We're back to treating short leg syndrome
and leg length discrepancies
that are apparent but not real. So we're
going to talk more about
the short leg syndrome
diagnosing and treating it.
I'm going to start by talking about
muscle energy techniques
or type 1 mechanics, type 1
or neutral mechanics
when a patient side-bends and
rotates to opposite sides.
It's when you have fluid motion and
you can use this fluid motion
to treat a person quickly and easily
and restore normal function.
In this type 1 dysfunction, we're going
to talk about treating
a leg length abnormality. Again, it's not
a change in the leg length.
It is a short leg syndrome. But you can
lie the patient on the side
and with the concavity of the curve,
move the patient posteriorly
rotate them and help induce
motion that way.
You want to monitor the motion
and make sure that
you're getting the hips and the sacrum
and the pelvis all moving.
You can flex the legs to approximately
bending the knees and using
that as a fulcrum.
Then feel the motion in the
You may want to side bend
the patient as well.
Again, you're using type 1 mechanics
and rotating to opposite sides. If you
don't have motion with
just positioning, you just move it to
a muscle energy procedure
and you have the person push down
engaging their muscles.
You don't want them to use
their lower leg muscles.
You want them to use
their hip muscles.
Then you have the patient relax
and repeat as long as
you have an increase in motion.
The patient will push down
again and again. Do this
at least three times.
But as long as they have more motion
each time, I'm happy.
The passive stretch after
the last repetition
and then reassess the
Next technique, facilitated positional
release is another way
of treating a short leg syndrome.
In this case, you'll place
the patient in the prone position.
I usually put a pillow
under their belly. First of all,
Second of all, a lot of times I use the
pillow as a fulcrum and
to help induce the motion. So I've
got a greater lever
of motion in treating the patient.
I stand to the left
of the patient and to the other side
of the hypertonic muscle
so that I can use gravity and use
positioning to help treat it.
I'll monitor the muscle as I treat
it to make sure that
the tightness goes away and
that I have an easing
or freedom of motion. I'll also
stabilize the patient
with my leg, my hip, or my hand
in order to keep
the patient's ilium from moving.
I'll then use the other side
of the patient to move the pelvis
and to make sure I get
a freedom of motion monitoring the
sacroiliac joint with my finger.
If you need to, you can cross the
leg over and put the hand
on the patient's thigh in order to
pull them and induce
the motion necessary and then
hold it make sure that
you have the full motion that you need.
Hold it and then
give it three to five seconds
and let it relax.
You may want to induce extension and
external rotation as well.
That just helps you find the barrier
and lock up the area
that needs to be treated.
Occasionally, a torsional motion
is needed in order to free up motion.
Hold the position for
three to five seconds, release, and then
I usually flip them over
check the ASIS, knee length,
medial malleolar length.
You can also do this with a patient
in a prone position.
What you do is you have
the patient lay prone
again with a pillow under their belly.
You may want to put
a pillow under their thigh as
well for comfort.
Stand to the left side of the patient and
monitor the lumbar spine,
the sacrum, and the pelvis.
You can monitor
the transverse processes where you'll
have the most tenderness
or you can monitor from motion.
I'll grasp the lower extremity
or the ankle in order to make sure
I can engage a barrier.
Bring the patient's leg into abduction
and find where you have
the restricted motion. Again, this is
facilitated positional release.
So you want to hold them in that position
for three to five seconds.
You'll rotate them until
you find the barrier
and where you can
no longer go.
Then you may want to add a
on the extremity in order
to engage the barrier
and find out where you need to hold them
in order for the body
to reset itself. Hold it for three to four
seconds or until you feel
the release. Then put them
back in a neutral position
and reassess leg lengths. You can
do this in a lumbar flexion
technique as well where you're
going to use gravity
and have the patient, while
they're laying prone
take their leg off the
side of the table.
You want to get behind
You may want to put the foot
against your white coat
in order to help induce motion. Get the
leg parallel to the table,
and then monitor the transverse
processes on that side
to see if you can find an increase
decrease in tenderness and see
how the motion is changing.
When you drop the leg off
the table, you want to
position yourself lateral to
the patient so you can
move the patient well, grasp the
patient's knee or
have them locked in against your
body and use your body
to engage them, and then
use the positioning
to help release the functioning.
You may want to push
the knee forward. But again,
find the area of restriction,
and then hold it in that place,
and then reassess.
Other causes for a short leg syndrome,
where they have,
when a person has a discogenic
they may have a right-sided dysfunction,
a herniated disc on the right.
Even though that's not the cause
of the short leg syndrome,
it can result in a patient locking up,
not moving comfortably.
You may want to treat that
even though you're not
treating the disc itself, you're treating
the secondary causes of the disc.
So I put in the patient prone with
the pillow under the belly.
You can sit on the patient's right
side facing towards the head.
Monitor the ease of
the disc motion.
You will notice that after a treatment
and after holding them,
you can get some easing
of the hypertonicity,
lessening of the muscle spasm
and better motion.
While the pain will still be there with
weight-bearing and with motion,
they are given an area of
comfort and ability
to have more comfort
in their functioning.
So make sure you monitor the muscle and
monitor the sacroiliac junction
while you're doing this procedure
so you have a good sense of
where the restricted motion is
and what you can do.
You may want to rest the leg against
you because again
in this procedure, you want to eliminate
the weight-bearing nature
of the condition since you're not going
to be fixing the problem itself.
You're just treating the secondary
So making sure you
monitor the muscles
while you're doing this is important
for safety reasons.
You may want to also use traction as a
way of pulling on the muscle
easing the hypertonicity and making
the person more comfortable.
I use my hand to monitor it, just gentle
pressure over the muscle.
Three to five pounds is enough
to tell when it's easing up.
Sometimes you need to
to get the locking up and find
out where the barrier is.
Hold it for three to five seconds.
Allow the release to occur
and reassess the muscle and the leg lengths
that you're finding on exam.
Those are some of the initial treatments
for short leg syndrome.
This is going to be a very common condition.
You will see this a lot.
You will treat this a lot and
you will witness it a lot.
Oftentimes, when you just
watch people walking,
you will see them
You will start noticing this
and diagnosing this
in the mall, with your friends
and just realize that
this is something that may
have deeper causes.
It may just be a temporary
But notice it and understand
what you can do to treat it
and how treatment will make
and life better for them.