Leg Length Discrepancy

by Tyler Cymet, DO, FACOFP

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    00:01 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.

    00:15 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.

    00:25 It’s got mechanical causes. It can have a nutritional etiology from early on in life.

    00:33 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.

    00:44 Another thing that we check for in the osteopathic world is pelvic torsion or pelvic trauma.

    00:51 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.

    01:28 These are the tests we have to do to see what’s going on with the musculoskeletal system.

    01:34 The first is the Trendelenburg test, the dropping of the hip, checking for gluteus medius weakness.

    01:42 Drop the hip. Drop the hip.

    01:44 We’re going to go through each one of these tests separately.

    01:48 Straight leg raising. Lay the person supine and raise the leg one at a time.

    01:55 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.

    02:09 Yes, it could be a contracted hamstring.

    02:11 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.

    02:22 The Stinchfield test will give you a sense of whether or not there’s intra-articular or extra-articular pathology.

    02:30 The Stinchfield test differs from straight leg raising.

    02:34 The straight leg raising, you do for the patient.

    02:38 Stinchfield, you put some resistance to see whether or not the pain develops.

    02:43 The FABERE or Patrick Fabere test is flexion, abduction, external rotation, extension and you’re looking for SI joint pathology.

    02:55 If you have pain with the flexion, abduction, external rotation, then you’ll know that you’ve got some pathology in the SI joint.

    03:04 The Fadir test is flexion, adduction, internal rotation.

    03:11 It’s telling you whether there are problems with the piriformis or more of the hip flexors and adductors.

    03:19 Thomas test will test for iliopsoas contraction.

    03:26 Erichsen’s is when you put the patient prone and you palpate the SI joint.

    03:31 It will tell you whether there are spondylitic changes.

    03:34 Ober’s test is testing for a contracture of the iliotibial band.

    03:40 Again, we’ll go through each one of these tests separately with a short video.

    03:45 Hip drop, you can actually elevate the patient, and then have them move their hip on each side to assess for lumbar involvement.

    03:54 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.

    04:08 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.

    04:16 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.

    04:28 When you have a leg length abnormality or discrepancy, we do OMT first.

    04:34 I don’t always do X-rays before I treat for a short leg syndrome.

    04:39 A heel lift is added to the heel on the side of the lowered sacral base.

    04:45 So, it’s the side where the leg looks longer because you want to elevate it.

    04:51 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.

    05:02 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.

    05:17 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.

    05:30 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.

    05:39 If I have someone coming to me to be treated for short leg syndrome regularly, that’s when I consider lift therapy.

    05:46 The first one, two, or three times, OMT should be enough.

    05:50 If it gets more chronic, then I look at the lift.

    05:53 When you correct a short leg syndrome, what are you doing? You’re shifting the body weight, you’re shifting the stance, you’re shifting the anatomic position so that the pelvis, back, and midline are all stable.

    06:08 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.

    06:19 That’s what fixing a short leg syndrome can do.

    06:24 Also, if it is not fixed, people tend to develop eye strain.

    06:29 They develop headaches and other musculoskeletal symptoms.

    06:34 Since the body is all connected, allowing a short leg syndrome to exist will get you into trouble.

    06:42 When I have a short leg syndrome, I want to make sure that the pelvis is aligned.

    06:47 I want to make sure that the motion is good.

    06:49 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.

    06:58 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.

    07:07 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.

    07:28 I also want to check the hip range of motion.

    07:33 Have the person flex their hip, extend their hip, abduct and adduct the hip, as well as internally and externally rotate.

    07:41 If they have restricted motion, if they can’t do something, that’s a sign that the problem is going to come back.

    07:47 They’re not fully treated, they have not been relieved, and they’re not going to get fully better.

    07:53 I check the passive range of motion of the hip.

    07:57 Usually with the patient supine, lying on their back, I’m going to test the hip motion by moving the hip myself.

    08:05 I’ll bend the knee, I’ll straighten out the abductors and adductors making sure the internal and external rotation is free.

    08:13 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.

    08:27 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.

    08:46 That’s just your cheat sheet.

    08:48 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 or functional.

    About the Lecture

    The lecture Leg Length Discrepancy by Tyler Cymet, DO, FACOFP is from the course Osteopathic Treatment and Clinical Application by Region. It contains the following chapters:

    • Leg Length Discrepancy
    • Heel Lift Therapy
    • Treatment of "Short Leg Syndrome"

    Included Quiz Questions

    1. Straight leg raise
    2. FABER/Patrick's test
    3. Ober's test
    4. Thomas test
    5. Trendelenburg test
    1. Ober's test
    2. Straight leg raise
    3. Trendelenburg test
    4. FABER/Patrick's test
    5. Thomas test
    1. Thomas test
    2. Trendelenburg test
    3. Straight leg raise
    4. FABER/Patrick's test
    5. Ober's test
    1. Trendelenburg test
    2. FABER/Patrick's test
    3. Straight leg raise
    4. Thomas test
    5. Ober's test
    1. 120 degrees
    2. 10–20 degrees
    3. 30–40 degrees
    4. 45–60 degrees
    5. 60–90 degrees

    Author of lecture Leg Length Discrepancy

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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