
function normally and function smoothly.
So, treatment of short leg
syndrome is usually OMT,
both relaxing and
stretching the muscle
so that the body can correct itself,
correct the somatic dysfunction,
and make sure you have full mobility reaching
the full range of motion of the joint.
Exercise is going to help prevent short leg syndrome.
Stretching before the exercise
will also help prevent a locking of
a short leg or a chronicity to it.
Lift therapy is done based on the sacral base
unleveling, how much you have,
what is the size of the discrepancy,
how frequent is it.
If I have someone coming
to me to be treated
for short leg syndrome regularly,
that’s when I consider lift therapy.
The first one, two, or three times,
OMT should be enough.
If it gets more chronic,
then I look at the lift.
When you correct a short leg syndrome,
what are you doing?
You’re shifting the
you’re shifting the stance, you’re
shifting the anatomic position
so that the pelvis, back, and
midline are all stable.
You’re also realigning the center of gravity so you know
if someone is balanced or unbalanced,
whether they’re going to be steady or unsteady,
more likely to fall, more likely to drop things.
That’s what fixing a short
leg syndrome can do.
Also, if it is not fixed, people tend
to develop eye strain.
They develop headaches and other
Since the body is all connected, allowing
a short leg syndrome to exist
will get you
When I have a short leg syndrome, I want to
make sure that the pelvis is aligned.
I want to make sure that
the motion is good.
I want to make you have an active lumbar
range of motion which meets
all the physiologic barriers the
person should be able to do.
I’ll even move them to the anatomic barrier
making sure I can push them further
so that the potential is there and we
identify any potential pathology.
So, in testing the active lumbar range of motion,
I’m going to have the patient flex forward,
extend, side bend, and rotate. So flex 80 to 90,
extend 15, 20, rotate 90, rotate 90,
flex to 45, side bend to 45,
side bend to 45.
I also want to check the
hip range of motion.
Have the person flex their hip,
extend their hip,
abduct and adduct the hip, as well as
internally and externally rotate.
If they have restricted motion,
if they can’t do something,
that’s a sign that the problem is
going to come back.
They’re not fully treated,
they have not been relieved,
and they’re not going to
get fully better.
I check the passive range
of motion of the hip.
Usually with the patient supine,
lying on their back,
I’m going to test the hip motion
by moving the hip myself.
I’ll bend the knee, I’ll straighten out
the abductors and adductors
making sure the internal and
external rotation is free.
Then I’ll flip the patient over and
test the passive hip extension,
something that most patients
will not do on their own
and is more likely, in my
experience, to be abnormal.
Again, hip range of motion, flex to 120 to 130,
extend 10 to 20, abduct 45 to 60
adduct 30 to 40, internal
rotation 35 to 40 degrees,
and external rotation
45 to 50 degrees.
That’s just your
Again, a review of some of the tests that
you’re going to be tested on as well:
The hip drop test to assess
whether it is pelvic or lumbar;
straight leg raising looking for radicular
symptoms and contracted muscles;
the Thomas test where you put some resistance
against the leg as they raise it;
FABERE test, hip flexion, abduction,
external rotation, extension
looking for hip and
SI joint pathology;
the Fadir test or Fair test, flexion,
adduction, internal rotation
testing for the piriformis
and hip motion;
and the forward bending test
looking for scoliosis
and whether it is structural