Question
Hi
I have been going to a DC for just over 1 year. I had severe sciatica that caused me to seek treatment. I am on my 2nd Dr now, he does almost all Muscle Energy Technique on me at this time and it seems to be helping. One thing that we cannot figure out is why my left leg is 3 inches short at the same time my left arm is 2-3 inches short. They will even up once he adjusts (the arms are the hardest, they are staying short most of the time however if I put my feet up on the table and bend my knees the arms are 100% even). I have 4 protruding discs, congenital narrowing of the neck, and have the thing (sorry, forgot the term) where my vertebrae is crooked in my lower back (spondicondylitis?) I am 34. I have left hip pain, no low back pain, neck pain and shoulder (left) pain. I am in PT for spinal dysfunction and neuromuscular instability (just finished 2 months and going for 1 more month). I am finally down to 2x per week visits, my DC IS trying to get me to 1x per week for now. I have been to a neurologist and he found nothing wrong however said with my MRI results if I get much worse I am looking at a level 2 fusion on my low back.
Any ideas on why the same sides are both short? I could see my arm being longer if leg shorter of vice-versa. Thanks!

Answer
Dear Keira,

Short leg syndrome is a clinical finding that can be either caused by an anatomical short leg which allows the pelvic bones to become unleveled, or it can be the result of contracted muscles which would be a functionally short leg.  

Functional short leg is caused by asymmetry in the muscular system.  Tightness on one side tends to pull the pelvis and leg upward thereby creating the illusion of a short leg when the legs are actually the same length.  This is easy to deal with....stretching of the tight muscular fibers is usually all that is needed to correct it.

Structural short legs are due to either trauma in which the bones may have been broken, or the growth of one leg was less than another. This can be a minor issue which can be corrected with an inexpensive heel lift inside the shoe or a rather large one in which you would need special lifts on the outside of the shoe.

Now, here comes the hard part.  The only way to determine if the leg is short functionally or structurally is by taking a standing x-ray of the pelvis which needs to include the top of the femur heads (leg bones), and it should also include the spine.  WHY?  because it has been proven that standard visual cues and measurements are often inaccurate.  It gets better...once the x-ray has been taken, it needs to be determined if one femur head is lower than the other, then the base of the sacrum needs to be analyzed for a low side, and the spine needs to be analyzed to see if it leans to the side of the short leg and short sacrum. The leg has to be short, the sacrum has to be low, and the spine has to lean to the same side to qualify for a heel lift.

Moving on...I use a short arm check in my practice daily with patients who have low back pain, and this check is related specifically to the Psoas muscle (psoas major and psoas minor) that runs through the torso from all the verterba in the lumbar spine to the inside of the leg...the psoas is responsible for hip flexion.  In anatomy books you may also see this muscle labeled the Iliopsoas.

Now, when the psoas muscle is contracted, it will tension one side of the spine and tend to bend the torso toward that side. so that if you pull the hands up over the head while the patient is lying flat on their back...then place the palms together you can measure for a short arm (one hands fingers will protrude a bit father than the other) which indicates tightness/contraction in that psoas muscle.  So all the doctor has to do is some focused soft tissue work on the psoas muscle to release the contraction (through the abdomen...this will be tender), and resisted psoas contraction exercises with the patient, and then recheck for the short arm.  The technique is easy to perform and takes less than 5 minutes for examination and correction.  I find this significantly reduces low back pain.

The fact that you have a short leg and short arm on the same side is most likely just coincidence.

Hope this helps Keira, good luck.

Respectfully,
Dr. J. Shawn Leatherman
www.suncoasthealthcare.net