Leg length discrepancy and pelvic tilt
In this article Ross Hauser, MD examines the problems of leg length discrepancy and its role in back and hip pain, and in walking difficulties. Also how these problems can be addressed with Prolotherapy. Leg length discrepancy can be a significant problem of joint instability and degenerative joint disease.
The hip joint joins the leg to the pelvis. Unfortunately for most people, both legs are not exactly the same. They may look the same, but from a biomechanical standpoint, they are not the same. One leg may be rotated either in or out, or one leg may be shorter than the other. The latter is especially common if one leg was broken during childhood. Because the hip joint connects the leg to the pelvis, the hip joint will sustain the brunt of any biomechanical abnormality that may occur.
Leg length discrepancy and degenerative joint forces straining the hip.
- If one leg is shorter than the other, the hip joints will be stressed as the leg-length discrepancy will cause an abnormal gait or walking motion. This is evidenced by the waddling gait of someone with a hip problem. This waddling gait helps remove pressure on the painful hip. The gait cycle is most efficient when the iliac crests are level, you have a straight pelvis, not a tilted pelvis. Unequal leg lengths cause the pelvis to move abnormally, this will cause stress on the pelvis and can include problems of Pelvic Floor Dysfunction, Pubic symphysis in Men, and Pelvic Girdle Pain.
Many people come in with a tilted pelvis. However for many of these patients, that is not what is causing their pain.
This seemingly obvious connection between leg length discrepancy, walking problems and hip and back pain is still a controversial subject.
In a recent study, doctors in Israel published findings in the medical journal Gait and Posture (1) that sought to determine if there is a relationship between the magnitude of leg length discrepancy and the presence of gait deviations.
- The first thing the researchers noted was that controversy still exists as to the clinical significance of leg length discrepancy in spite of the fact that further evidence has been emerging regarding the relationship between several clinical conditions and leg length discrepancy.
- Despite the controversy, the researchers found a significant relationship between anatomic leg length discrepancy and gait deviation. The evidence suggests (something of the obvious) that gait deviations cause more pain and instability in the joints as the discrepancy increases.
Even a small deviation in leg length could impact joint stability and degenerative joint disease
University researchers in Australia and Spain combined to publish research in Journal of manipulative and physiological therapeutics (2) that evaluated the correlation between mild leg length discrepancy and degenerative joint disease or osteoarthritis.
They looked at 235 adults, (121 women and 134 men) who went to the chiropractor for back pain. The researchers found a strong connection between leg length discrepancy and degenerative disc disease at the L5-s1 spinal segment and the L4-L5 spinal segment.
The researchers concluded that patients with hip and lower back pain should be evaluated for leg length discrepancy.
In Finland, doctors writing in the medical journal Acta Orthopaedica went back 29 years to show how different leg lengths affected patients over this near 30 year period.
- Of note: The researchers suggest that 7% of the population have leg-length inequality of 12 mm (almost a half inch or greater) but display no symptoms or problems.
- It has been suggested that leg-length inequality of 5 mm (about 1/5th of an inch) can be associated with an increased risk of osteoarthritis of the knee and hip.
- The Finnish team followed the records of 193 individuals for 29 years. They all started with no leg-length discrepancy.
- When the patients were first observed they had no clinical histories or signs of leg symptoms. The initial standing radiographs of their hips revealed no signs of osteoarthritis.
- After 29 years :
- 24 (12%) of the subjects still had no discernible leg-length difference,
- 62 (32%), had a leg-length difference of 1-4 mm, (less than 1/5th of an inch)
- 74 (38%) of 5-8 mm, (less than 1/3rd of an inch)
- 21 (11%) of 9-12 mm, (almost a half inch)
- and 12 (6%) of over 12 mm (More than a half inch)
- 16 (8%) of the subjects had undergone hip replacement arthroplasty for primary osteoarthritis. Half of the group had both hip and knee replacement.
- Another note: 10 individuals had undergone a joint replacement of the longer leg and only 3 of the shorter leg. In the group of equal leg length, 3 had had an arthroplasty of hip or knee.
- Interpretation – Hip or knee arthroplasty due to primary osteoarthritis had been done 3 times more often to the longer leg than to the shorter.(3)
With leg-length discrepancy, either hip joint can cause pain and usually both hip joints hurt to some degree.
With leg-length discrepancy, either hip joint can cause pain and usually both hip joints hurt to some degree. To propel the leg forward, the hip joint must be raised which strains the gluteus medius muscle and connective tendons and the posterior hip ligaments. Leg-length problems are also associated with recurrent lower back problems because they cause the pelvis to be asymmetric.
Whether it is a low back problem, pubis problem, pelvic floor, or hip problem, leg length discrepancy can cause significant and disabling problems down the road.
Prolotherapy to the sacroiliac and hip joints will correct the asymmetries in the majority of cases. The leg-length discrepancy disappears as a result of the leveling of the pelvis. Often a shoe insert or heel lift will be added to help correct the problem.
Do you have a question? You can get help and information from our Caring Medical staff
1. Murray KJ, Molyneux T, Le Grande MR, Mendez AC, Fuss FK, Azari MF. Association of Mild Leg Length Discrepancy and Degenerative Changes in the Hip Joint and Lumbar Spine. Journal of Manipulative and Physiological Therapeutics. 2017 Jun 30;40(5):320-9. [Google Scholar]
2. Khamis S, Carmeli E. Relationship and Significance of Gait Deviations Associated with Limb Length Discrepancy: A Literature Review. Gait & Posture. 2017 May 31. [Google Scholar]
3. Tallroth K, Ristolainen L, Manninen M. Is a long leg a risk for hip or knee osteoarthritis? A 29-year follow-up study of 193 individuals. Acta Orthopaedica. 2017 Sep 3;88(5):512-5. [Google Scholar]