Panaceas & Unicorns

The Oxford dictionary describes a panacea as A solution or remedy for all difficulties or diseases.”

Or, put another way, a;

There is a common theme throughout all of my blogs, the theme being that there is very, very rarely a single cause of injury. There are, of course, exceptions to this, such as being punched in the face, or standing on lego, or even falling off a curb and spraining your ankle. Acute injuries with obvious cause.

However, pain is nearly always a multifactorial experience, with many layers, particularly if the pain has been insidious (with gradual effect over time).

So, of course, the flip side of that same coin, is that there is very, very rarely a single cure for any injury, pain, discomfort or illness.

Now, as someone who works all day every day with people in pain, this sucks! What a world it would be if every time someone walked into my clinic with lower back pain I could just insert a home-made orthoses; if every one with sore shoulders could just foam-roll the pain away; if every headache could just be a quick C-3 high velocity manipulation; if every “tight” hamstring could just be massaged better; if every foot injury just bought new shoes; if every running injury was just given strengthening exercises.

Alas, its never that simple, and so I have to be – see my blog on Evidence Based Practices – cynical of anything that claims to be a miracle cure.

For any intervention to be offered, I fully believe that we must be able to stipulate exactly why this will be beneficial. There are limitations to most treatment modalities and interventions, and so to offer any service, the research must show benefit to the client, or else we get into the realms of an ethical debate; can a service be offered if the research does not support its use?

And why does the research matter?

I met a flat-earther. They told me that the earth was flat.

I said that ‘science’ (studies) believes the earth to be spherical, because we can show this by empirical evidence (level 1 evidence acquired by experimentation), so that is what my beliefs are aligned with.

The flat-earther said that “studies aren’t important” because the earth “feels” flat.

And we got on like a house on fire, because that’s cool!

I do not seek to change anyone’s belief system – see my blog on Placebo – but that does not mean that I wish to advise on anything that isn’t proven to be beneficial.

So, yeah, panaceas are – unfortunately – as real as*

Recovery happens through clinical reasoning; diagnosis as close to correct as physically possible; the most relevant treatment and/or interventions; hard work; and consistency.

* if my daughters are reading this, Unicorns are totally real

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

GUEST BLOG: Do you have time for time? by John Lewis

Nietzsche once said, “He who has a why …. can bear almost any how”.

I spend a lot of time as a Therapist explaining the ‘why’ – but to what extent are people prepared to endure the how? What are the barriers to their adherence? Often, “time” will be one such barrier…

John Lewis is a Life & Performance Coach. He is a member of the Association for Neuro Linguistic Programming, the Association for Coaching and the UK College of Personal Development, taking you on a journey, from where you are to where you truly want to be. 

 

 

 

 

 

 

Here is an abstract from his latest blog, where he expertly looks at the importance of finding time for change;

How often have you heard yourself say that you are short on time? Probably more than you realise. It is no secret that our lives are busy and that we have lots of things on our minds, but does this mean that we are short on time?

We all have 24 hours a day.

It sounds like the most obvious statement in the world, but we all have exactly the same amount of hours in our day. No matter where you live in the world, no matter whether or not you have children, no matter what type of job you have and what hours you work. There is always going to be 24 hours in each and every day.

Sure, some people have more “spare time” than others, depending on their own personal or professional choices. However, it is what you do with the 24 hours within your day that will really make a difference to what you can achieve.

You might not like the idea of getting up early or perhaps using your lunch break or weekends to reach your own personal goals, but if this is the spare time that is open to you, then perhaps that means this time is your window to achieving your goals?

A lack of time is the perfect excuse…

Please click here to read the full article!

You can contact John via his website – www.jlmindsetperformance.co.uk – or via his Facebook page; JL Mindset Performance.

Understanding Your Iron Levels

The nervous system works in two parts; the sympathetic nervous system works primarily in “fight or flight” mode. The parasympathetic nervous system focusses on “rest and digest”.

So, opposites, to a point. You can’t run away whilst resting!

When exercising (or running away!) blood flow is directed to muscles – often screaming for oxygen to keep you going – and so the blood flow to the stomach lining decreases. The body requires iron to transport oxygen from the lungs throughout the body and to muscle tissue, which uses oxygen to create energy. Without adequate iron stores, athlete’s performance suffers.

Iron deficiency is a common cause of tiredness, or overtraining syndrome, particularly in endurance athletes – runners, cyclists, swimmers. Active people are susceptible to iron deficiency for a number of reasons; primarily, iron intake, increased iron loss, inadequate iron absorption. Other factors to consider include menstruation, and internal bleeding.

Absorption
Iron, when eaten, is absorbed (in a state called ferrous) in the first & second section of the small intestine (duodenum and proximal jejunum).

Circulation
In the blood, iron moves about bound to a molecule called transferrin. Transferrin carries iron (in its ferrous state) to the bone marrow and to other organs.

Distribution
Most iron in the body is found in hemoglobin (in the adult male that accounts for approx.2300 mg; in the female, approx.1750 mg). Hemoglobin is the iron rich red blood cells, which carry oxygen from the lungs to the rest of the body (i.e. the muscles, organs, tissues). Once at its destination, it releases the oxygen to permit aerobic respiration to provide energy to power the required activity or function, in a process called metabolism.

Metabolism
Most of this circulating iron is taken up by red cell precursors and incorporated into heme (which is then combined with globin chains to make hemoglobin!).  85% of heme molecules are synthesized in bone marrow, the rest mostly in liver, but almost all body cells possess the ability to synthesize heme (Reference 1)

Storage
There are two storage forms of iron: ferritin and hemosiderin.

  • Ferritin is the main storage form of iron. It is a protein which is released, and it is a useful measure of the tissue stores of iron (in other words, if you are iron rich in your tissues, your ferritin levels will be high). Iron can transfer in and out of this form quickly, which makes it easily accessible, but also means that it goes up in certain conditions, like chronic inflammation.
  • Hemosiderin – made up of ferritin and cell debris – is a  more stable form of iron storage, but is less readily accessible.

Measuring levels is a bit of a minefield, with lots of different markers indicating lots of different levels;

Haemoglobin is a protein responsible for transportation of oxygen in the blood. Normal male levels being between 13.5 and 17.5 grams per decilitre of blood, and normal female levels are 12.0 to 15.5 grams per decilitre of blood.

Haematocrit; this is the volume of red blood cells in blood. It is normally recorded as a percentage; 47% ±5% for men, 42% ±5% for women. The higher the ‘better’.

REFERENCES:

  1. http://fblt.cz/en/skripta/vi-dychaci-soustava/4-metabolismus-hemoglobinu-a-transport-krevnich-plynu/

Achilles Tendinopathy

The Achilles Tendon is a very common area of pain or discomfort. Going back, everything tendon related seemed to be considered “tendonitis” – ‘..itis’ being latin for inflammation. Often, we simply don’t know if the condition is inflammatory or not, and so it is considered a tendinopathy, where the suffix “…pathy” is derived from Greek, indicating a disorder,which is typically used to describe any problem involving a tendon.

The most common cause of Achilles tendinopathy is continually putting too much load on the tendon and not allowing enough time for the tendon to recover and adapt. This can be via;

Training Error – such as an increase in volume, frequency, intensity.

A Biomechanical issue – leg length difference, over pronation, or poor mobility in the foot, ankle and lower leg could be causal factors. Running “form” can also play a role here.

A flexibility issue – When your foot hits the ground the ankle moves the foot up – called dorsiflexion. Any loss of range can increase stress on the Achilles. Dorsiflexion range is commonly lost after ankle injury/sprain or due to calf muscle tightness

A strength discrepancy – Dr Ida Rolf once said where the pain is, the problem isn’t. Whilst the most common villains are usually the 2 calf muscles – gastrocnemius and soleus – something further up the kinetic chain could also be causing compensatory issues.

Symptoms usually begin gradually with onset of achilles pain during or after exercise/running. Over time, the pain becomes more frequent and can even begin to be a problem at rest. Usually the tendon itself is painful if you squeeze it, and you may become aware of swelling or thickening of the tendon. Some report pain first thing in the morning.

However, it can be aggravated by the simplest of things due to its weight-bearing location, and due to the various possible casues; using the stairs, walking uphill, squats, running fast or uphill, and lastly, some massage techniques and stretching! Yes, you read those last two correctly; if you have a tendinopathy that is compressive in nature, stretching will not help (Reference 1)… if you have an inflammatory response, having your sports masseur rub it/friction it for 30 minutes will not help.

Tendinopathy is usually divided into stages – reactive, disrepair, and degenerative.  Depending on which stage you are at, the most important treatment can be load management. This means reducing both tensile and compressive load on the tendon, much like proximal hamstring tendinopathy. Tendons connect muscle to bone and as a result are placed under a great deal of tension during activities that involve the muscle contracting or resisting a stretching force. Every time your foot contacts the ground during walking or running, the body has to deal with an impact force many times your body weight. Strength endurance seems key here (Ref 2).

The P.O.L.I.C.E protocol is useful, but as the condition can persist, ideally a structured, graded rehabilitation procedure of strengthening and stretching the relevant tissues will be discussed, with (potentially) a return-to-play plan put in place.

For more information, please contact Dan@DC-InjuryClinic.co.uk

REFERENCES

  1. https://www.ncbi.nlm.nih.gov/pubmed/22113234
  2. http://yaroslavvb.com/papers/alfredson-heavy.pdf

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

 

Gluteal Tendinopathy

Having written a couple of blogs on “Pain in the Bum”, (see #1 and #2) gluteal pain (gluteal; pertaining to the buttock muscles or the buttocks) is an interesting one as – generally speaking – despite the name, this usually reports, initially at least, as a hip condition…

Gluteal tendinopathy usually causes pain towards the outside of the hip. Also attributed to this condition are muscular stiffness, and/or loss of strength in the hip musculature. Other symptoms can include;

  • pain that is worse when you use the tendon e.g. running, jumping or hopping.
  • pain and stiffness that may be worse during the night or first thing in the morning.
  • pain that is often worse when you lie on your affected hip.
  • The outside of the hip may have tenderness, redness, warmth, or even visible swelling if there is inflammation of the hip bursa (sack of fluid).

Risk factors of the Gluteal Tendinopathy include being female(!) – as females are more at risk in the region of 4:1 – a high BMI, weak hip ABduction (the ability to take the leg away from the bodies midline) and excessive hip ADDuction (the movement of the leg across the bodies midline). It is also seen in high explosive sports and/or a rapid increase in explosive movements, such as plyometrics or HIIT workouts.

It is often mis-diagnosed as Tronchanteric Bursitis, which is an inflammation of a sac filled with lubricating fluid, located between tissues such as bone, muscle, tendons, and skin, that decreases rubbing, friction, and irritation”. The actual cause of the pain is thought to be a combination of pathology between gluteus medius and minimus (Ref 1)

Gluteus Medius (GM) is an important muscle in controlling the level of the hips. The role of the GM during activities such as walking and running is to dynamically stabilize the pelvis in a neutral position during single leg stance. Weaknesses often results in a trendelenburg sign, which is an abnormal walking/running gait where the hip of the swinging leg drops down, rather than raises up. On my Strength & Conditioning for Runners Workshop we spend a good portion talking about the ability to ABduct the hip, and the importance of the smaller gluteal muscles in not only the ability to achieve their primary function, but also to reduce the effects of their opposite movements. We spend a long time looking at effective ways of strengthening this potentially weak link – and it is way more simplistic than the well outdated method of doing hundreds of Clams….

Treating an aggravated tendon such as this is a great example of how stretching and or foam rolling is not the answer. Stretching the glutes can increase tendon compression and in doing so delay recovery and even make symptoms worse. Massage can help relax muscles but we should avoid allowing anyone or anything from applying direct pressure to the painful area. Successful treatment of GT includes, in ascending order, Education, Isometric Loading, Isontonic loading (without compression), Isotonic Loading (with compression) and, finally, graded exposure to explosive, plyometric based loading. This approach was found to have a 78.6% success rate at just 8 weeks (2), whereas corticosteroid injection was less effective (57%).

As always, when I doubt, get it checked out.

REFERENCES

Ref 1 Long et al, 2013 Sonography of greater tronchanteric pain syndrome and the rarity of primary bursitis

Ref 2 Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial, Melloret al, 2018, https://www.bmj.com/content/361/bmj.k1662

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Elite Athletes ≠ Elite Treatments

Early last year my website lost a Page –  “Electrotherapies”. It would have gone largely unnoticed as, despite my training, qualification and insurance to carry out such treatments, I have never felt comfortable with their efficacy, and so very, very few people will have even realised it was a treatment modality that was on offer. It was far more likely that someone had asked for that specific treatment, and I had gently talked us out of it, in favour of a more effective, and so cost-effective, treatment plan.

This is a good article, by physiotherapist Adam Meakins, looking at where these modalities sit;

“To try and help with this issue Connect Health shared their traffic light system they use to help their physios focus on what should, could, and doesn’t need to be done with patients. A GREEN LIGHT means there is strong evidence that this intervention SHOULD always be done. An AMBER LIGHT means ambiguous evidence so this intervention COULD occasionally be done. And a RED LIGHT means this intervention has no strong evidence of effectiveness and so DOESN’T need to be done”.

The article continues to say that ultrasound has been “red lighted and now removed as an intervention for all MSK conditions”

But wait, here’s a picture of the most expensive footballer in the world having ultrasound treatment on his injured foot. So if you have foot pain, this MUST be the best treatment, right…?

A quick scan of some research;

“There was little evidence that active therapeutic ultrasound is more effective than placebo ultrasound for treating people with pain or a range of musculoskeletal injuries or for promoting soft tissue healing”

https://www.ncbi.nlm.nih.gov/m/pubmed/11444997/

——————————

“No high quality evidence was found to support the use of ultrasound for improving pain or quality of life in patients with non-specific chronic LBP.”

https://www.ncbi.nlm.nih.gov/m/pubmed/24627326/

——————————

This is an interesting one which found;

“A significant improvement was noted when the effect of continuous ultrasound was compared with rest, but continuous ultrasound treatment was not significantly better than placebo ultrasound.”

https://www.researchgate.net/…/19967762_A_comparative_study…

…..where “continuous” ultrasound was 2 appointments per week for 6 weeks, and still no better than placebo!

That’s gonna cost.

——————————-

Which is where I sit in conclusion; I understand why elite sports teams use these modalities, as money is – seemingly – no object and there are a lot of hours to fill in the life of an injured athlete, so why not? There seems to be no negative effect…

At least not for the athlete – the negative effect can be that weekend warriors, gym goers, even chronic pain sufferers can get caught up in expensive, long term treatment plans that simply don’t make sense, because we correlate elite athletes with elite treatments. Taking into consideration hugely important factors such as time constraints, money available, psychological and sociological factors there is always a better option.

Here is another article looking at why exactly you will see these treatments carried out in elite sport, but why that doesn’t make it the correct treatment for us, non-full time athletes;

Thoughts welcome

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Sportive Bike Riding

Based here in Swindon, on the edge of the Cotswolds, we are blessed locally with numerous annual Sportives, over a wide range of distances and terrains – from road to cyclo-cross. Sportives are great ways to ride new roads without having to spend hours route-planning (or risking getting lost, inadvertently turning your 20 miler into a 40 miler!), and they are great fun for those looking to ride in a big group – and of course there’s also the huge sense of achievement at the end!

Depending on your goals, there are a few ways to make your long hours on your bike more comfortable. Incorporating other forms of training (cross-training) will be beneficial to your cycling, but naturally you will want to spend the majority of training in the saddle. There are plenty of good, generic strength and conditioning for cyclists articles to be found, such as this one on the TrainingPeaks website. Ideally, knowing your current strengths and weaknesses can isolate a more specific approach.

Phil Burt, Lead Physiotherapist for Great Britain Cycling Team advocates sports massage as part of the training protocol saying “A regular, say monthly, appointment with an experienced soft tissue therapist can be useful as a body MOT and can help identify areas of tightness or concern”, which in turn can lead to a more specific approach to your training.

It is a good idea to get your bike checked over, pre-event, to ensure it is in working order and so there is less chance of you having mechanical issues on the day. Whilst there may be mechanics on course, it will effect your enjoyment of the day, so learning the very basics (such as how to use your puncture repair kit) can be beneficial. Locally, I can recommend Run&Repair for bike maintenance.

A big factor effecting your enjoyment on the bike is of course how comfortable you are on the bike; this is effected by your bike position, the clothing you are wearing and your cycling history. I advocate a 3-step integrated process, devised to harmonise Man and Machine.

STEP 1 – Musculoskeletal Screening: Identify common musculoskeletal and biomechanical deficits and imbalances highly prevalent in cyclists.

STEP 2 – Rehabilitation and/or S&C Plan: Address aforementioned musculoskeletal and biomechanical deficits, with tailored, bespoke exercises and stretches.

STEP 3 – Discipline Specific Bike-fit: Incorporating the aforementioned musculoskeletal and biomechanical deficits, discipline specific adjustments of the bike take place, designed to maximise your position within the ‘3 Pillars’;

For many years, bike fitting has been the domain of the bike mechanic, but research suggests time and time again that it is in fact the clinicians perspective which can be most valuable. For full details of what I offer – see here.

The keys to successful training are like in any other sport;

  •  try to increase the amount you are doing gradually.
  • The sooner you start your training and more time you have to train, the greater the progression you will make before your event.
  • Try and incorporate some group rides into your training, as riding in a group is a good skill to learn before an event with people around you.

Let me know how you get on!

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Placebo & Nocebo

Placebo. We’ve all heard of it, but what is it exactly?

A placebo is a substance or treatment with no active therapeutic effect. The Placebo Effect is a phenomenon in which the recipient perceives an improvement in their condition due to personal expectations, rather than the treatment itself. So lessening pain through no intervention. Placebo effects are absolutely fascinating, with some placebos seemingly more effective than others; large pills seem to work better than small pills, colour pills work better than white pills, an injection is more powerful than a pill, and fake surgery gives a stronger placebo effect than injection (Ref 1)! Whilst fake surgery seems a crazy idea, the Finish Meniscal Legion Study Group’s trial published in The New England Journal of Medicine, found a sham meniscal (cartilage) surgery to be equally effective as the actual procedure. Think about that.

The use of placebo is also an interesting ethical topic for any therapist, which I wrote a little more about here.

And what of Placebo’s lesser know twin – Nocebo. The Nocebo Effect is when a negative expectation causes a treatment or therapeutic intervention to have a more negative effect than it otherwise would. It is the perception that will have a negative influence on the result, not the treatment itself. So creating more pain, through no intervention….The words we use can be incredibly nocebic; a simple diagnosis can sometimes have that effect if it is not communicated correctly. We all know someone that ‘cant’ do exercise because of the negative effect that it will have, having been told so by a health professional, and the healthcare profession is full of potentially nocebic words; “rupture” and “impingement” for example. Another classic example of this a therapist saying “…oooh, this is gonna take a least 10 treatments…”, reinforcing the persons perception that they are “in a bad way”.

This in turn leads to catastrophizing – we know from studies that we can “… successfully manipulate pain catastrophizing in positive and negative directions in both chronic pain patients and healthy volunteers and … show that these manipulations significantly influence pain levels”. So just by our words and body-language, we can alter other peoples pain state.

A classic case of catastrophizing that many a runner will be familiar with is ‘Maranoia’, where every sneeze or ache turns into a career-ending condition days before an event…

So be aware of the tricks our own brain can play on us – in both positive and negative directions, and don’t be afraid to question your health professional to clarify exactly what the treatment is setting out to achieve.

REFERENCES

Reference 1. https://books.google.co.uk/books?id=NfCDR_Yl7f0C&lpg=PA21&ots=K0nNndldOB&dq=large+pills+capsules+placebos&pg=PA21&redir_esc=y#v=onepage&q=large%20pills%20capsules%20placebos&f=false

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

The Foot/Pedal Interface

Humans are asymmetrical beings. Yet bikes & pedal systems are designed symmetrically which can create biomechanical challenges for the lower extremities of a cyclist. In this blog we will look at the most crucial, and often misunderstood, connection point on the bike: the foot/pedal interface.

On Physics Of Cycling, it is said that “At the start of the ride, the cyclist initially has chemical energy stored in his/her body as a result of the cyclist’s food intakes. This chemical energy in the cyclist is then converted to kinetic energy on the bike pedal due to the cyclist applying a downward force upon the bike pedal. As a result, the kinetic energy upon the bike pedal is transferred to the cogwheel on the bicycle’s backside via the bike chains attached to the pedal. The cogwheel begins to output motor energy onto the back bike wheel, which enables the bicycle back wheel to move in a clockwise direction.” In other words, every watt of power generated in the key cycling muscles, is transferred in to forward motion of the bike via the foot/pedal interface.

One of the most important and overlooked aspects in bike fittings is the tilt and angle of the forefoot. Studies show that 96% of all cyclists are misaligned in their connection to the bike, decreasing comfort and efficiency.  Of these cyclists, most have what is known as a Forefoot Varus (the inside of the foot tilts upward) – for runners who may have had a “gait analysis“, they will be familiar with terms such as ‘pronation’. This causes a misalignment as soon as you clip into a pedal because the pedal is flat, and solid carbon fibre. This misalignment can also lead to pain and/or numbness in the feet, with reports suggesting up to 54% of cyclists suffer from such (ref 1).

A specific tilt adjustment where the cleat/shoe meet can resolve the most common painful or numb areas of the feet. Cleat Wedges, or In-The-Shoe Wedges, are stackable to fine-tune your unique forefoot tilt, which can be measured by a professional. They are specially designed to fill the gap between the natural angle of your foot and the flat, hard pedal. This allows your foot to maintain its natural position – not change it.

This can also have dramatic effects further up the chain, as, whereas with running the foot is a slave to the hip, in cycling, the knee becomes a slave to the foot. If your foot is forcing itself flat in the solid shoe, the knee will follow. Have your cycling friends ever commented on your knees deviating in toward the frame on your rides together? Do you suffer from knee pain in the low impact sport that is bike riding?

And its not all about wedging the foot; the fore-aft (front-back) position of the cleat, the width of the spindle, the medial-lateral (left-right) position and the rotation (or float) of the cleat will all have dramatic effects on where both the foot and the knee will travel in each single revolution – of thousands at a time.

If you are suffering from foot or knee issues on the bike, or would like to know more about increasing your efficiency, more information can be found here.

REFERENCES

  1. Journal of Science and Cycling 2012; 1(2): 28-34

Leg Length Discrepancies…

Leg length discrepancy (LLD) is a measurement that is taken by many rehabilitation professionals when patients present with various conditions. Its something that a lot of people locally to myself present with as a previous diagnosis, their symptoms ranging from plantar fasciitis to headaches. However, I think its fair to critically appraise the research, and ask ourselves if these inequalities are truly associated with all these symptoms and, if so, how much of a discrepancy must exist before we see problems?

Firstly, here are a couple of classifications of LLDs

Anatomical or true leg-length discrepancies (which I think of as “mechanical” difference) are when there are actual measurable skeletal differences in the shape and length of the leg bones, such as the femur, tibia and fibula. These can only truly be confirmed by scanning.

Functional or apparent leg length discrepancies are where there are no bony differences and the legs are technically the same length, instead its other conditions such as spinal scoliosis, pelvic asymmetries or muscular imbalances that create the appearance of one leg to act longer or shorter than the other.

There are numerous ways to measure leg length; and unfortunately, they are all pretty unreliable if the LLD is less than 1cm. (Ref 1). And according to the review study below (Ref 2), which examined studies on LLD over a 25 year period, LLD was found to exist in 90% of the population. In fact, on average most of us have a LLD of 5.2 mm (0.5cm) and suffer no negative consequences.

Reading on, seven studies in the review compared asymptomatic (no pain) individuals with people who had symptoms somewhere in the kinetic chain (knee, hip, and low back) and found that there was no statistically significant difference in leg length (5.1 mm versus 5.2 mm). These results suggest that average LLD is not correlated with painful lower limb issues, the most proximal position to the any fitted orthotic, for example….

Which leads us onto orthoses; again, I come across a huge number of people who have been fitted orthotics, for a wide range of symptoms, and have had them in their shoes for a number of years. Orthotics, also called orthoses, are devices that are worn to “correct” foot and ankle problems without surgery. Most people think of shoe inserts or “arch supports” when they hear the word orthotics, but they can include devices such as foot pads, shoe inserts, ankle braces and similar items. They should – in my humble opinion – only ever be fitted by a trained podiatrist. I am a huge fan of the work of Ian Griffiths, Sports Podiatrist who says “Orthoses are rarely, or seldom, going to be a life sentence….Orthoses change the load in our tissues; rather than thinking of Orthoses as an external crutch, or brace, which they are not; as something which realigns the skeleton, which they don’t…they are another way of managing load…When that tissue is built up to have the appropriate and the requisite strength, conditioning, endurance capacity; that Orthoses is now redundant and should be removed(Ref 3)

So, when might a LLD matter? Well, it appears that a LLD of >20 mm (2cm) may be associated with the development of knee osteoarthritis and/or low back pain. A LLD <20 mm can usually be compensated for by passive structural changes.

So, are your legs the same length? Probably not.
Is that the cause of your pains? Probably not

As always, when in doubt, seek out a trained therapist. 

REFRENCES

  1. Interexaminer reliability of supine leg checks for discriminating leg-length inequality. https://www.ncbi.nlm.nih.gov/pubmed/21621725
  2. Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Chiropr Osteopat. 2005.”
  3. https://youtu.be/FmohVPOODac