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Leg length discrepancy

  • 28-02-2013 10:18pm
    #1
    Registered Users Posts: 117 ✭✭


    Just wondering if theres anyone that may have knowledge or first hand experience of such a thing as mentioned in the title. Ive got a history of niggles in one leg, while Ive often gone to physios over the years Ive been constantly told that stretching, orthotics, etc would fix the niggles here and there but still the niggles go on! Recently its been suggested to me that I have one leg shorter (the problematic leg) than the other. I can run no problem, and im putting up 40+ miles per week but every so often the niggles throw me off for a bit as they flare into an injury. And Ive constant niggles in the the one leg. Ive an appointment with physio next week, just to get a second opinion, but I thought it may be worth throwing it out here for a third opinion to see if other people have this problem, how did they detect it, and what did they do about it to rectify it??? May not be the cause of my problems, but just curious about the symptoms and cure for such a thing in case it is a factor.


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Comments

  • Closed Accounts Posts: 4,134 ✭✭✭Tom Joad


    I have one leg shorter than the other and used to suffer a lot of injuries - Physio suggested that this was a factor in some of the injuries I got - other thing he suggested that might be exacerbating the problem was constantly running on the hard shoulder of the road. Stopped doing this and touch wood have been injury free since..


  • Registered Users Posts: 15,704 ✭✭✭✭RayCun


    I always wonder how they measure this without the use of x-rays


  • Registered Users Posts: 47 fleck


    I reckon it's a generic piece of diagnosis some physios will give anyone with a complaint they can't track down. I've been told by a physio that I've one leg slightly shorter slightly than the other, after a quick stretching of my legs, while no other physio I've been to thought to mention it.


  • Registered Users Posts: 2,676 ✭✭✭niallb


    I was at a physio in Navan who referred me to a podiatrist to do the actual measuring of leg length difference.
    It took two visits to assess I think, though I was doing a lot of physio at the time, so it might just have been one to measure and one to collect and fit. The difference is small, and the podiatrist made up a set of insoles to balance the leg lengths. They're not quite the same as orthotics, and are a heck of a lot cheaper.

    I can't believe the difference it's made over the last couple of years.
    I used to get sciatica and lots of lower back pain as well as knee injuries,
    but this seems to have nailed it. The first few days wearing them felt very odd,
    but now it's odd without them (which is disturbing in a way...)

    They fit perfectly into my Asics when I take the original insoles out,
    and I'm much more comfortable running with them in.

    I started running mostly on track rather than road, and only distances of 5km a few times a week which might have made a difference too, but I think it's the lift in my step.


  • Closed Accounts Posts: 10,762 ✭✭✭✭ecoli


    I am surprised that not once has it been mentioned that anyones hips were checked for pelvic tilt which can be one of the most apparent causes of presenting with apparent leg length discreprancies


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  • Registered Users Posts: 2,676 ✭✭✭niallb


    Mine weren't. I'm guessing a lot of pelvic tilt could be caused by leg length discrepancies too. It's a bit of a chicken and egg situation. Most likely thing though is that a podiatrist simply looks first for problems in your feet!
    I do think though that it would have showed up during the gait analysis, and would have been mentioned if it had been a main issue. All I can say for sure is that I've felt consistently better for several years after the adjustment.


  • Registered Users Posts: 1,312 ✭✭✭hot to trot


    In my experience, unless there has been a fracture in a growing bone or there is a big deformity at the knee , generally most leg length differences are soft tissue in nature.
    If the LLD is the same when lying straight out on your back , as when you are sitting with the legs straight out in front of you ... there is usually a bony shift and you may need some work to realign iliac bones or sacrum.
    If they are different in lying and sitting , its usually just differences in soft tissue tension on both sides. Psoas/hip flexors are often implicated.
    Just throwing a raise into the shoe on the apparently shorter side can be looking for trouble if the other end of the leg hasnt been assessed.

    Compare hip flexor tightness
    Compare glut felxibility is a good start for self assessment.. and stay off the camber :-)


  • Closed Accounts Posts: 4,134 ✭✭✭Tom Joad


    In my case - its definitely there and was pointed out from an early age - it was caused by a broken bone and damage to my leg as a kid. At one stage there was talk of an op to try and rectify this but thankfully I was below the threshold for this. I have never worn insoles to correct it and since I stopped running on hard shoulders have been free of injury (well running ones anyway!!!)


  • Moderators, Regional Abroad Moderators Posts: 26,928 Mod ✭✭✭✭rainbow kirby


    ecoli wrote: »
    I am surprised that not once has it been mentioned that anyones hips were checked for pelvic tilt which can be one of the most apparent causes of presenting with apparent leg length discreprancies

    That was part of the problem with my injury - a quite significant pelvic tilt (right side higher than left). Needed a lot of strength work and physio to try and loosen out a lot of locked up muscles around it.


  • Registered Users Posts: 117 ✭✭GKiraly


    Thanks guy, plenty food for thought there!

    In the past I would often go to a physio complaining bout constant niggles in the calf, the hamstring, ITB, etc, all in the same leg, so im looking forward to going to a highly recommended physio this time and saying that the whole leg is a constant problem and seeing what happens! rather than 'firefighting' symptoms all the time, of what I believe is now more than just something orthotics, compression gear, etc can fix.

    Going by what Im reading above, researched, and been told already, Im even suspecting myself that theres probably something amiss in the hip/glute area. And especially when I do glute/hip stretches, I notice that my left (problematic) side is alot tighter than the right, this could very well be a major factor, and it certainly pointing that way, but hopefully will know for certain soon!


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  • Registered Users Posts: 245 ✭✭calabi yau


    I went to my physio and my major complaint was painabout in my upper back when running. She performed a 2 hour biomechanical assessment after which she asserted that my right leg was shorter than the left by about an inch I think.

    It was measured using a measuring tape starting at the same point on the hip on both sides whilst lying down. This should negate any pelvic tilt inaccuracies.

    She gave me some insoles to correct. At that time, about ten weeks ago, I also had massive problems with my IT bands where I could not run for more than 1 hour 40 mins.

    Last Sunday I ran a 3 1/2 hour long run with no problems and hope to line up at Barcelona injury free ( in taper). Amazing progress for me, I believe in it.


  • Registered Users Posts: 558 ✭✭✭clear thinking


    Everyone has a leg shorter than the other.

    Before assusing its a huge difference do you run on cambered roads? This would have the same effect in causing niggles.

    Is this not a medical issue anyway?


  • Registered Users Posts: 117 ✭✭GKiraly



    Before assusing its a huge difference do you run on cambered roads? This
    would have the same effect in causing niggles.

    Is this not a medical
    issue anyway?

    No I dont run on cambered roads.

    And ya it is a medical issue, but im not looking for medical advice only potential other stories tha may relate to such issue, as stated, 3rd opinion! This theory was a suggestion put to me so thought id put it out there to the wider public. Im getting by with my weekly mileage, have a physio appointment coming up but you cant beat first hand knowledge of these things!


  • Registered Users Posts: 241 ✭✭Shazamm


    this is an old thread.

    Did you ever find out if you had a leg length difference?


  • Registered Users Posts: 241 ✭✭Shazamm


    this is an old thread.

    Did you ever find out if you had a leg length difference?


  • Registered Users Posts: 117 ✭✭GKiraly


    this is an old thread.

    Did you ever find out if you had a leg length difference?

    Nope I never did. But what did clear up the problems in the end was finally finding a reliable physio who was able to diagnose the constant issues and with that prescribed plenty of yoga to loosen and stretch out the muscles. And it worked! more often I spend in yoga, less niggles I have. Neglect the yoga, and despite all the before and after stretching with the running, the niggles slowly creep back. Different strokes for different folks I guess, gym for some, strength and conditioning for others, lots of yoga for me!!!


  • Registered Users Posts: 241 ✭✭Shazamm


    I see
    It sounds like they may exist thought, the length issues


  • Registered Users Posts: 117 ✭✭GKiraly


    Thats true, the main problem may be somewhat resolved with yoga, but it doesn't mean there still isn't an underlying issue with leg length discrepancy that could still pose its fair share of problems down the road. Lets hope not!


  • Registered Users Posts: 173 ✭✭Juan More Time


    Sorry to hear you are suffering injury problems with your running... The significance of Leg Length Discrepancy should NEVER be underestimated..
    In Scandinavian countries they take a far more enlightened view of human bio-mechanics.. They consider any LLD (Leg length discrepancy) greater than 5mm is going to cause significant problems later in life...

    When I began to suffer from lower back and hip pain many years ago..I was diagnosed with a 3/4 inch OR 17-19mm Structural Leg Length Discrepancy of my left leg.. This was confirmed at Tallagh Hospital by Scanogram X-Ray..



    Here in Ireland we are still in the dark ages, and only wealthy adults suffering from structural Orthopeadic deformities receive treatment in posh private hospitals...The rest of us are forced to suffer apparently...



    I am suffering the ill effects of being forced to live long term with a leg length discrepancy. My left leg is 18mm shorter than my right leg. Despite being unable to work because of the hip and lower back pain this condition causes me, I was refused corrective surgery by Tallaght Hospital's Adult Elective Orthopedic unit solely because my leg length discrepancy is less than an inch or 25mm, apparently I fall a mere 7 mm outside their somewhat arbitrary criteria for corrective surgery ......


    One of the senior orthopedic surgeons at Tallagh Hospital in Dublin was very dismissive of my 18mm leg length discrepancy, and suggested I should try a shoe with a built up outsole. I tried this and it did improve my lower back and hip pain and my posture improved significantly too.. I felt my spine was much straighter.. The BIG problem with the shoe raise is, it made my left ankle very unstable and I ended up spraining my left ankle really badly several times..If you have ever rolled your ankle, you will know just how excrusiatingly painful this is, So I just gave up with a shoe raise in despair.

    While another one of their (Tallagh Hospital's) younger orthopedic surgeons told me it would be a very simple matter to correct my leg length discrepancy with modern minimally invasive surgery...(intramedullary nail or rod) Apparently he had seen very small leg lengthening surgeries done in the USA using this technique when he was training there...

    At this stage I feel my only option is to have this surgery done abroad. The hospital who developed leg lengthening surgery is located in Russia, and they have agreed to lengthen my left tibia 17mm for €20,000 to €30,000



    The thing is I have been offered loads of work, and I would love to get off disability allowance. The only thing is quite a lot of this work would entail me being on my feet for periods of time, something I find incredibly tiring and painful solely because of my leg length discrepancy...


  • Registered Users Posts: 2,456 ✭✭✭Ceepo


    GKiraly wrote: »
    Thats true, the main problem may be somewhat resolved with yoga, but it doesn't mean there still isn't an underlying issue with leg length discrepancy that could still pose its fair share of problems down the road. Lets hope not!

    " somewhat resolved with yoga "

    Tell on


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  • Registered Users Posts: 117 ✭✭GKiraly


    Tell on

    when I say somewhat I may be a little underestimating the significance of the yoga on my running!
    Anyways, to put it this way, the difference in my running when putting in high miles when I'm doing yoga several times a week is a big difference in form, and over months shows a big reduction in injuries, versus when putting in same miles but very little yoga. Just like any athletic participation though, no matter how good the conditioning theres always the risk of injuries at some point when pushing the body to the limits.
    Like I said, different strokes for different folks, but for me over the years, theres definitely a positive correlation with doing yoga on my running.


  • Registered Users Posts: 408 ✭✭iHungry


    I'm not sure if this might be your issue. I was diagnosed with a pelvic tilt years ago which meant my legs were uneven, one longer than the other. It gave me a sore lower back. I was told to wear a lift in my left shoe.

    Recently I found that I can correct it. This is working for me. Check out this video.

    https://youtu.be/Js5xg9o78Jw[URL][/url]


  • Registered Users Posts: 2,456 ✭✭✭Ceepo


    GKiraly wrote: »
    when I say somewhat I may be a little underestimating the significance of the yoga on my running!
    Anyways, to put it this way, the difference in my running when putting in high miles when I'm doing yoga several times a week is a big difference in form, and over months shows a big reduction in injuries, versus when putting in same miles but very little yoga. Just like any athletic participation though, no matter how good the conditioning theres always the risk of injuries at some point when pushing the body to the limits.
    Like I said, different strokes for different folks, but for me over the years, theres definitely a positive correlation with doing yoga on my running.

    Thanks, but I'm not sure what that has to do with LLD
    No one here ( including me) can dispute your subjective feelings of what the impact of yoga may have on your running.
    There is also the thought that if you were moving better you might not need to do yoga to stay injury free.

    However, there is a big difference between saying [ paraphrasing "I feel I am running better, injury free because of yoga" and what impact yoga could/might have on leg length discrepancy..
    There are many variables that could cause leg length discrepancy, so of which could be structural (actual length of bone) and functional.. such Anterior pelvic tilt, posterior tilt, hip shift, QL imbalance, quad imbalance etc etc...


  • Registered Users Posts: 173 ✭✭Juan More Time


    Doing Yoga will only help your body to compensate for a leg length discrepancy..It won't address an underlying issue of poor bio mechanics..


    One of the main problems with even mild LLD, it causes a lateral curvature of the lumbar spine...This places unnecessary lateral pressure on ones lumbar discs.. It's standing and walking that causes me problems with my L5 disc... If I had equal length legs, My posture would improve significantly and I am almost certain the issue with my L5 disc would dissapear.


    One study on LLD found If you have a leg length difference of greater than 9 mm, then you have a 6X greater likelihood of having an episode of lower back pain.




    LLD also places increased strain on the longer leg... If I walk for than twenty minutes or one mile, I get quite lot of pain in my iliopsoas... Iliopsoas bursitis was the medical diagnosis.. I had an MRI done on my hips and no osteoarthritis or degenerative changes were found on either of my hips..

    (The bursa is a fluid-filled sac between bones, muscles, tendons, and skin. It provides cushion between tissue to decrease friction and irritation)



    Leg length discrepancy and osteoarthritis in the knee, hip and lumbar spine


    Osteoarthritis (OA) is an extremely common condition that creates substantial personal and health care costs. An important recognised risk factor for OA is excessive or abnormal mechanical joint loading. Leg length discrepancy (LLD) is a common condition that results in uneven and excessive loading of not only knee joints but also hip joints and lumbar motion segments. Accurate imaging methods of LLD have made it possible to study the biomechanical effects of mild LLD (LLD of 20mm or less). This review examines the accuracy of these methods compared to clinical LLD measurements. It then examines the association between LLD and OA of the joints of the lower extremity. More importantly, it addresses the largely neglected association between LLD and degeneration of lumbar motion segments and the patterns of biomechanical changes that accompany LLD. We propose that mild LLD may be an important instigator or contributor to OA of the hip and lumbar spine, and that it deserves to be rigorously studied in order to decrease OA’s burden of disease.

    Keywords: chiropractic, leg length discrepancy, osteoarthritis, knee, hip, lumbar spine

    LLD can exist from childhood or it can develop in adult life.20,39 In addition, functional activities of the individual play a role in determining whether LLD becomes symptomatic. Athletes may suffer complications such as patella tracking disorder or trochanteric bursitis in cases of unilateral foot pronation with a much smaller degree of LLD than non-athletes. Subotnick28 proposed that 18 mm of LLD in a non-athlete equates to 6 mm of LLD in an athlete since during running approximately three times the body weight is transmitted through the supporting limb compared to walking. Additionally, Friberg has demonstrated using his rigorous method of measuring LLD, a positive correlation between the degree of LLD and incidence of stress fractures in 547 Finish Army conscripts involved in very strenuous training.26 In fact 89% of these fractures occurred in those with an LLD of greater than 3mm. Of the 130 stress fractures in this study, unilateral fractures occurred in the tibia, metatarsals and femur in 73% and 16% of cases in the longer or shorter leg respectively. Bilateral fractures occurred in subjects with equal leg length or LLD not exceeding 3mm. It is important to note that stress fractures in these army conscripts with LLD occurred predominantly on the side of the longer leg. From a clinical biomechanical perspective, this is consistent with the longer leg being under increased mechanical stress during strenuous physical activities associated with military training.


  • Registered Users Posts: 117 ✭✭GKiraly


    Doing Yoga will only help your body to compensate for a leg length discrepancy..It won't address an underlying issue of poor bio mechanics..

    Yep, that sums it up about right!


  • Registered Users Posts: 270 ✭✭Hani Kosti


    RayCun wrote:
    I always wonder how they measure this without the use of x-rays


    You measure it lying down on a table/floor, measurements are done pelvic bone to knee, knee to ankle. Not 100% (as nothing is) but can show where the problem is


  • Registered Users Posts: 2,456 ✭✭✭Ceepo


    Hani Kosti wrote: »
    You measure it lying down on a table/floor, measurements are done pelvic bone to knee, knee to ankle. Not 100% (as nothing is) but can show where the problem is

    If you measure from a point in the pelvic bone say ASIS to the knee on both side and there is a difference in a few mm. And measure from a point on the knee to the ankle bone, and they measure the same. You then are of the conclusion that it is shorter here ??


  • Registered Users Posts: 173 ✭✭Juan More Time


    Using a tape measure to determine a leg length discrepancy can be wildly inaccurate, especially if one has a pelvic asymmetry...ie the illiac crest bones may be of different heights...



    Try using a Stadiometer or height measuring stick like they have in a Pharmacy or Doctor's surgery...Failing that use a carpenters Tri -square, or anything with a 90 degree angle.. ( a thick hardback book also works a treat)

    Stand barefoot on one leg against a straight wall, while elongating your spine as much as possible without lifting your heel....Repeat on the other leg... This technique should show up any LLD greater than 10mm..

    When I used this method myself,, I got a measurment of 19mm.. While the scanogram x-ray I had done at Tallagh Hospital showed I had a 17- 19mm of a leg length discrepancy..


  • Registered Users Posts: 349 ✭✭kal7


    we were taught at university to measure from greater trochanter (bony bit on outside of hip) to the maleolus (ankle bone)

    measure from iliac crest would suffer from pelvic asymmetry and sometime big difference in height of pelvic bones, give false reading.

    even then told that a tape measure not very accurate, unless you have x-ray to go on.


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  • Closed Accounts Posts: 1,271 ✭✭✭Elemonator


    I have the same problem OP. No such problems as yours bar crepitus in the knee but I am not sure if they are related. Mine was diagnosed by a podiatrist when I went to see them about my flat feet. They gave me insoles for both problems.


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