Top

Chiropractic & Manual Therapies

Published in:

Open Access 01-12-2005 | Review

Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry

Author: Gary A Knutson

Published in: Chiropractic & Manual Therapies | Issue 1/2005

Abstract

Background

Part II of this review examines the functional "short leg" or unloaded leg length alignment asymmetry, including the relationship between an anatomic and functional leg-length inequality. Based on the reviewed evidence, an outline for clinical decision making regarding functional and anatomic leg-length inequality will be provided.

Methods

Online databases: Medline, CINAHL and Mantis. Plus library searches for the time frame of 1970–2005 were done using the term "leg-length inequality".

Results and Discussion

The evidence suggests that an unloaded leg-length asymmetry is a different phenomenon than an anatomic leg-length inequality, and may be due to suprapelvic muscle hypertonicity. Anatomic leg-length inequality and unloaded functional or leg-length alignment asymmetry may interact in a loaded (standing) posture, but not in an unloaded (prone/supine) posture.

Conclusion

The unloaded, functional leg-length alignment asymmetry is a likely phenomenon, although more research regarding reliability of the measurement procedure and validity relative to spinal dysfunction is needed. Functional leg-length alignment asymmetry should be eliminated before any necessary treatment of anatomic LLI.

Available only for authorised users

Travell JG, Simons DG: Chapter 4, Quadratus Lumborum Muscle. Myofascial Pain and Dysfunction. The Trigger Point Manual. The Lower Extremities. 1999, Williams & Wilkens: Baltimore, 2: 42,35,35,42,107-2

Mannello DM: Leg Length Inequality. J Manipulative Physiol Ther. 1992, 15 (9): 576-590.PubMed

Walker BF, Buchbinder R: Most commonly used methods of detecting subluxation and the preferred term for its description: a survey of chiropractors in Victoria, Australia. J Manipulative Physiol Ther. 1997, 20: 583-588.PubMed

White A, Panjabi M: Clinical Biomechanics of the Spine. 1987, Philadelphia: J.B. Lippincott, 96,352-

Gossman MR, Sahrmann SA, Rose SJ: Review of length-associated changes in muscle. Physical Therapy. 1982, 62 (12): 1799-1807.PubMed

Giles LGF, Taylor JR: Lumbar spine structural changes associated with leg length inequality. Spine. 1982, 7 (2): 159-162.CrossRefPubMed

Knutson G: The supine leg check as a determinant of physiological/postural leg length inequality; a case study and analysis. Chiropr Res J. 2000, VII (1): 8-13.

Petrone MR, Guinn J, Reddin A, Sutlive TG, Flynn TW, Garber WP: The accuracy of the palpation meter (PALM) for measuring pelvic crest height difference and leg length discrepancy. J Orthop Sports Phys Ther. 2003, 33: 319-25.CrossRefPubMed

Gibson PH, Papaioannou T, Kenwright J: The influence on the spine of leg-length discrepancy after femoral fracture. J Bone Joint Surg (Br). 1983, 65 (5): 584-7.

10.

Papaioannou T, Stokes I, Kenwright J: Scoliosis associated with limb-length inequality. J Bone Joint Surg. 1982, 64-A (1): 59-62.

11.

Young RS, Andrew PD, Cummings GS: Effect of simulating leg length inequality on pelvic torsion and trunk mobility. Gait Posture. 2000, 11 (3): 217-23. 10.1016/S0966-6362(00)00048-5.CrossRefPubMed

12.

Murrell P, Cornwall MW, Doucet SK: Leg-length discrepancy: effect on the amplitude of postural sway. Arch Phys Med Rehabil. 1991, 72 (9): 646-8.PubMed

13.

Klein KK, Redler I, Lowman CL: Asymmetries of growth in the pelvis and legs of children: A clinical and statistical study 1964–1967. J Am Osteopath Assoc. 1968, 68: 105-108.

14.

Rhodes DW, Mansfield ER, Bishop PA, Smith JF: Comparison of leg length inequality measurement methods as estimators of the femur head height difference in standing x-ray. J Manipulative Physiol Ther. 1995, 18 (7): 448-452.PubMed

15.

Cooperstein R, Lisi A: Pelvic torsion: anatomic considerations, construct validity, and chiropractic examination procedures. Top Clin Chiro. 2000, 7 (3): 38-49.

16.

Gossman MR, Sahrmann SA, Rose SJ: Review of length-associated changes in muscle. Physical Therapy. 1982, 62 (12): 1799-1807.PubMed

17.

Grostic JD: Dentate ligament – cord distortion hypothesis. Chiropr Res J. 1988, 1 (1): 47-55.

18.

Knutson G, Owens E: Erector and quadratus lumborum muscle endurance tests and supine leg-length alignment asymmetry: An observational study. (accepted for publication, JMPT 12-03).

19.

Mincer AE, Cummings GS, Andrew PD, Rau JL: Effect of leg length discrepancy on trunk muscle fatigue and unintended trunk movement. J Phys Ther Sci. 1997, 9 (1): 1-6. 10.1589/jpts.9.1.CrossRef

20.

McGill SM, Childs A, Liebenson C: Endurance times for low back stabilization exercises: clinical targets for testing and training from a normal database. Arch Phys Med Rehabil. 1999, 80: 941-944. 10.1016/S0003-9993(99)90087-4.CrossRefPubMed

21.

Andersson EA, Oddsson LI, Grundstrom H, Nilsson J, Thorstensson A: EMG activities of the quadratus lumborum and erector spinae muscles during flexion-relaxation and other motor tasks. Clin Biomech. 1996, 11 (7): 392-400. 10.1016/0268-0033(96)00033-2.CrossRef

22.

Indahl A, Kaigle A, Reikeras O, Holm S: Sacroiliac joint involvement in activation of the porcine spinal and gluteal musculature. J Spinal Disord. 1999, 12 (4): 325-30.PubMed

23.

Allum JHJ, Honnegger F: Interactions between vestibular and proprioceptive inputs triggering and modulating human balance-correcting responses differ across muscles. Exp Brain Res. 1998, 121: 478-494. 10.1007/s002210050484.CrossRefPubMed

24.

Nguyen HT, Resnick DN, Caldwell SG, Elston EW, Bishop BB, Steinhouser JB, Gimmillaro TJ, Keating JC: Inter-examiner reliability of Activator methods relative to leg length evaluation in the prone, extended position. J Manipulative Physiol Ther. 1999, 22: 565-9.CrossRefPubMed

25.

Hinson R, Brown SH: Supine leg length differential estimation: an inter- and intra-examiner reliability study. Chiropr Res J. 1998, 5: 17-22.

26.

Cooperstein R, Morschhauser E, Lisi A, Nick TG: Validity of compressive leg checking in measuring artificial leg-length inequality. J Manipulative Physiol Ther. 2003, 26 (9): 557-66. 10.1016/j.jmpt.2003.08.002.CrossRefPubMed

27.

Knutson G: Incidence of foot rotation, pelvic crest unleveling, and supine leg length alignment asymmetry, and their relationship to self-reported back pain. J Manipulative Physiol Ther. 2002, 24: e1-10.1067/mmt.2002.121414.CrossRef

28.

Knutson G, Owens E: Leg length Alignment Asymmetry in a Non-clinical Population and its Correlation to a Decrease in General Health as Measured by the SF-12: A Pilot Study. Journal of Vertebral Subluxation Research. 2004, 1: 1-5.

29.

Pollard H, Ward G: The effect of upper cervical or sacroiliac manipulation on hip flexion range of motion. J Manipulative Physiol Ther. 1998, 21 (9): 611-616.PubMed

30.

Nansel DD, Waldorf T, Cooperstein R: Effect of cervical spinal adjustments on lumbar paraspinal muscle tone: Evidence for facilitation of intersegmental tonic neck reflexes. J Manipulative Physiol Ther. 1993, 16 (2): 91-95.PubMed

31.

Seemann DE: Bilateral weight differential and functional short leg: an analysis of pre and post data after reduction of atlas subluxation. Chiropr Res J. 1993, 2 (3): 33-8.

32.

Seemann DE: Anatometer measurements: a field study intra- and inter-examiner reliability and pre to post changes following an atlas adjustment. Chiropr Res J. 1999, VI (1): 7-9.

33.

Kondziella W: Clinical and functional diagnosis and treatment of low-back pain from pelvic malposition. Schmerz. 1996, 10 (4): 204-10. 10.1007/s004820050041. (article in German).CrossRefPubMed

34.

McCaw ST: Leg Length Inequality. Implications for running injury prevention. Sports Medicine. 1992, 14 (6): 422-429.CrossRefPubMed

35.

Friberg O: Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 1983, 8 (6): 643-651.CrossRefPubMed

36.

Beattie P, Isaacson K, Riddle DL, Rothstein JM: Validity of derived measurements of leg-length differences obtained by use of a tape measure. Phys Ther. 1990, 70 (3): 150-7.PubMed

37.

Hanada E, Kirby RL, Mitchell M, Swuste JM: Measuring leg-length discrepancy by the "iliac crest palpation and book correction" method: Reliability and validity. Arch Phys Med Rehabil. 2001, 82 (7): 938-42. 10.1053/apmr.2001.22622.CrossRefPubMed

38.

Aspegren DD, Cox JM, Trier KK: Short leg correction: A clinical trial of radiographic vs non-radiographic procedures. J Manipulative Physiol Ther. 1987, 10 (5): 232-238.PubMed

39.

Danbert RJ: Clinical assessment and treatment of leg length inequalities. J Manipulative Physiol Ther. 1988, 11 (4): 290-295.PubMed

Title: Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry
Author: Gary A Knutson
Publication date: 01-12-2005
Publisher: BioMed Central
Published in: Chiropractic & Manual Therapies / Issue 1/2005
Electronic ISSN: 2045-709X
DOI: https://doi.org/10.1186/1746-1340-13-12

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry

Abstract

Background

Methods

Results and Discussion

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results and Discussion

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2005

The necessary future of chiropractic education: a North American perspective

Is obesity a risk factor for low back pain? An example of using the evidence to answer a clinical question

Chiropractic & Osteopathy. A new journal

Influence of static lumbar flexion on the trunk muscles' response to sudden arm movements

Subluxation: dogma or science?

The biopsychosocial model and hypothyroidism