Looking back on my past and current injuries, they seem to be mostly on my right side. One completely useless ortho did tell me that my right leg is shorter than the other. However, I think it may be because my hips are unbalanced, which based on my own observations seems to be the case. Anyways, I’m just wondering who the best person to seek out treatment and diagnosis is: chiro/PT/sports medicine? I currently have PF in my right foot and lower back pain on my right side and seem to lean to the right when I am on my bike. Any help would be much appreciated.
you need to be referred to a radiologist… an X-ray specifically designed to determine leg length discrepancy is the best.
Having said that a good bike fitter can lie you on the floor and do all the tests and measurements they do and figure out which leg is shorter and by how much. I use LeWedge shims in my cycling shoes now on my left side and have cut injuries way down.
good luck.
Do I still want to use shims if the discrepancy is caused by a misaligned hip? Shouldn’t I try to fix the hips first?
not sure what a misaligned hip is. That’s a questionable area that you should see a doctor on. The only place I see that online after a quick search on a popular search engine is on chiropractic websites, so again, I question it.
For example, you have a misaligned hip. This is caused by muscles on one side of your body tensing. This is caused by overuse injures because you are an endurance athlete. This in turn was caused by a leg length discrepancy, which caused your body to tense up, which threw your muscles out of balance, which misaligned your hip.
You see what I’m getting at? If you’re a serious cyclist, ie. you cycle a few times a week and do some longer rides on the weekends, I’d say see a REPUTABLE bike fitter, get yourself lined up, shimmed, etc, and meanwhile get an xray of your legs.
Please let me save you time, money and aggravation. Just see someone who can make an insert for your shoe for your short leg. You might need to experiment until you get the right fit.
As someone who has struggled with a longer left leg (for whatever reason, I’ve stopped caring why) for a long time believe me I have heard it all … chiropractors and PTs want to tell you your hip is “misaligned” and you need to work with them to “open it up.” Let me tell you in my experience the entire field of physical therapy and chiropractors is a rip off and fraud. I have seen a half dozen PTs and chiros about various problems related to this problem and none of them (except the one who told me to get an insert) have been more helpful than RICE and a decent insert. Prima facie, hip treatments are absurd. Here you have the strongest bones and muscles in the body, muscles that take the pounding of dozens of miles of walking and running per week, perhaps 100+ miles of cycling (how many tens of thousands of movements is that per week?), and PTs and chiros want to claim that there are exercises that in 15 minutes per day are going to “strengthen” and “re-align” some misalignment that is so severe that it is causing a raft of injuries. Complete nonsense. Get an insert.
Edit: Rereading your post I see your chief complaint is related to the bike. Although I wear an insert for running I don’t wear one for biking. Definitely I can tell that my cycling technique is a little unbalanced, but I would be willing to bet the running is what is causing the problems for you.
If you don’t mind my asking, how was your length discrepancy diagnosed? X-ray or direct measurement?
Just asking because I might have the same thing (suggested by several here who saw a video of my running stride), and am wondering how best to go about taking care of this. X-ray would certainly be convenient for me (obviously), but I’d really rather avoid the extra radiation if there’s a good alternative.
I went the insert route for about 2 years and that just allowed new injuries to pop up, you really shouldn’t need an insert or a shim unless the difference is pretty drastic. My right leg was supposedly 8mm off (assessment of bad chiropracor) and then when i finally had the right x-rays done and read by a radiologist it turned out the true difference in bone length was 2mm the other direction. Good consistent work on functional movement, pilates, core strength, regular massage and stretching has helped me way more than the insert did. Also, finding a good PT or Chiro can be tough but they are out there…I
Most everyone out there is walking around with a small leg length difference. If you have an anatomical leg length difference and not a pelvic problem then shims and inserts/orthotics are the way to go. If however, your leg length problem is due to a rotation/slippage of your pelvis then a physical therapist will be able to determine this and correct the problem for you. I am a PT and see several people a day with one side of there pelvis rotated causing a very noticable leg length discrepancy. Usually do to a combination of muscle imbalances and some sort of trauma. When searching for a PT look for one that has a sporting background of some sort and has a particular interest or advanced training in manual therapy.
Chiro- see if your pelvis is out of alignment. Ask fro referrals from other athletes in your area. I have a GREAT chiro that does A.R.T. as well
Hey,
Hey,
Firstly, most people I see tend to have the majority of injuries on one side, so that’s pretty normal.
Second, WRT LLD, you can either have a functional or structural leg length difference. (Functional means that muscle imbalance/spasm/chronic tightness may be the underlying culprit, where structural refers to bone length (ie one femur is longer)
The gold standard to assess a structural LLD is to get a scanogram which are a series of radiograph’s that can accurately determine the exact LLD (should you get one-radiation etc is another debate). Short of this eyeballing, tape measure etc etc are not really accurate enough the truly tell.
Once you know structural vs functional, then you can start to treat appropriately. I would be very hesitant to start shimming etc without knowing exactly the problem. Generally, something as simple as weak/dysfunctional hip abductors, and or external rotators on your right could easily give you a whole whack of right sided issues (PF included), so make sure you are treating the right thing, and go get professionally assessed.
Good luck,
Martin
Hey,
Hey,
Firstly, most people I see tend to have the majority of injuries on one side, so that’s pretty normal.
Second, WRT LLD, you can either have a functional or structural leg length difference. (Functional means that muscle imbalance/spasm/chronic tightness may be the underlying culprit, where structural refers to bone length (ie one femur is longer)
The gold standard to assess a structural LLD is to get a scanogram which are a series of radiograph’s that can accurately determine the exact LLD (should you get one-radiation etc is another debate). Short of this eyeballing, tape measure etc etc are not really accurate enough the truly tell.
Once you know structural vs functional, then you can start to treat appropriately. I would be very hesitant to start shimming etc without knowing exactly the problem. Generally, something as simple as weak/dysfunctional hip abductors, and or external rotators on your right could easily give you a whole whack of right sided issues (PF included), so make sure you are treating the right thing, and go get professionally assessed.
Good luck,
Martin
I am glad to see someone talking about the difference between a functional and structural leg length discrepancy. The difference is key to determining proper therapy. That being said, I disagree that radiography is superior over manual measurement for diagnosis. They could both be equal in skilled hands but one involves zero risk, much less cost and much less training.
I believe I have had fairly similar problems to what you have. For me, it tends to become the biggest problem when I am running high mileage. I have long been a runner and tend to always run on the left side facing traffic here in the states. With time as my muscles tighten up my right hip starts to have issues with the SI joint. I almost feel like I am a car that is severly out of alignment. I found that a combination of chiropractic and massage worked very well together. Ultimately I found the massage to be the most important at keeping things aligned, but the manipulation (freeing up the SI joint) did require the chiro. Keeping hamstrings, Glutes and Pirformis muscles loose using tennis ball and stretching have replaced the massage for the most part. Good luck.
Sanjeev Sabharwal1 
and Ajay Kumar1 (1) Division of Pediatric Orthopaedics, Department of Orthopaedics, UMDNJ—New Jersey Medical School, Newark, NJ, USA
**Received: **4 February 2008 **Accepted: **5 September 2008 **Published online: **4 October 2008 Abstract The use of accurate and reliable clinical and imaging modalities for quantifying leg-length discrepancy (LLD) is vital for planning appropriate treatment. While there are several methods for assessing LLD, we questioned how these compared. We therefore evaluated the reliability and accuracy of the different methods and explored the advantages and limitations of each method. Based on a systematic literature search, we identified 42 articles dealing with various assessment tools for measuring LLD. Clinical methods such as use of a tape measure and standing blocks were noted as useful screening tools, but not as accurate as imaging modalities. While several studies noted that the scanogram provided reliable measurements with minimal magnification, a full-length standing AP computed radiograph (teleoroentgenogram) is a more comprehensive assessment technique, with similar costs at less radiation exposure. We recommend use of a CT scanogram, especially the lateral scout view in patients with flexion deformities at the knee. Newer modalities such as MRI are promising but need further investigation before being routinely employed for assessment of LLD. Level of Evidence: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Sanjeev Sabharwal1 and Ajay Kumar1 (1) Division of Pediatric Orthopaedics, Department of Orthopaedics, UMDNJ—New Jersey Medical School, Newark, NJ, USA
**Received: **4 February 2008 **Accepted: **5 September 2008 **Published online: **4 October 2008 Abstract The use of accurate and reliable clinical and imaging modalities for quantifying leg-length discrepancy (LLD) is vital for planning appropriate treatment. While there are several methods for assessing LLD, we questioned how these compared. We therefore evaluated the reliability and accuracy of the different methods and explored the advantages and limitations of each method. Based on a systematic literature search, we identified 42 articles dealing with various assessment tools for measuring LLD. Clinical methods such as use of a tape measure and standing blocks were noted as useful screening tools, but not as accurate as imaging modalities. While several studies noted that the scanogram provided reliable measurements with minimal magnification, a full-length standing AP computed radiograph (teleoroentgenogram) is a more comprehensive assessment technique, with similar costs at less radiation exposure. We recommend use of a CT scanogram, especially the lateral scout view in patients with flexion deformities at the knee. Newer modalities such as MRI are promising but need further investigation before being routinely employed for assessment of LLD. Level of Evidence: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
How did they assess the accuracy of each measurement? What was the degree of accuracy they wanted, tenths of millimeters? What accuracy is necessary for this measurement? What was their basis of saying “this is what they got, this is what it was”? I guess the scanogram might be more accurate in those with “in patients with flexion deformities in the knee” since the tape measure requires the patient to have a full knee extension to be accurate. What is the usual cost of these different modalities?
You have to show me that there is clinically significant difference to justify both the extra cost and the risk to the patient, especially as a screening tool, before I will join this parade.
Sanjeev Sabharwal1 and Ajay Kumar1 (1) Division of Pediatric Orthopaedics, Department of Orthopaedics, UMDNJ—New Jersey Medical School, Newark, NJ, USA
**Received: **4 February 2008 **Accepted: **5 September 2008 **Published online: **4 October 2008 Abstract The use of accurate and reliable clinical and imaging modalities for quantifying leg-length discrepancy (LLD) is vital for planning appropriate treatment. While there are several methods for assessing LLD, we questioned how these compared. We therefore evaluated the reliability and accuracy of the different methods and explored the advantages and limitations of each method. Based on a systematic literature search, we identified 42 articles dealing with various assessment tools for measuring LLD. Clinical methods such as use of a tape measure and standing blocks were noted as useful screening tools, but not as accurate as imaging modalities. While several studies noted that the scanogram provided reliable measurements with minimal magnification, a full-length standing AP computed radiograph (teleoroentgenogram) is a more comprehensive assessment technique, with similar costs at less radiation exposure. We recommend use of a CT scanogram, especially the lateral scout view in patients with flexion deformities at the knee. Newer modalities such as MRI are promising but need further investigation before being routinely employed for assessment of LLD. Level of Evidence: Level IV, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
check this out: CONCLUSION: Our study shows that physical examination (direct
measurement and the block test) is more reliable and clinically
relevant than CT scanogram measurement in the assessment of LLD after
femoral fracture.
I believe I have had fairly similar problems to what you have. For me, it tends to become the biggest problem when I am running high mileage. I have long been a runner and tend to always run on the left side facing traffic here in the states. With time as my muscles tighten up my right hip starts to have issues with the SI joint. I almost feel like I am a car that is severly out of alignment. I found that a combination of chiropractic and massage worked very well together. Ultimately I found the massage to be the most important at keeping things aligned, but the manipulation (freeing up the SI joint) did require the chiro. Keeping hamstrings, Glutes and Pirformis muscles loose using tennis ball and stretching have replaced the massage for the most part. Good luck.
I used to have trouble with my right SI joint. I got hit by a minivan a few years ago, though, and that seems to have fixed it. Landed hard on my right hip, and both SI joints were sore for a week, but I almost think that the right side ended up in a better position than it was.
While this particular treatment is relatively inexpensive, I think that the potential side effects might be an issue.
Hey,
I missed the part where the OP mentioned his femoral fracture, haha
Point being, you better be sure you have an accurate method and measurement before you start shimming up cleats/orthotics/shoes. For my professional practice clnical methods such as tape measure are not good enough, and the review I posted is one of many that point out the unreliability of clinical LLD measurement. I mentioned that scanograms were the gold standard, and they are. Should our OP get one? I would need a thorough history and physical before I touch that question, as mentioned, a myriad of right handed problems may have a much easier explanation.
Thinking outside the box it is also highly debated what to do once you have a diagnosed structural LLD. Less than 20-30mm most say leave it alone as the bio-mechanical effect is negligble. Having said this, 20 or 30mm should be obvious in a clinical exam, and can help in your clinical decision making.
Martin
Hey,
I missed the part where the OP mentioned his femoral fracture, haha
Point being, you better be sure you have an accurate method and measurement before you start shimming up cleats/orthotics/shoes. For my professional practice clnical methods such as tape measure are not good enough, and the review I posted is one of many that point out the unreliability of clinical LLD measurement. I mentioned that scanograms were the gold standard, and they are. Should our OP get one? I would need a thorough history and physical before I touch that question, as mentioned, a myriad of right handed problems may have a much easier explanation.
Thinking outside the box it is also highly debated what to do once you have a diagnosed structural LLD. Less than 20-30mm most say leave it alone as the bio-mechanical effect is negligble. Having said this, 20 or 30mm should be obvious in a clinical exam, and can help in your clinical decision making.
Martin
As far as I am concerned the “scanogram” is only the gold standard because the cost a ton of gold. Any test is only as good as the care with which it is given. I am unaware of any data suggests that a properly conducted manual (tape measure) measurement of leg length is clinically (meaning having diagnostic or therapeutic usefulness) inferior to any other method.
I might add that this insistence on equating the “latest” thing with the “best” thing is part of the problem driving up health care costs beyond what is supportable. It is understandable that the lay person might fall into this “marketing” trap. However, the provider should be above this hype. Few are, unfortunately.
Hi Frank,
From your last 2 posts I can only deduce:
- You are joking
- You don’t know much about this topic (sorry to be so blunt)
If the first review I posted was not enough, here is another one for you. (PM me if you need more)
CONCLUSION: There appears to be a lack of agreement concerning incidence, classification and point of clinical significance. However, the manifestations or consequences of LLI demonstrate greater accordance. Of the three most commonly utilized evaluation methods, radiographic measures such as the scanograms are recognized as the most reliable procedure for the evaluation of anatomical LLI. Much controversy exists with some of the clinical orthopedic methods and the visual “quick” leg check. Because there is such a vast range in estimates of reliability, few if any definitive conclusions can be made regarding these methods. Given this, it is evident that more research is needed before the use of certain orthopedic and visual checks are considered reliable and valid.
The first paper I have that shows tape measuring LLD as inaccurate was written in 1955. These days its common knowledge that there are far to many variables using a tape measure to get an accurate measurement. In fact, it is just as accurate (if not more accurate) to ‘eyeball’ a LLD than to tape measure.
Since this is very off topic for our OP, feel free to PM me if you need further information,
Martin