Does My Short Leg Matter?

“Doc, I know you said my right leg is 1/2″ shorter than my left leg, but is it really that bad? Doesn’t everyone have this problem?”

“Wow, 1/2″ difference. Is that a lot?”

These are some of the common questions that come up during my consultation when I screen people using a leg length examination.

Many of us have had our legs measured at some point in time. Whether it was to get a new pair of slacks tailored, or in the office of an MD/PT/Chiro. But does it really matter and can anything be done about it?

Does it Really Mean Anything?

Before we assess it’s meaning, we have to look at some of the causes of a short leg:

• History of fracture in the tibia or femur  (Anatomical)
• Congenital malformation in the femur, tibia, or pelvis (Anatomical)
• Poorly measured hip and knee replacements (Anatomical)
• Twisted or rotated pelvis (Functional)
• Loss of postural control (Functional)

In the case of a Anatomical short leg from things like fractures or congenital malformations. In other words, there is a bony deficiency in one of the legs compared to the other. With an anatomical short leg, there is a physical limitation to the body’s ability to maintain structural symmetry. The the implications of a short are more mechanical in origin. People with anatomical short legs will probably notice an uneven wear pattern on their shoes. They will also be more susceptible to back pain and lower extremity (knees, hips, ankles) pain in the future. Activities like lifting, jumping, or things with high impact are likely to trigger musculoskeletal pain over the course of time.

In my office, I am much more concerned about a Functional short leg. What this means is that the patient has a short leg, but there is minimal or no deficiency in the bony anatomy, but the alignment of the hips and pelvis are distorted. Because anatomical deficiency has been ruled out, then the reason the leg is shorter has to be attributed to another cause.

Short Legs and the Brain

The reason I look for short legs is because of a concept called Postural Control. A tremendous amount of the metabolic activity in the brain is dedicated to keeping your body upright in gravity. There are literally chunks of your brain whose only job is to control the muscles of your spine that help it adapt to any situation.

Think about it like this. A simple task like standing up out of a chair requires the coordination of dozens of muscles. While we think about using the muscles of your legs to propel you out of a chair, the muscles of your spine have to brace your lumbar, thoracic and cervical spine as you move. These muscles give feedback to the brain, and the brain makes almost instantaneous change to how we move based on the incoming information.

We don’t have to think about that, because our brain is managing this on an subconscious level. But if there’s visible evidence that the brain and body aren’t working in harmony, then we have to figure out why.

In some extreme cases, there may be brain damage. That’s one of the big reasons that you can see significant postural problems in people that have had stroke, traumatic brain injury, and cerebral palsy. If nerves in the brain have died, then there’s profound limitations to how much control that person will have over their body.

Atlas Displacement and Postural Control

A few months ago I wrote about how your posture isn’t that important. It’s not that a low shoulder, slumped shoulders, or forward heads don’t matter, but the fact that they exist is a sign that the  brain is not in full control of the body. 

Now that we know what the extremes of nerve damage does to posture, it helps us to understand why a shift in the head and neck disrupts your postural control.

Your head and neck is IMMENSELY studded with nerves that fire into the brain stem and cerebellum. When your head and neck are stuck and locked in a bad position, your brain stem and cerebellum are IMMEDIATELY affected by that.

When the body lacks postural control, then it is an indicator that the nervous system is functioning at less than 100% through poor signals in and out of the brain.

Can this be fixed?

I’m not going to lie. Lots of things can address a short leg. They range from:

• Heel lifts
• Targeted stretches
• Chiropractic manipulations
• Reflex challenge tests

Many of these can create a false (heel lift) or temporary sense of balance. This is often why chiropractors get the reputation for seeing people over and over again leaving patients wondering if their spine will ever stay put.

Uneven legs = Poor Postural Control

Balanced Legs = Good Postural Control

When I take care of a patient, I’m looking to go beyond a temporary or false correction. When I look at someone’s leg length and posture, I’m expecting it to stay in place. If the legs aren’t staying balanced, then it’s very likely that I am not affecting the person’s structure and my correction is very poor.

However, when the atlas is put into a Normal Structural Position, then postural control will be re-established and the legs will STAY BALANCED rather than slipping in and out over and over again.

And it’s not that I care about the person’s legs are balanced, I care because when the brain is working better and more efficiently, then the body has a great capacity to heal itself again.

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