In all seriousness, there are many people experiencing back, hip and knee pain, for whom, a slightly more sophisticated version of the beer mat, may indeed be the answer. A larger number of people than you might imagine, experience significant, often debilitating pain, as a result of a leg length discrepancy. This, quite simply, is a difference in the length of the left and right leg, and it can be the result of a number of issues. As usual in this blog, I will examine each of these in turn, and then offer an explanation as to how an Orthotist can be of assistance in reducing pain, increasing stability and mobility, and helping us to live a happier and more independent life.
The first cause of a leg length discrepancy (LLD), can be a congenital issue that manifests itself during childhood. This can be the result of several conditions, but can arise at different ages, be of varying degrees of severity, and can be treated in different ways. One common cause of an LLD in a child, is where growth rates are not consistent in both limbs. This can be treated by attaching a plate, during surgery, to either the femur, the tibia, or on rare occasions both, on one leg, to prevent growth, in order to let the other limb ‘catch up’, for want of a better phrase. This is obviously quite a severe case, and is not the norm. What is more common however, is that someone goes through childhood with a slight LLD, that is largely unnoticed as at that age, we are less likely to see significant pain or reduced mobility. The problems become more acute and noticeable in older age however, and it is not uncommon for someone to present with pain, only to discover that this LLD has been present for years, prior to becoming something that needs to be treated.
The second cause of LLD, is trauma. This can be something such as someone suffering an impact injury whilst playing sport, or in a car accident, or even during a trip or fall on ice or snow for example. Again, if this happens in someone young and fit, then it may not be picked up as a significant issue at first, but may then manifest itself as a severe problem later in life. This is very often the case in people who play sport, particularly at a high or intense level. We are starting to see more of these issues in runners for example, as more and more people take up marathon running or take part in triathlons. Pain during training is seen as ‘the norm’ for many, but may ultimately be the product of an undiagnosed and intreated LLD, which may see the end of a career at worst, or a reduction in performance at best.
As more people are now electing to have replacement surgery, referring particularly to knee and hip replacements here, there are a whole new group presenting with pain, following their surgery, and this is also very often a result of an LLD, caused potentially by the surgery itself. It’s not impossible to see how this may happen, once the limbs being replaced are manipulated to permit the replacement, resulting in a change to the length of one leg and not the other.
Regardless of the cause of the LLD, the problems are the result of an asymmetrical gait, which then causes the sufferer to change their posture, or how they manage walking more generally. It’s well known , that something like stubbing a big toe, can the lead to temporary pain elsewhere in the body, as the change in the way we walk as a result of the pain in the toe, causes pain further up the skeleton, either in the knee, the hip, the back, or even as far up as the neck. So, imagine this on a much more permanent basis. The discrepancy doesn’t need to be large to cause pain, and it doesn’t necessarily follow that the greater the difference, the more intense the pain.
The key message here however, is that pain suffered as a result of an LLD, can often be easily sorted, and of course, the earlier it is detected, the easier it is to fix, and the better the results are likely to be. I started this piece with the wonky table leg analogy, and as simple as this may sound, managing pain and increasing stability in someone with an LLD, is very much the same solution. Depending upon the severity of the discrepancy, a simple heel raise can either be worn inside footwear, or an external raise can be added to shoes to compensate for the length difference. There is a warning here, as there is a bit more science to this than simply adding bits until it feels about right. This is a considerable biomechanical issue, and an Orthotist is best placed to assess the discrepancy, and ultimately to then prescribe an appropriate course of action to rectify the problem. This is not something that will usually ‘mend’ itself in time, unless in young children of course, and the raise may become a permanent feature, albeit one that reduces or even removes the pain, makes you more stable, and increases your mobility, and your confidence whilst walking.
If you are experiencing knee, hip, back or neck pain, then a trip to your Orthotist may just be the start of your journey to a happier life, and with such a simple solution to boot.