Research
Henry Ford Health System, 2001
St. John Neuromuscular Therapy is Effective in Reducing Symptoms of Intractable Headaches: A Complementary and Integrative Medicine Study
St. John, P and Levine, R et al
Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance.
Knutson GA.
BACKGROUND: Leg-length inequality is most often divided into two groups: anatomic and functional. Part I of this review analyses data collected on anatomic leg-length inequality relative to prevalence, magnitude, effects and clinical significance. Part II examines the functional "short leg" including anatomic-functional relationships, and provides an outline for clinical decision-making. METHODS: Online database--Medline, CINAHL and MANTIS--and library searches for the time frame of 1970-2005 were done using the term "leg-length inequality". RESULTS AND DISCUSSION: Using data on leg-length inequality obtained by accurate and reliable x-ray methods, the prevalence of anatomic inequality was found to be 90%, the mean magnitude of anatomic inequality was 5.2 mm (SD 4.1). The evidence suggests that, for most people, anatomic leg-length inequality does not appear to be clinically significant until the magnitude reaches approximately 20 mm (approximately 3/4"). CONCLUSION: Anatomic leg-length inequality is near universal, but the average magnitude is small and not likely to be clinically significant.
| Spine. 1983 Sep;8(6):643-51. |
Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality.
Friberg O.
A simple and reliable low dose radiologic method developed by the author was used to measure leg length inequality of 798 patients with chronic and therapy resistant low-back and/or unilateral hip symptoms and 359 symptom free subjects. Statistically highly significant correlations of the symptoms and leg length inequality were observed. In the majority (79 and 89%), the chronic or recurrent sciatic pain and unilateral hip symptoms occurred on the side of the longer lower extremity. When correcting the leg length inequality simply with an adequate shoe lift, a permanent and mostly complete alleviation of symptoms was achieved in the majority of the cases. The unilateral symptoms associated with mostly unrecognized leg length inequality of 5 to 25 mm were, at least in part, due to the biomechanical responses, like bending and rotational forces, needed for compensation of the lateral imbalance caused by leg length inequality.
Sports Med. 1992 Dec;14(6):422-9.
Leg length inequality. Implications for running injury prevention.
McCaw ST.
Department of Health, Physical Education, Recreation and Dance, Illinois State University, Normal.
Leg length inequality is a relatively common musculoskeletal malalignment related to structural, postural and environmental factors. The inequality is a plausible aetiological factor in the development of a variety of overuse injuries because it alters the magnitude and distribution of mechanical stress within the body. Leg length inequality has been linked with lower extremity stress fractures, low back pain, hip pain and vertebral disk problems of runners. The appropriateness of using inshoe lifts to reduce or eliminate the inequality has not been rigorously evaluated. Further research is needed to quantify the biomechanical effects of leg length inequality as it interacts with other factors related to running injury.
Eur Spine J. 1999;8(1):40-5.
Acute systematic and variable postural adaptations induced by an orthopaedic shoe lift in control subjects.
Beaudoin L, Zabjek KF, Leroux MA, Coillard C, Rivard CH.
Departement de chirurgie, Faculte de Medicine, Montreal, Quebec, Canada.
A small leg length inequality, either true or functional, can be implicated in the pathogenesis of numerous spinal disorders. The correction of a leg length inequality with the goal of treating a spinal pathology is often achieved with the use of a shoe lift. Little research has focused on the impact of this correction on the three-dimensional (3D) postural organisation. The goal of this study is to quantify in control subjects the 3D postural changes to the pelvis, trunk, scapular belt and head, induced by a shoe lift. The postural geometry of 20 female subjects (X = 22, sigma = 1.2) was evaluated using a motion analysis system for three randomised conditions: control, and right and left shoe lift. Acute postural adaptations were noted for all subjects, principally manifested through the tilt of the pelvis, asymmetric version of the left and right iliac bones, and a lateral shift of the pelvis and scapular belt. The difference in the version of the right and left iliac bones was positively associated with the pelvic tilt. Postural adaptations were noted to vary between subjects for rotation and postero-anterior shift of the pelvis and scapular belt. No notable differences between conditions were noted in the estimation of kyphosis and lordosis. The observed systematic and variable postural adaptations noted in the presence of a shoe lift reflects the unique constraints of the musculoskeletal system. This suggests that the global impact of a shoe lift on a patient's posture should also be considered during treatment. This study provides a basis for comparison of future research involving pathological populations.
| Spine. 2003 Nov 1;28(21):2472-6. |
Comment in:
Spine. 2004 Aug 15;29(16):1838; author reply 1838-9.
The effect of leg length discrepancy on spinal motion during gait: three-dimensional analysis in healthy volunteers.
Kakushima M, Miyamoto K, Shimizu K.
Departments of Orthopaedic Surgery, Hirano General Hospital, Gifu, Japan.
STUDY DESIGN: This study focused on the effects of leg length discrepancy on the motion of the normal spine during gait in healthy male volunteers who wore a heel-raising orthotic device on the right foot. OBJECTIVE: To evaluate the effect of leg length discrepancy on the changes in curvature of the normal spine during gait. SUMMARY OF BACKGROUND DATA: There are few published data on the effects of leg length discrepancy on the motion of the normal spine during gait. METHODS: An orthotic device that raised the heel by 3 cm was used to simulate leg length discrepancy. Twenty-two healthy male volunteers participated (age: 28.2 +/- 6.1 years, average +/- SD). The dynamic curvatures of the spine under two conditions (without and with a heel-raising orthotic device; normal gait and heel-raising gait) were evaluated during gait. The leg length discrepancy values without and with the device were measured and analyzed using a VICON system (Oxford Metrics, United Kingdom). RESULTS: The spine showed an asymmetrical lateral-bending motion during heel-raising gait as compensation for the leg length discrepancy. Maximum lateral bending angle of the thoracic spine was 4.2 +/- 1.4 degrees in heel-raising gait, whereas it was 3.0 +/- 1.0 degrees in normal gait. Maximum lateral bending angle of the lumbar spine was 8.1 +/- 2.8 degrees in heel-raising gait, whereas it was 6.1 +/- 2.1 degrees in normal gait. The maximum bending angle and bending velocity were significantly larger in the heel-raising gait than in normal gait. CONCLUSION: Patients who have leg length discrepancy due to disorders in the lower extremities are at greater risk of developing disabling spinal disorders due to exaggerated degenerative change. Therefore, treatment for leg length discrepancy may be helpful in preventing degenerative spinal changes.
PMID: 14595166 [PubMed - indexed for MEDLINE]
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