Leg length discrepancy and lumbo-pelvic alignment
Structurally, leg length discrepancies (LLD) have been widely reported to result in misalignment and physical alteration of the pelvis, sacrum and lumbar spine. Despite this, there is limited evidence that shows an association between somatic dysfunction of the above areas with LLD. Taking a top down approach, the authors of the present study sought to characterize the most common dysfunctions of the lumbo-pelvic complex and find correlations with weight bearing alteration and LLD.
98 asymptomatic participants between the age of 18 and 40 were included in the study. LLD was measured from the anterior superior iliac spine to the medial malleolus and only those with mild LLD were included. Structural deviation was evaluated by an experienced osteopath while weight bearing was measured using a standardized scale.
There are 2 categories of LLD: structural and functional. A structural LLD is associated with a measurable alteration in the length of the bones commonly as a result of congenital growth or trauma. Functional discrepancies occur more frequently and are thought to be due to altered mechanics of the lower extremity and lumbo-pelvic complex.
After completing the present investigation, the authors found the most common somatic dysfunctions to be: superior innominate sheers, left-on-left sacral torsions, and right rotated lower lumbar spine segments. Of those measured, the majority of participants were found to have ipsilateral longer legs on the side with a right anterior rotation. In conjunction with this, those with an anteriorly rotated pelvis tended to weight bear more through their contralateral leg. Lastly, left-on-left sacral torsions were associated with those individuals with shorter left legs.
The authors point out that structural deviations can help guide clinicians in decision making, but one should proceed with caution, as asymptomatic patients will often present with measurable somatic deviations.
> From: Qureshi et al., J Am Osteopath Assoc 114 (2017) 620-630. All rights reserved to The American Osteopathic Association. Click here for the online summary.