Question
Hello,

I recently went to a chiropractor, seeking treatment for relief of mild tingling in my left face which I felt was probably related to working at a computer everyday and the stress that builds up in my upper back and neck muscles.  I had done some preliminary research on this, and also thought there was probably some correlation with inflammation of the trigeminal nerve.  After my initial interview, the doctor basically concurred with these thoughts.

On my first visit, I was asked to do a few tests, such as standing with legs at shoulder width and closing my eyes, and checking the ROM of my neck.  I also got 2 x-rays of my neck and upper spine, and was told that I have some early signs of osteoarthritis in my neck (probably related to a non-injury auto accident I had in 1977, according to the Dr.).  I was next asked to lie on his exam table face down, whereupon he bent my legs at the knee one at a time and then together, and then asked me to open and close my mouth several times as he returned my legs to their extended position.  He then held my feet, pushing my heels together laterally (with boots still on), and asked if I could tell that my left leg was a bit shorter than my right.  I really couldn't tell because my boots were blocking any orientation I might've had of my foot position...and I told him so.  He moved my legs again as before and asked me again to see if I could feel the length difference (while he was still holding my heels together).  This time, I did sense that one leg was a bit shorter than the other.  He then proceeded to adjust my thoracic back in 2 locations with an electric activator-type device, and again went back to holding my heels together to demonstrate that I now had equal leg length.  After that, he used the device on my left C-spine in several places, my left jaw and near my left ear to begin treatment of the facial tingling.  

My questions are:  
1.  How does opening and closing one's mouth while lying face down on a table, help to identify leg length discrepancies or anything else that would involve the spine?
2.  How can leg length be accurately identified by manipulating the legs while the patient is in a prone position (with face down) and being pushed and pulled on a slippery table?
3.  Can one really get an accurate idea of leg symmetry when they are fully dressed, shoes on, lying prone, and someone is holding their heels together?

As you might have guessed, I was very skeptical of these so-called tests and maneuvers that I was put through, and before I continue with any further treatments with this doctor, I would very much appreciate your expert opinion of the evaluation I was given and the subsequent treatment.

Thank you!

Answer
Hi Nikki,

While many DC's still play with the silly leg length thing, the reality is that it is not a rational, valid examination parameter.   It's a "relative" discrepancy in length that is dependent on muscle tone from just about anywhere.    You can fiddle with the appearance of leg length discrepancy by doing just about anything to the patient, e.g. pressing on different body parts, having them turn their head to left or right, or having them say the word banana.   The problem is that it's all the same and it's wrought with error and bias.   It is no substitute for a thorough physical examination.    In my opinion, you were evaluated by someone who forgot how to do modern, clinical examination, or simply has ignored what they once learned.  I hope this DC checked your reflexes, skin sensation with pinwheel or 2-point pin evaluation, and thoroughly examined your jaw and neck with palpation of joint and soft tissue structures  -  before futzing with the silly leg length thing.   I am also not a fan of that Activator instrument, especially when that's all the DC uses.     If you have trigeminal neuralgia, no leg length checks are going to fix that....

'Hope this was helpful.

Dr. G