Leg length inequality

Leg length inequality leads to more arthritis in the hip, knee and back.

The relationship of limb length inequality with radiographic knee and hip osteoarthritis was researched by Golightly et al, and reported in the journal Osteoarthritis and Cartilage. They conclude that there is strong correlation in the knee, but to a lesser extent in the hip, where the hip on the short leg side was more likely to be arthritic.

Interestingly, folk with a short leg were also more likely to be obese, with an average BMI of 29.0. It would seem they are less likely to be active.

Hip arthritis

Hip arthritis is worsened by a short leg.

The causes of knee and hip arthritis are legion, but leg length inequality must be included.

Health is additive, both in a positive and a negative sense. If you are a couch potato and smoke, you're even more likely to get a host of diseases.

Likewise, if you are overweight, and have a short leg, then arthritis of the knee and hip are highly likely.

Conversely, if you are active and walk or swim regularly, for example, and use an orthotic to correct for a short leg, then you are far less likely to have these arthritic disabilities; eat plenty of omega 3 rich foods and you're home and dry.

It is well known that osteoarthritis is one of the most common, chronic conditions and a leading cause of disability among older adults. This is particularly true in the USA where obesity compounds other known causes, arthritis of the knee affecting six percent of the adult population and of the hip, three percent.

This study examined the relationship of limb length inequality (LLI) with radiographic hip and knee osteoarthritis (OA) in a large, community-based sample.

Hypothesised is that a short leg alters gait symmetry and joint mechanics during weight bearing, potentially contributing to the development of arthritis in the knee and hip.


They found that those with LLI were 80% more likely than those without a short leg to have radiographic knee OA, and but only 20% more likely to have hip arthritis seen on x-ray.

In the presence of a short leg, hip OA was found to be 30 percent more common on the short leg side versus 18% on the longer limb.

Here is the hypothesis.

They speculated, with support from other studies, that mechanical factors, including joint instability and malalignment, contribute to the progressive degeneration that characterizes radiographic OA. Said the authors;

Individuals with short leg often modify their movement patterns to functionally minimize the inequality, i.e., increasing knee flexion or hip adduction of the longer limb. These compensatory mechanisms may amplify forces across a smaller joint contact area, thus acting as a biomechanical precursor to lower extremity OA.

“A short leg may lead to altered or amplified joint forces, resulting in accelerated degeneration of joint structures and increased OA severity.”

The authors's definition of short leg was a difference of more than 2cm, as they felt that a lesser inequality would not be "clinically meaningful", an opinion that chiropractors, with the spine rather than the hip and knee in mind, would take issue with.

“These results may have important clinical implications for patients seeking treatment for knee or hip OA. Evaluation of LLI should be incorporated into physical examinations for these patients.”


“Treatment of the anatomically short leg in patients with knee or hip OA, with heel or shoe lifts, may aid in reducing joint stresses, pain, and disability, but more research needs to be done.”

Leg length inequality

Leg length inequality research on 926 subjects recommended that LLI was an important consideration in the physical exam.

Leg length inequality is one of the most common causes of scoliosis and degenerative change in the lumbar spine too.

How common is LLI in persons suffering from LBP?

In a remarkable study done on servicemen suffering from LBP, researchers discovered that ...


For the Chiropractor

  • With the Chiropractic emphasis on prevention rather than simply the treatment of disease, perhaps more emphasis should be given to the use of heel and shoe lifts, not simply for the patient WITH osteoarthritis, but for the pre-arthritic patient.
  • Have any Chiropractors done research on a presumed association between osteoarthritis of the spine and LLI? Could mechanical factors, including joint instability and malalignment, also contribute to the progressive degeneration that characterizes radiographic OA of the lumbar, thoracic and cervical spine?
  • Most significant is the opinion of the authors that: "Evaluation of Leg Length Inequality should be incorporated into physical examinations for these patients." Why not every pre-arthritic patient?
  • Should the authors be correct in their thesis that "mechanical factors, including joint instability and malalignment, contribute to the progressive degeneration that characterizes radiographic OA" in the knee and hip, could we not assume that the same holds true for the spine?

From LLI to Research @ Chiropractic.org

Case file

How does this work out in practice? The first thing a chiropractor would do would be to check out the feet when examining a new case file. A dropped medial arch with concommitent pronation would obviously contribute to a short leg syndrome. A suitable arch support such as provided by FOOT LEVELERS, without a heel raise may be adequate to level the pelvis.

Short leg

Short leg is of course just another name for leg length inequality; would a rose smell any different if you gave it another name? Does lumbago hurt more than low back pain? A leg length inequality is often a consequence of conditions such developmental hip dysplasia.

Sacroiliac Joint Treatment

Due to altered biomechanics leg length inequality also contributes to osteo-arthritis in the sacro-iliac joint. For more about the chiropractic Sacroiliac Joint treatment click here: SACROILIAC JOINT TREATMENT.

Neck pain

A Journal of Rheumatology report confirms the connection between LEG LENGTH INEQUALITY AND LOW BACK PAIN, and invites questions about the use of heel lifts in the treatment of recalcitrant neck pain.


Knee Joint Distraction

Research confirms that unloading of joints and increasing cartilage perfusion can dramatically reverse osteoarthritic changes.


Contribute to Research topics you would like to see evauated: COLLEGE RESEARCH TOPICS ...

Pain in upper leg

There is nothing simple about leg length inequality, particular when it's associated with other syndromes. It frequently causes a sacroiliac syndrome, perhaps a Maignes, often in the older person there is associated Immobilisation Arthritis from a life time of subluxations. Perhaps there might be hip arthritis, more common with a short leg... it takes a chiropractor as pertinacious as the Bruce's spider to sort all the threads out...

(PS. Know the story about how Robert the Bruce was inspired by a spider... google it, fascinating yarn.)

Chiropractic books

Chiropractor Dr Bernard Preston writes his chiropractic anecdotes from his own coalface with disarming honesty. Humorous, sometimes tragic, his theme is no spread the good news of better health through chiropractic, more exercise and a better diet.

His third chiropractic book is written from his seven years practising in Holland.

Stones in my clog contains a true story about a leg length inequality.

Did you find this page useful? Then perhaps forward it to a suffering friend. Better still, Tweet or Face Book it.

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 have left alone. After seven treatments his pain and stiffness is 50 percent better, and he is 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 is 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 pain-free. 

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 is well pleased; sixty-five percent better after three treatments.

5. Mr T is a wise man; he has 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 stroll 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; he has a short leg.

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. X-rays 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 few months 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 is a non-complicated upper cervical facet syndrome, and she is doing well.

12. Mr D is a 38-year 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 could not 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 should not be treating the elderly most medical sites state but that is so much bunkum.

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