Can heel lifts help with 'apparent' not actual leg length discrepancy?

In the groin or the sacroiliac?

In the groin or the sacroiliac?

Can heel lifts help with 'apparent' not actual leg length discrepancy? The short answer is an emphatic no.

Dear chiropractor

I've just been reading about Mrs D with interest. (I have the same condition though the hemi sacralisation is on my left side).

My question is did Mrs D have an apparent or actual leg length discrepancy?

I have an apparent LLD with a pelvic imbalance. My (excellent) chiropractor has told me to stop using the leg lift I was trying out on advice of a podiatrist. ( To me I seemed miserable with it and without it). He thought it might be more of a problem than not. (I have what he says is quite severe resultant scoliosis first one way then back and then back again).

I am trying to find a solution because aged 49 (having been symptomless and active and sporty all my life), a (successful) patellar tendon graft to repair a ruptured left side knee ACL after a soccer injury, seems to have triggered what I can only really describe as nearly a year of functional disability.
I struggled to resume a fluid gait. My hips / pelvis became exhausted as if I was walking with the wrong muscles. Weight bearing activity caused misery and I would be desperate to lie down after shopping or walking / going to the gym.
Eventually after several months my lower back joined in. Now I can no longer really sit or stand with any comfort.
I then found out about my hemi sacralisation & scoliosis by X-ray and am seeing a great physio.
My gluteus/hips/SI are so stiff all the time and I constantly stretch but it never changes. It has become chronic. Hip stretching helps me walk. But problems just resume. My muscles don't seem to retain the benefits of stretching. My SI joint isn't locked. Chiropractor has passed me to physio now as seems muscular. I walk and move slowly like an elderly person yet just a year ago was full of movement and life with no problems at all that I was aware of. I had set up a veteran's soccer team and was looking forward to playing on for years more. Now my only goal is to very basic functional fluidity in ordinary life. I have long given up hope of a sporting life as before. I want to be able to travel, to shop, to hike, to bend quickly and naturally etc.!!

My only real question is about the LLD because the rest as you say is about sensitively trying to find a solution in each case and I understand that my chiro and physio are best placed to keep trying to help me with that. But any other ideas of course are welcome.

Best wishes

Hello A,
Can you tell me which page at Chiropractic Help you read about Mrs D? Mostly I make the letter up to protect their identity and have no idea who she is, or where you found out about her.

The short answer is that no, a heel lift should not be used to correct an "apparent" leg length discrepancy; the correct chiropractic adjustment is what's needed.

It's complicated though; very often, when there's a true short leg, it's on the opposite side to the apparent short leg; if you used a lift to correct the 'apparent' short leg, you'd simply be making the scoliosis worse.

Correcting the true leg length discrepancy with a lift in the shoe, often will correct the "apparent" short leg automatically; but not always! Each case has to be treated on its own merits.

Making an orthotic, as podiatrists do, is an art form; done correctly it can be miraculous, but so often they don't seem to get the pronation quite right and it does indeed make the wearer miserable. I've returned to using something very simple in the shoe, sometimes under the heel, sometimes the whole foot, depending on another test. Made wrongly it certainly can worsen the problem, with knock on effects in the knee, hip and sacroiliac joints.

The difficulty with a scoliosis is that sometimes it's from the short leg, sometimes from an anomaly such as yours in the lower back. Then a heel lift in the shoe of the real short leg may balance up the pelvis, but increase the scoliosis. So, there are lots of ifs and buts.

Have you got an erect (standing) AP pelvis and Lumbar x-ray? Send it to me at brlewisatmweb.co.za Use your camera to photograph it on a window with sky background.

An ACL rupture is very serious, and frankly I would give up all ideas of playing soccer again.

Are you doing any lower back and SI exercises every morning? I recommend doing them on your bed before arising.

Just to be sure there isn't an incipient hip problem too, lie on your back, pull your knee to the chest, then to the opposite shoulder, and then into the lotus position. Are they much the same, right and left? Does it seem inordinately stiff or painful in the groin or side of the hip?

Each case I'm afraid has to be treated on it's merits; hemisacralisations can be a bugger.

I hope this helps. Thank you incidentally for taking the time to write with proper grammar, spelling etc.

Dr B



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Interesting challenges of the day

1. Mr S is a 76 year old man with neck pain of some 9 months duration. Luckily, most of the discomfort is upper cervical which is only rarely arthritic; his lower cervical spine is a degenerative mess that I've left alone. After seven treatments his pain and stiffness is 50 percent better, and he's happy in the circumstances. He can sleep through the night now and that makes a huge difference.

2. Mr P is 32 year old man with very severe lower back pain radiating to the big toe which is 30 percent numb. He had an episode three weeks ago, took anti inflammatories and was soon better as is typical of the medial disc herniation. But before it healed, after a trivia it came roaring back, much worse. The characteristic crossed sign was evident; sitting in a chair, straightening the right leg provoked severe left back pain and tingling in the leg. He's doing well.

3. Severe lower back pain is scary; just ask Mrs P. Just watching her get out of the car I she was in trouble; she had a slipped disc at L4 making her lean towards the opposite side; luckily she had no pain in the leg. Despite family pressure that this was far too severe for a chiropractor, she persevered. Within five days she was standing upright, and after two weeks almost painfree. 

Despite a hectic job, she wisely took my advice and stayed home for what I call exercising bed rest.

4. Mr S has had lower back, groin and back of thigh and calf pain for fourth months.

He has a pincer deformity in the hip causing the stabs in the groin, and a degenerative facet causing the sciatica. Both are responding well to chiropractic and he's well pleased; sixty five percent better after three treatments.

5. Mr T is a wise man; he's taken a warning TIA seriously and has lost 15 pounds, and has at least as much again to lose. A change to a low starch diet and half hour daily walk has made the difference; but the walking is making his foot and back miserable. The expensive orthotic is hopeless; luckily his hips and back are fine, but he needs a simple heel lift.

6. I too have had serious lower back issues, luckily fixed by my own chiropractor; so I too have to do my exercises, take care when lifting supers full of honey, gardening and using the chainsaw. Regaining the function of your spine is just as important as the pain.

7. My own granddaughter, only 7 is hypermobile giving her pelvic, knee and ankle issues. Xrays show a mildly dysplastic hip. Years ago we would have called it growing pains. She too regularly needs chiropractic care and luckily responds well. Increased range of motion is more difficult than too stiff in my opinion. Our care is for kids too.

8. This 65 year old lady is a serious gardener; every day she is bending, lifting and digging for 2 to 3 hours a day. It regularly catches her in the sacroiliac joint, so she has a treatment once a month that sorts it out. She does her lower back exercises faithfully.

9. This 88 year old lady is an inspiration; every day she is busy in the community. With a nasty scoliosis she manages very well with a chiropractic adjustment every six weeks and exercises faithfully done.  

10. Mr X is a 71 year old retired man who wants to continue with maintenance care every six to eight weeks; he had suffered from two years of lower back pain when he first came a year ago. He has no discomfort now after 8 chiropractic treatments, but is aware that danger lurks.

11. Mrs C has been having severe headaches, and taking a lot of analgesics. It's a non complicated upper cervical facet syndrome, and she's doing well.

12. Mr D is a 38 old year man with chronic shoulder pain after a rotator cuff tear playing cricket. It responded well to treatment, but he knows he must do his exercises every day; for two years he couldn't sleep on that shoulder.

13. Mr D, a 71 year old man, has a severe ache in the shoulder and midback since working above his head. Trapped nerve tests are negative but he has advanced degenerative joints of Luschka; after just two treatments he is 50 percent better. Can we reach 90?

And so the day goes; chiropractors shouldn't be treating the elderly most medical sites state but that's so much bunkum.



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