How to convince my Chiropractor to check leg length?
(Lakeside, CA, USA)
Is the rib cage level?
How to convince my Chiropractor to check leg length? Frankly there's none so blind as those who will not see.
I have been to many DCs over the years. When I mention I think I have a short leg, they say my pelvis is off but not a short leg as those are rare. One DC I went to for over a year with little progress on my low back pain, so after stopping there, I put a heel lift in...I was good for about 5 years (only minor stiff necks). I am again seeing a different DC and she too says a short leg is rare and a lift could have been doing more damage. I asked to have my legs checked and she never xrayed for it (back shots were above femur heads), she just checks them on the table. I have been going for a few months and I still have lower back pain when standing, while my upper back keeps slipping out, sometimes before I leave the office. Standing with a construction level at the top of my tibias, one is about 3/8" higher. Laying on my back with knees at 90 degrees, the same one is higher. What xrays or tests are most accurate to convince her and me, whether I actually have a short leg or not? I don't want to keep going so often if a heel lift would shorten the treatment.
Hello Sally, It's a very good question your raise, and it would seem controversial.
There are two kinds of short leg.
1. An anatomical short leg. One leg simply grew faster than the other, or perhaps there was a fracture or a fallen arch. It's not uncommon at all, in fact I'd suggest it's the norm, just most are only a millimetre or two and not clinically significant.
I don't think it takes much imagination to see that a short leg was in part the cause of the scoliosis above.
Also there is quite strong research showing that a short leg, again for obvious reasons results in more arthritis, wear and tear, in the spine, hips and knees. But not if it's only a mm or two.
2. Then there's a functional short leg. This is the kind that we chiropractors are checking for whilst you are lying on your tum; it's caused by a subluxation in the pelvis, and is very correctable with the right kind of thrust. Keeping it correct involves inter alia a set of pelvic exercises done daily before getting out of bed, otherwise you keep needing to see your DC.
And of course, most often they occur together; the art of chiropractic is to know what is anatomical, and should be managed with an insert usually inside and occasionally under the shoe; and what is functional and needs adjusting.
I'm disturbed the chiropractors you've seen over the years don't seem to appreciate what for me is basic chiropractic.
It's not rocket science. Ask hubby to stand behind you, feet together, easiest seen with no clothing on the upper body, and slowly bend forwards. Is there an obvious list to port or starboard? Minor anatomical short legs will cause tiny deviations; that's not what we are talking about. Is the rib cage level?
Now, ask him to place his hands on the iliac crests, top of the pelvis and simply eyeball whether his hands are level. If there is a markedly anatomical short leg, it's immediately visible, even to the lay person. Perhaps if you were standing in front of a mirror, you could see it too.
More difficult is what to do about it. How thick should the lift be, and should it go under the heel or the whole foot. I use a test that I can't really explain. It's called a proprioception test.
Orthotists have some fancy devices that will measure it too.
An x-ray of the pelvis, taken standing and centred on the tops of the femurs will give a pretty good measure of how short the leg is, should hubby's test be significant.
I suppose you could print a copy of this and it might help how to convince my Chiropractor to check leg length? Probably not, as most of us are know it alls and won't easily change an opinion held for many years; more likely put his back up and his pelvis out!
One last thing; I'm not convinced that expensive orthotics are the solution, but perhaps they are. That you have to work with. For me, a simple inexpensive lift in the shoe is very effective.
Good luck, you've opened a can of worms!
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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.
Greetings, Dr B. You helped me quite some time back with a soothing and professional response which turned out to be exactly correct. I now consult a local chiropractor. You write a superb newsletter, too.
Knowing that up to 70% of the time the correct diagnosis is made with no examination, no special tests, no xrays, but just from the history, there's a fair chance I can add some insight to your unresolved problem. But at least 30% of the time, I may be quite wrong! Give plenty of detail if you want a sensible reply.
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