Are Your Legs The Same Length?
This may sound like a funny question but it is something I get asked quite often. In fact, it is an often overlooked component in relieving low back pain, sports injuries and many other problems. Some clues could be pant legs that don’t seem to be the same length making you wonder if the seamstress was wacky! Maybe you noticed some postural distortions in the mirror that didn’t seem “normal”. A health professional may have commented that your legs were not balanced or the same length; chiropractors frequently evaluate leg length and comment on discrepancies. Maybe you had joint replacement surgery that changed the length of the bones. All these scenarios make this a common question worth discussing, especially since it has a significant impact on your spinal health.
So how do you know if your legs are the same “length” and what do you do if they aren’t? First, let’s start with some basic explanations and concepts. For the purpose of this discussion, we are going to focus on functional leg length imbalance although I will also mention some more precise procedures to evaluate anatomical (actual) leg length. When we determine functional leg length, it is done by visual inspection or measuring with the subject lying down with the head and body in a neutral position, arms resting by the side. At home, lying face up with shoes on is the easiest but lying face down across the bed is fine if you can keep the head off the other side looking straight down; make sure the subject is lying “straight” without lateral deviation. Stand at the bottom of the subject and grab the outside of each foot with your thumb under the middle of each shoe; gently sha ke or rock their legs to encourage relaxation and achieve a neutral position. Push upward without tilting the foot and compare the bottom of the sole on each shoe to see if the leg length appears equal or if one appears longer or shorter than the other. This seems a bit odd at first and the measurement can be unduly affected by the examiner so it takes a bit of practice to establish a routine and get comfortable with the process. Consequently, it might be helpful to check the same person several times over a period of hours or days when you first start to establish a routine and see if there is a consistent pattern. Almost everyone will have some degree of imbalance with ½ inch or less being fairly typical. Anything more than ½ inch is significant enough to warrant further evaluation by a professional, although even smaller discrepancies should be evaluated if other abnormalities such as pain, uneven shoe wear, unlevel shoulders, etc. are noted.
Functional leg length assessment gives us information about how the legs are “functioning” which correlates to pelvic  balance and function. Another method of evaluating leg length as part of a postural analysis is done in the standing position. Feel for the hip bones on each side of the waist and place your index finger along the top of each hip bone with your thumbs at a 90° angle resting on the back of the subject. Look at the height of each thumb and see if there is a significant difference in height. Again, most people will show some degree of imbalance but anything more than ½ inch is something that should be evaluated further. This particular assessment gives us an idea of how level (or unlevel) the pelvis is in a standing position and correlates well with leg length imbalance. If you find a significant discrepancy in hip height, you should also step back and visually inspect the level of the shoulders and ears by connecting an imagin ary line across both sides at the same location. You can even evaluate shoulder level on your own by merely looking in a mirror. Is there significant unleveling in either or both of these lines? Are the ear, shoulder and hip lines all relatively level or is one or more of the lines high on one side or the other? Does the high side of these lines stay on the same side or does it switch with one line higher on the left and another higher on the right? Significant tilting in any of these lines suggests postural imbalance and a negative effect on spinal health.
So what does all this mean and what can be done if you suspect a significant imbalance? Completing these evaluations constitutes basic spinal or postural screening. It provides clues about the extent and types of spinal compensations that are present which has a strong correlation to “posture”. Spinal screening is important because it determines if your spine is relatively straight, if it is resting on a level surface or if it is being forced to compensate for an unlevel foundation which creates biomechanical stress on both the joints and soft tissues. Spinal compensations of this nature increase the possibility of developing scoliosis, back pain, arthritis, disc problems and a whole host of health issues. Spinal compensations are also usually associated with vertebral subluxation which is a problem with how a vertebra functions causing interference with normal nerve function. Chiropractic philosophy states that vertebral subluxation has a detrimental effect by decreasing nerve function to organs and tissues; this could relate to essentially any health condition!
So what’s the next step if you suspect your legs are not the same length? First, schedule an appointment with a professional trained to evaluate leg length. This will most commonly be a chiropractic doctor because they are specially trained in this area although other professionals can provide assistance with basic screening. If you have had joint replacement surgery, you should have a more thorough evaluation by someone that specializes in evaluating and treating leg length imbalances. A standing x-ray is a great way to perform a more detailed evaluation of leg length and pelvic balance. More in-depth cases might also benefit from a more thorough evaluation which could include specific measurements or even a special x-rays called an orthoroentgenogram which precisely evaluates actual bone and leg length. If a significant imbalance exists, then it is appropriate to implement treatment that might include anything from stretching and exercise to chiropractic adjustments designed to restore pelvic balance and function. Use of a heel lift is also quite common in cases of moderate to severe leg length discrepancy. Orthopedic doctors may recommend a bone surgery known as osteotomy in more severe cases. Sometimes it is necessary to have an orthotist modify shoes to compensate for significant leg length discrepancies.
Failure to evaluate and maintain leg length function and balance can be a predisposing factor to unnecessary scoliosis, postural distortions, disc problems, premature degeneration of the hips and knees, back pain, degenerative disc disease and much more. LifeSource Health Partners offers a free postural screening and leg length analysis as a community service to increase awareness about spinal health and prevent unnecessary health problems.
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