The "one leg is shorter" Excuse


Before reading this, realize it’s lengthy and somewhat detailed. Either get comfy, or come back and read it later. If you’ve ever been told you have “one leg shorter”, this article is for you. If you have a friend who’s been told they have one leg shorter, forward this on to them…

Both in private practice and in working with the Rev3 triathlon series across the country, I treat hundreds of pro and age group triathletes.  In doing so, I hear so many stories of anguish and despair as the athletes recount their history of injuries and what they’ve done to try and remedy the problem.  This is the part when I get frustrated, because many, if not most of their previous treatments are questionable at best, but downright irresponsible when they tell me what they were prescribed by their health care provider.

I could make this into a small book if I were to get into the cortisone injections, the colorful self adhesive stretchy taping and the over abundance of stretching an injured muscle, but this post will strictly be about a pet peeve of mine – the “one leg is shorter than the other” excuse.  (from here on out, I will refer to a Leg Length Inequality as “LLI”)

The post will be in 4 sections:

  1. How was your LLI determined? (methods are important)
  2. Is the leg really shorter or, does it just appear that way? (functional vs. anatomic)
  3. Is your LLI even relevant? (size IS important…)
  4. What should you do about it? (Can the treatment cause more problems?)

1) Functional vs. Anatomical Differences

Anatomic LLI denotes an actual difference in the length of the femur, tibia, talus or calcaneus, which are the weight bearing bones of the leg. Functional LLI is referencing a difference in the apparent length but is caused by biomechanical issues in the kinetic chain such as pelvic rotation, excessive foot pronation, knee valgus (knee deviating inward), muscle contractures etc.  In other words, in a functional LLI, the length of the bones isn’t different side to side, but one foot may be pronated, one knee may be collapsing inward a bit or some other factor that makes one leg “appear” shorter”.
Trying to correct a functional LLI with a shoe insert (heel lift) is silly, and not addressing the real problem. In his book, Michaud correctly states “a heel lift should never be used to treat a functional limb length discrepancy because the lift does not address the cause of the discrepancy and may even create a unilateral weakness of the involved lower extremity” [1]

2) How was your LLI determined?

leg-length-5If we want to have a discussion on LLI, we have to realize that the way the vast majority of people are diagnosed is by laying on a table and having a clinician look at their legs with a visual inspection. Unfortunately, this is a very unreliable way of looking at things as there are many factors that can cause one leg to “appear” shorter, including pelvic obliquity, suprapelvic hypertonicity (muscle tone in the low back pulling asymmetrically on the pelvis) etc. Many studies have shown that this method is unreliable. For example, Rhodes et al., demonstrated that the side and magnitude of  “short legs” were not significantly correlated with radiographic anatomic LLI, indicating they are separate phenomena [2].

In another study, 45 patients were examined via this method by 2 clinicians. All (100%) of patients were determined to have a leg length discrepancy (Yes, you read that correctly – 100%).  Also, there was “poor reliability when determining the precise amount of that leg length difference.”  In addition, the study noted “There does not appear to be any correlation between the side of pain noted by the patient and the side of the short leg as observed by the clinicians” [3]

Many therapists will say that they are more accurate because they measure the leg length by using a tape measure to go from a point on the pelvis to a point on the ankle. Again, this doesn’t account for functional differences between sides. One study summarized this nicely by stating, “Tape measure methods for measuring LLI have been found to be of equivocal accuracy and may be less accurate than radiological criterion standard method for assessing anatomical LLI” [4]

OK, so doing a visual examination isn’t reliable, using a tape measure isn’t reliable, what’s left? One purportedly reliable method is done with a standing x-ray of the pelvis and measuring the levels of the femoral heads. This method was developed by Friberg and even he states that it is unreliable, “The method described here is not meant to substitute the methods for measuring accurately the length of the different parts of the lower extremity” [5]

Essentially, it is unreliable because it fails to account for other functional factors. (For example, I take an X-ray of your pelvis so I can see the height of each femoral head. Is there is a difference in the length of the bones, or is it because there is more pronation on one side which is causing that leg to “appear” shorter?)

Another article pointed out that, “methods that incorporate both anatomical and functional LLI without distinction (eg, Friberg method) necessarily overestimate the incidence of anatomical LLI compared with a stricter definition.” [6]

So what is the stricter definition? The only way to reliably determine an anatomic LLI is to take x-rays of the lower extremities and actually measure the length of the femur, tibia, talus and calcaneus, since these are the primary weight bearing bones.  However…even when that is done (usually laying down), it doesn’t account for the other aspects of biomechanics which occur when standing, running or walking.  For example, if I have 7mm LLI when x-rayed laying down, maybe I also run with more knee valgus on that side which would negate the anatomic difference.  It is an inexact science at best!

3) Is your LLI even relevant?

Let’s pretend that you’re healthcare provider is “positive” there is a LLI. They want you to wear a heel lift to compensate for your 12 mm short leg… Is 12mm (1/2 inch) a lot? Is 6mm (1/4 inch) a lot? what about 19mm (3/4 inch)? Well, we have some clues…

Studies show that 90% of the population has LLI [7]. We know that LLI of >20 mm (>3/4 inch) affects only approx. 1/1000 people. [8].

So, if LLI is so common, and 999/1000 people don’t have LLI greater than 20mm, how big does LLI have to be before it becomes “clinically relevant”. In other words, how big does LLI have to be before it causes either gait compensations or pain/injury? Again, we have some clues…

leg length incidenceOne study found that in 74 adults, there were no functional or cosmetic problems if the LLI was less than 20 mm (3/4 inch). [9]

Another study, looking at 35 marathon runners, found “discrepancies of 5 to 25 mm are not necessarily a functional detriment to marathon runners, and no consistent benefits could be attributed to the use of a lift.” [10] Again, another study used data from force plates to look at how compensations for LLI happened. They found a threshold discrepancy of 3.7% of the limb length (approx 20mm on average) before an asymmetrical gait occurred [11]. Yet another study examining gait on 35 children found “discrepancies of less than 3% of the length of the long extremity were not associated with compensatory strategies.” [12]

So, these studies show that gait compensations usually do not occur in subjects with LLI less than 20mm (3/4 inch), or less than 3% of the limb length. Since 999/1000 people don’t have LLI >20mm, and gait compensations and ground reaction forces aren’t different with anything less than 20 mm, why all the hype? In other words, in a typical triathlon of 3000 people, there are only 3 people with a LLI >20mm. My own anecdotal experience [13] in my clinic and working on hundreds and hundreds of athletes at triathlons across the country tells me there are a heck of a lot more people than that who have been “told” they have LLI.

4) What should you do about it?

So, we’ve examined the unreliability in determining LLI, we’ve looked at functional vs. anatomic LLI and realized that anything less than 20mm difference should probably be left alone (exceptions exist, such as acquired LLI. For example, people who have a shorter leg due to a femoral fracture).

So now, what do we do if there truly is LLI that needs to be compensated for?

As you may have already guessed, there is even disagreement as to how to deal with the LLI if one is found. In his textbook, Michaud states that placing a heel lift under the calcaneus will result in 33% less of a change in the total compensated height, since the talus is 1/3 of the way between the calcaneus and the metatarsal heads. For example, a 6mm lift under the calcaneus will result in raising the talus 4mm [14]

In addition, only using a heel lift ends up causing “altered motion and/or transfer weight to the medial forefoot.” Essentially, this then means that your are altering the biomechanical stresses applied to the foot, raising the potential for foot pain/injury by altering it’s normal function. To compensate for this, many clinicians recommend a full-length insole, rather than just a heel lift. I don’t think I need to say it, but I will:  this will still result in altered biomechanics of the foot, and again, raise the potential for foot pain and injury.

However, this also brings up another point. If there is pain somewhere, and the LLI excuse is used without properly addressing the real problem, more problems can result. Rather than disclosing names, I can tell you of one pro triathlete this year who played around with inserts after she was told she had one leg longer. She missed most of the season because she was battling pain. At a Rev3 race, she came to see me. It really wasn’t a long diagnostic process to realize that she had an internal hip pathology and needed surgery. She went back home, consulted with a good surgeon who agreed that there was a significant internal hip pathology and she has since had the appropriate surgery. Could the whole thing have been avoided with proper earlier diagnosis?  I guess we don’t know, and it’s pretty tough to speculate.

My point is, messing around with invalid and unreliable diagnoses delays proper treatment on the real problem.

Please keep in mind, this article is not intended to deny that LLI exists, doesn’t cause pain and suffering, or should never be treated. My problem is that it is over-diagnosed without proper thought or investigation, not diagnosed properly and usually managed poorly. Until healthcare providers actually take the time to THINK and critically analyze runners in a thorough and step by step process, quick and easy solutions will prevail…such as cortisone injections, stretchy colorful taping and heel lifts.

*** Please keep in mind in the comments section below that I am not able to answer specific questions about YOUR LLI.  With the medicolegal system the way it is today, advising people over the internet is a dangerous business and one that I would like to steer clear of.  Please consult with your own physician, chiropractor or physical therapist with whom you have an established doctor/patient relationship with.
==============

1) Michaud, Thomas, DC. Human Locomotion: The Conservative Management of Gait-Related Disorders. Newton, Massachusetts: Newton Biomechanics. 2011. Pg. 189
2) Rhodes DW, Mansfield ER, Bishop PA, Smith JF. Comparison of leg length inequality measurement methods as estimators of the femur head height difference on standing X-ray. J Manipulative Physiol Ther. 1995 Sep; 18(7):448-52.
3) Schneider et al., Interexaminer reliability of the prone leg length analysis procedure.
J Manipulative Physiol Ther. 2007 Sep;30(7):514-21.
4) Cooperstein R, Lew M The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. J Chiropr Med. 2009 Sep; 8(3):107-18.
5) Friberg O., Koivisto E., Wegelius C. A radiographic method for measurement of leg length inequality. Diagn Imag Clin Med. 1985;54:78–81.
6) D.W. Rhodes, The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. J Chiropr Med. 2010 June; 9(2): 95–96.
7) Knutsen, G. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance. Chiropractic & Osteopathy 2005, 13:11
8) Guichet J-M, Spivak JM, Trouilloud P, Grammont PM: Lower limb-length discrepancy. An epidemiological study. Clin Orthop Rel Res 1991, 272:235-241.
9) Gross, R. H.: Leg length discrepancy: how much is too much?. Orthopedics,1: 307-310, 1978.1307 1978
10) Gross, R. H.: Leg length discrepancy in marathon runners. Am. J. Sports Med.,11: 121-124, 1983.11121 1983
11) Kaufman, K. R.; Miller, L. S.; and Sutherland, D. H.: Gait asymmetry in patients with limb-length inequality. J. Pediat. Orthop.,16: 144-150, 1996.16144 1996
12) Song KM, Halliday SE, Little DG. The effect of limb length discrepancy on gait. J Bone Joint Surg, 1997;79A(11):1690-1697
13)  Ha!  Just checking to see if anyone is looking at the references.  Good for you!
14) Michaud, Thomas, DC. Human Locomotion: The Conservative Management of Gait-Related Disorders. Newton, Massachusetts: Newton Biomechanics. 2011. Pg. 188

Comments (76)

  1. Mike Savvides says:

    Very informative post. Thanks. In my case, as you touched on, my LLI occurred to what I believe was my naturally shorter (left) leg, as a result of a bike crash resulting in a completely fractured femoral head. It was pinned together with three ti-screws. It has been six month to the day (10-1-12). It is very noticable relative overall discomfort (lower back, leg muscle tightness in the longer leg) and overall performance, endurance and long range comfort when riding my bike. Any recommendations? By the way I’m in Seattle.

    Thanks again for this informative site.

    Regards,
    Mike Savvides
    mikesavvides@hotmail.com

    • gerald says:

      I snapped my femur head clean off in a mountain bike accident, and like you the doc pinned the whole lot together again. After 3 months compression occured—possibly due to crutch slip. I lost about 10mm between the femur head and the femur itself. It took another 3 months to walk without crutches. I walked with a diminishing limp for another 4 months. Initially I had some pain in my lower back so I went to the physio thereapist who gave me some exercise routines for the gluts and the hameys this eventually got rid of most of the limp and the back tenderness also went away. You can walk normally with leg differeces upto 20mm

      So I suggest see a pysio therapist…….also you need to be checked for A.V.N for about 2 years after the injury occured.

      regards
      G.Hesselink

  2. Nick says:

    I had knee problems for a while and was told by a physiotherapist something along the lines of my back being out of alignment. After a few twists and a snap, the problems seem to have gone.. however, is it psychological?.. the physio I saw told me it’s natural to expect one leg (I think he said right) to be longer than the other, as humans are designed that way. I think my legs were equal or the unnatural side was the longer side or some such. I reiterate though, the treatment worked, as it was a time I was experiencing pain running and walking up and down steps, this pain has since, well, 95% of the time, gone.. every now and then there will be a short sharp pain but it happens rarely and quickly disappears, whereas before the pain was constant and getting worse.

    • admin says:

      Nick,
      Great to hear that you’re feeling better. In the end, that’s mostly what counts.
      However, I wouldn’t be convinced that it was because he somehow lengthened your leg with a few twists and a snap. I hope that you received more treatment that just that one procedure. Perhaps some exercises and other manual therapy. Obviously this is pure speculation since I have never examined you, but I suspect that the whatever was done to you involved some reduction in central pain sensitization via descending inhibitory pathways. In other words, the twists and the snap generated complex neurologic reflexes which helped block the pain for a while. Sometimes when this happens, certain muscles start firing properly and function is temporarily restored. If you can take advantage of that window of opportunity by exercising those muscles while they are firing better, movement patterns can restored. If you feel like some reading on this topic, here is a good start or you can check out this study. Here is a case study outlining what you have described.
      With respect to the one side being naturally longer or shorter, this study found that there is a slight skew toward the right leg being shorter than the left (opposite of what you had thought I guess). However, as I said in the main post, there is little evidence to say that it makes any difference.
      Anyway, regardless of the mechanism, you’re feeling better and hopefully your physio has given you some home rehab exercises or drills to keep you healthy.
      Thanks for the question,
      Kevin

      • Nick says:

        Hi, yes the physio recommended one exercise, placing a football between the knees, sitting down, pushing the knees together as if attempting to crush the football. That was it though.. I do live an active lifestyle so perhaps that enabled me to take advantage of that window of opportunity. However, a few months later.. over the last 3 days, whenever walking up steps, the pain suddenly comes back for one step at random moments. I did take an extra dose of cod liver oil the other day.. just wondering if that might effect the joints in a negative way?

        To go into more details, the physio told me to stand straight at first, noticed I apparently had one shoulder higher than the other.. or the side that should be lower wasn’t (can’t remember what he said now).. then when laying on a table, compared leg length, told me to attempt to crush his forearm with my legs, then a few twists and a small snap, I was ok.

        Thanks for the material, I will read these now. Thanks Kevin

  3. Mark says:

    Thank you Doc That was a question that was bothering me for DECADES. Back in the late 80′s I was at a hospital being checked for scoliosis. After some routine test, measurements and x-rays they determined I had LLI. The thorough explanation was “your left femoral artery (the big artery that drains blood into the leg) is smaller in diameter so hence that leg received less blood and nourishment to the bone, which caused the left leg to grow a 1/2 inch (12mm) smaller. So I was ok with the diagnosis but, not the treatment. I was at the time around 17 years of age therefore the doctor explained that since I still had a chance of growing, that I should jump on my left leg every day in hopes that it would stimulate growth in my left femoral artery which could possibly stimulate growth in that leg. At my tender age I looked him and thought “jump every day on that leg until my growth was over in hopes that it’ll stimulate growth?!” Anyway being an obedient patient I did it for about a ………..week then quit. To make a long story short after that I enlisted in the Navy found myself having to run 3 mile with the Marines. When I finished my enlistment I jogged to stay in shape. No real problem with the LLI. I can’t thank you enough for taking the time to post this study.

  4. Tom McArt says:

    After 3 Physical Therapist, one Podiatrist and several Massage Therapist… my pain in my left hip, left thigh and most intense pain in my heel has pretty much disappeared. Forgot one person, a Chiropractor.

    This had started about 3 years ago. Could not sleep on my left side for the past 3 years. This past November 1012 I developed Plantar Fasciitis on my left foot.

    One month ago I made friends with a Physical Therapist (20 years of experience) who moved into our community. I had told him of my journey and he examined me at my place of employment. He told me to come to his office the next day. He more thoroughly examined me and told me my right leg was shorter then my left. He told me if the lift for my right foot was the correct prescription for my ailment, I would see results within days.

    It has been just over 30 days and my depression is gone…. as well as the pain. All the other health professionals talked about a possible issue with concerning a leg length problem. All I can speak to is the absence of pain. The massage therapist made me feel better on a temporary basis, but my thigh and calf would tighten up in a matter of two weeks. In reflecting on my journey of the other Physical Therapist, they were all pretty young and recently out of school.

    In your article, paragraph #6 it mentioned “no correlation between the side of pain and the side of the short leg”. Are they implying that no hard info was determined in either pain on the short leg or the opposite leg? In my personal experience… the longer leg took the pain.

    I enjoyed your article, especially having traveled this journey. I thought there was no help for me and that I had to live with his pain. Pain is real to the person whose nerve receptors are processing this feeling. When a doctor asks you “On a scale of 1-10… 10 being really painful” does not always convey the real issue the patient feels.

    Tom :)

    • admin says:

      Hi Tom,
      Thanks for the note. With respect to your question “In your article, paragraph #6 it mentioned “no correlation between the side of pain and the side of the short leg”. Are they implying that no hard info was determined in either pain on the short leg or the opposite leg?” The study was performed on people with a history of low back pain. Many clinicians will try and link low back pain to being on the “long leg” side or the “short leg” side, but this study found that there was no correlation to low back pain being on the short or the long leg side.
      Kevin

    • Ted Maher says:

      Hey , i am wondering did you see a pediatrist ? and if so did they make you the lift for the shorter leg ?

  5. Robert Kennedy says:

    due to a accident and numerous surgeries (age 13), one leg is 1″ shorter than the other. Question – When I purchase shoes with a 1/4″ heel, and bring it to the shoe maker to add the 1″ lift. They remove the original heel and add the 1″ lift, and replace the original heel over that. Now that shoe has a total of 1 1/4″ inch addition. Is that what it should be or should they only add 3/4″ lift plus the original making the new heel equaling 1″? I’ve wondered which should be the correction. Thank you for your time

    • admin says:

      Robert,
      It is difficult dispensing treatment advice over the web. As always, I’d advise you consult with your own health care provider.
      Since you were 13 when it happened, you hadn’t hit skeletal maturity yet, so there may have been some compensatory skeletal changes after your accident which may make the 1″ shorter diagnosis less relevant. It is difficult to say without proper examination.
      If it is truly a 1″ difference, they are adding 1″ to the shoe to make it 1″ taller than your other shoe. If they only added 3/4″, as you proposed, to total 1″, it would only be 3/4″ taller than the other shoe which already has a 1/4″ heel.
      However, I’d advise you stick to the advice of your healthcare provider.

  6. Kristi Montes says:

    Kevin, I had a full hip replacement April 1, 2013 due to avascular necrosis of the femoral head and some hip displacia. I am 44 years old. My doctor wrote I had no leg length discrepancy before going in for surgery.

    According to the Kaiser Physical therapist and an outside PT they measured me with a tape measure at 30mm and 25mm LLI and say it is actual and anatomical.

    My surgeon seems to be in denial because he says my LLI “is not that bad”. He says I should walk around on it for with just one lift and limp for a year or two and my body “should adjust to it”. He said if he goes back in and does a second surgery it will make the hip “less stable and more prone to dislocation” so I opted not to have the second surgery.

    It seems to me that if I limp around for a year or two that will really jack me up. I just went to a cobbler and when I stood on a half-inch block it seemed OK, so he is putting a lift on the outside on a couple of my shoes.

    Is it possible that my LLI will get better? I don’t want to be naive. I look like the Leaning Tower of Pisa and have a huge limp now. Frustrating to say the least. Thank you for any help!

    • admin says:

      Hi Kristi,
      Based on what the research says, I am skeptical about the accuracy of these measurements, but 30 and 25 mm are quite significant so I would be inclined to believe there is at least some LLI from your hip replacement.
      You say you feel OK with the lift in the shoe, so there has to be some merit to that.
      I cannot recommend what you should do since we do not have a doctor/patient relationship and there are no shortage of lawyers who would love to pounce on that situation. This advice is for information purposes only. If you have concerns about your condition or treatment you should ALWAYS speak to your own doctor.
      Kevin

  7. Amy Wojaczyk says:

    I just stumbled upon your article after doing a search on google trying to see if my diagnosis was accurate. About 3 weeks ago, I developed significant pain in my left hip. After the pain reached an unbearable level (taking 800 mg of ibuprofen at a time and still not getting relief), I decided to seek treatment from a chiropractor. He proceeded to do x-rays to analyze what was going on and informed me that I have an 18mm difference in my left hip. Just yesterday, he gave me a 9mm heel insert to try. I added it to my running shoes, but now it feels as if my right leg is shorter. I am training for an Ironman 70.3 that is only 2 weeks out. At this point, I have surrendered to the fact that I may end up walking the 13.2 miles at the end so that I am able to actually finish the race. What would your advice be at this point? Should I seek a second opinion from an orthopedic? All I know is that I am in an excruciating amount of pain (I can’t lay on that side or even cross my left leg over my right) and want desperately to finish my event.

    • admin says:

      Hi Amy,
      Sorry to hear.
      Obviously there are many different causes for the hip pain. I am not in a position to do an exam and history on you over a public forum on the web. Firstly, you need to find the origin of the hip pain (muscle strain, acetabular labral tear, bursitis etc.) and then find the reason why that structure has become angry.
      As you can tell from this blog post, I am usually skeptical of the “one leg is shorter” excuse due to the many inherent flaws in how clinicians measure this difference.
      If you don’t like that chiropractor’s reasoning, then you should get a second opinion from either another chiro, PT or ortho, but make sure they make an effort to find the reason for the pain. I am biased toward recommending clinicians who are well certified in ART (Active Release Techniques) and TPI (Titleist Performance Institute)
      Good luck on your 70.3. I hope it works out for you.
      Kevin

  8. Leslie says:

    I was looking for information on this, since I had a chiropractor tell me this after an xray and suggested a customized lift he could sell me for about 200, which I did not get. I’ve had sciatic pain in my left leg, the “longer” leg for the last year which improves to the point of tolerable pain without ibuprofen, but then will turn into excruciating pain upon movement., and there I go taking the pills 3 to 4 times a day.
    I’m pretty much at my wits end and looking for any explanation to why I still have this pain. Massages, stretching, adjustments… nothing helps. I’m 39 and have three children, all teenagers. I’ve noticed my hips don’t look aligned to me for a really long time, one looks a little higher than the other, was thinking that years of wear and tear with the misalignment has somehow come to a head? I originally was thinking it was because my leg was longer than the other, but you’re article is basically disapproving this theory.
    The last chiropractor I went to basically told me he wasn’t sure what was causing my pain, because I was in alignment and all “nerve conductors” (I think that was the term) were working well. That was after I already spent about $500 of adjustments and also herbs and supplements he recommended I take from a “voodoo” test he gave, as I call it. My faith in chiropractors is dwindling, since I can’t seem to find the right one, and this last one was highly recommended by several people as being the “miracle dr.”. At this point if someone told me to wait until it was a full moon and turn around 50 times and my pain will go away, I’d happily do it. Anything to get me back to my old self again.
    The origins of the pain started when I basically hurt my lower back to the point of having to be on muscle relaxers and gabapentin, also a round of corticosteroids from my MD. I’m a nurse and switched to pediatric home health and was picking up 20 pound babies, which I haven’t done in about 15 years, then a round of CPR class did me in. I eventually quit taking the pills after a couple of months, and that’s when my sciatic pain started. I recently switched from ibuprofen to naproxen sodium, and it seems to work much better for my pain. I can actually move around and feel normal for a few hours.
    This may not be the appropriate place to post, but it started out about LLI :) Any ideas for me to explore? Or referrals in the Houston, Tx area? I’d greatly appreciate any help! Thanks!

    • admin says:

      Hi Leslie,
      Sorry to hear about your pain. I cannot get into your previous imaging and treatments (have to be careful on the web – we don’t have a doctor-patient relationship).
      If you want to give the chiropractors one last chance, I would recommend Dr. Chris Sanders as he has many credentials that I would recommend
      Kevin

  9. Dushan says:

    I’ve been battling issue with my legs for about 2 years now. Currently I’m training for IM70.3 (in 3 weeks) and full IM in 3 months.
    My issue(s) are: on my right leg, for the longest time I thought is ITB. Outside of the knee, but I believe now that it is exactly at the insertion of vastus lateralis (which is intertwined with ITB as far as I understand). After running 30-60 minutes (varies with every run), I start getting pain in that area. Sometimes I’m able to finish the run (with pain/discomfort), but sometimes it progresses into shooting pain and I stop.
    Now, on the left side I have pain just below hip area. Ultrasound showed 2 calcification spots and my left ITB snaps over it, although left ITB is intact.

    In addition I have disc hernia (that doesn’t bother me any more since being super active with triathlons, last 6-7 years) but in the past when I would have an episode with lower back, my torso was tilted to the right.
    These days I was told but almost all practitioners (athletic, chiro, physio, doctor) that my pelvis is tilted to the right, which makes sense. I’m seeing physio currently to correct my pelvis (not sure how effective that will be, just started).
    In addition to that I was also told numerous times that my right leg is shorter.

    I’m not sure if there is correlation between left (hip area) and right (outside and above the knee) legs, but I desperately need to figure out the cause and start doing longer runs to properly prepare for Ironman. Otherwise, it will be a loooong walk.

    On top of that I was just about to start running with lift in my right shoe (I got sport insoles from before) to see if that would help when I read your article. I’m afraid to do that now.
    I need to fix the pain at the vastus lateralis insert on my right leg.

    I’m not even going to ask what could be the cause of all this, but what do you think I should do.
    Also, would you have anybody to recommend in Toronto, Ontario area.

    Thanks,
    Dushan

    • admin says:

      HI Dushan,
      Sorry it took a while for me to respond.
      It is difficult for me to diagnose you with anything over the web or to give treatment advice. However, if I can help you at all, I would highly recommend Dr. Greg Lehman. He is a chiropractor and a physio, certified in ART and very knowledgeable about running. He can be found here.
      Let me know how it goes, and tell him I said “hi”.
      Kevin

  10. Teen says:

    Hello,

    I am do glad that I found this article…I am 33years and had an active lifestyle until I got pregnant last year. Things looked fine until my 5 th month and things changed drastically …I had severe pelvic pain where my pelvis used to fe locked all the time and I could never sleep of left side..I slso saw that I was limping all the time and the pain was unbearable and to my surprise my baby is 9 months and its the same…
    I used to visit a chiro even during pregnancy and she mentioned that I had short leg syndrome and after a year and a half I have severe pain in left leg from the hip to my knee..,
    The chiro took my x rays and found that I have left hip inclined than right and it’s near sacrum about 4 mm and near hip bone about 16 mm and also my neck is complete straight which is causing tension from my neck to my leg…
    I also have nerve compress in palms feet and upper back… Please can you suggest some exercises and if this is ever curable.. Does calcium tablets help in this condition?
    Also can you help me with a good chiro in Schaumburg Illinois

  11. Chris Wrigley says:

    Hi there! I just read your article with great interest and wonder if you could give me any advice.
    I have a LLI discrepency of 50mm on my right leg,this is due to an accident 24 years ago.I suffered many injuries but the one concerned here was a severe fracture of my right acetabulum.Initially i underwent an arthrodesis to stabilise the joint then in 1998 i had a full low friction arthroplasty,i walk with a terrible gait due to the asymetry of the pelvis.
    I have always maintained a reasonable level of fitness since the accident and now as i am in my fifties i tend to stick to low impact sport such as cycling and fell walking but i want to start fell running and here is where the problem starts,i wear va 35mm insert in my right boot this does help ease pain in my knees and right ankle but i have to wear high boots to stop my foot being pushed out of the footwear,i really would like to wear shoes,and more important after a few kilometers my gait becomes very uncomfortable and i end up walking instead of running.I have considered wearing 50mm insert and a high boot on my right foot and shoe on the left. Second and i am serious,i have considered amputation below the knee and having an adjustable prosthectic limb fitted. So im searching for good advice if you feel you could offer some? yours sincerely.

  12. My daughter is an elite GB Gymnast who is 16 years old and has just fetid due to persistent injuries since dislocating her knee at the age of 13 and since then she has suffered lots of injuries, particularly ankle and knee stuff.
    The GB Doctor confirmed what we already knew, that our daughter’s left leg is shorter than her right one, we thought this followed her dislocation but the doctor feels she was born with this. The shock was that there is a 27mm difference which surprised s but explains the ongoing ankle problems. We want to new concentrate on helping her to sort this problem out and ensure she doesn’t suffer medical problems in the future with her limbs and back.
    An advice would be welcome.
    Steve

    • admin says:

      Hi Steve,
      27mm is certainly quite a large discrepancy. I would certainly encourage you to follow your doctor’s advice regarding your daughter if you feel the measurement is accurate.
      This article was intended to point out that there is a large amount of inconsistency and poor reliability in leg length measurements and many therapists and doctors point to LLI as the cause of many problems. It was not intended to say that significant LLI’s do not exist. If she truly has a 27mm difference, it could very well be contributing to her ailments.
      I would follow your doctor’s advice.
      Kevin

  13. Sorry that was meant to say retired – silly ipad!!

  14. Rachel says:

    I have had knee pain on and off for about 15 years. I notice worse in winter. My knees grind and are sore when I go upstairs. Was told I over pronate a long time ago, not hugely, and was recommend to try exercises before arch supports. I managed fine for a number of years. However, since taking up running about 2 years ago it has gotten worse. So much so that I have not really been running for about 6 months. Over the last few months my ankles, knees, hips and lower back are quite sore. I normally wear flat shoes but recently wore high heels on a night out and had terrible pain the next day. Yesterday I saw an orthotist who advised that the reason I have knee pain and lower back pain is because my pelvis is not straight because my right leg is 10mm longer than my right (10 mm determined visually) he also concurred that I over pronate and recommended orthotics to support the arch and a heal lift in the left one. From reading your article, I gather you would disagree with the diagnosis based on the assessment being visual. He did scan my feet. I would really appreciate any advice you can give, I understand it’s difficult to comment when you haven’t examined me but I would be interested in your perspective before I purchase the orthotics for €290. Thanks!

    • admin says:

      Hi Rachel,
      Yes, I agree €290 is a bit much. It looks like you’ve already read the piece I wrote on leg length differences. Since you are talking about spending that kind of money on something to fix “over”pronation, you may want to read this other piece I wrote: http://runningreform.com/the-definitive-guide-to-pronation-patient-version/
      Have you tried off the shelf orthotics?
      Yes, I agree that a visual determination of 10mm difference is suspect, but that doesn’t make it wrong either.
      I walk a fine line (legally and therapeutically) when telling people what to do over the internet. I wish I could help you, but a face to face physical examination would be best. If you let me know where you live (approximately…no need for addresses please!), I may be able to point you to a therapist or podiatrist I know.
      Kevin

  15. Rebecca says:

    I have pain and vibration across my right buttocks toward the right hip. My SI joint pops into place on the right side when I hang out on my miracle balls. The chiropractor I am recently seeing took an X-ray that shows my right leg is 8mm longer than my left leg. He asked me to wear the lift in my left heel for two weeks to see if there is any improvement. I’ve only had the lift in for 1 day and my right hip feels like it is wonky. If I try 2 weeks with the lift could I do damage that can’t be reversed?

  16. Rebecca says:

    Might you know of any reputable chiropractors in the El Paso, Texas area?

  17. Serena says:

    I have been having spinal problems for years, which led to a severe pinched nerve this last year. I normally see a chiropractor, but at the time, I was abroad for several months in Spain, and didn’t want to search for a reliable one there. It took several months to correct the problem once I got back, and during this time, I had several x-rays. My chiropractor had always suspected it, and sure enough, I have a LLI of about 10 mms on my left leg. He took the X-rays while I stood, as well as sitting and lying down.
    He suggested I wear an insert on my left leg. Now, I’ve already worn inserts, the tri-comfort kind, because I have high arches. If I am standing/walking for long periods without them, my feet will cramp and my arches feel over-stretched. In fact, if I flex my feet a certain way while sitting/lying, they will always cramp. It’s a habit I’ve had to break.
    Because I already wear inserts, I decided to wear the tri-comfort kind on my left foot, and a simple arch support on my right foot. That way the heel and ball of my left foot are both lifted. Over the last couple months, I’ve noticed a new pain in the balls of both my feet. I’ve self-diagnosed it as Metatarsalgia, an inflammation of the joints caused mostly by high arches and a 2nd toe longer than the big toe, both of which I have.
    Now, you said that inserts alter the biomechanics of the foot, and that is what I fear is happening. My back and spine feel much better when I wear the inserts, so it seems they are doing their job, although causing side effects. I feel that the milder Metatarsalgia in my right foot may be related to no longer wearing the tri-comfort inserts, which provided cushioning, and have bought ball-of-foot inserts to test this. As for my left foot, I’m not sure what is causing the inflammation. It hurts too much to walk on sometimes. I’m beginning to think I should just give up and go in for monthly or bi-weekly chiropractic adjustments for my spine the rest of my life. Do you have any advice as to a better solution than inserts?
    Thanks,
    Serena

    • admin says:

      Serena,
      As always, I cannot provide advice over the internet.
      There are some potentially spurious ideas that you have been told, but since I have not examined you, I cannot say that for sure.
      I would suggest that you find someone who understands biomechanics and is not eager to sell you more foot orthoses.
      Best wishes,
      Dr. Kevin

  18. Samantha says:

    Hi,
    I recently went for a chair massage by a massage therapist and she noted that my spine has a slight curve to the left and I should go to a trusted chiropractor. I went and the chiropractor took x-rays and noted the slight curve in my spine is due to the left leg being 3/4 inch shorter then the right leg. She measure my hips on the x-ray. She also measured my legs with a tape measure while laying on a table. She suggested I wear/buy a 1/4 heel lift. Which I had and have been wearing for a few weeks now. And she her twice a week for two months, which I have not been able to do because of work. Also, due to time constraints I have yet to get a second opinion. I have no pain what so ever(I am 25). But she suggested if I did not start correcting this now by the time I am in my 40′s or 50′s my spine will be curved severely. Should I take the heel out? And get a second opinion? Or…?

    Thanks!

  19. Tom Hayes says:

    Hey Ive a problem with “lli” for a few years now. But its not just my legs, when i stand my whole body tilts down to the left. It has gotten worse this year. Everytime i get into a routine of exercise sooner or later i begin getting pain in muscles down the right side of my body. Mainly hamstrings, groin and chest. Ive been to physios who have told me its because my hip flexors are so tight. Its got to the point where my left side is much stronger than my right. One thing that may have caused the inequality is my high jump. I was involved in high level competitive high jump for about 8 years. (finished last year) My jumped off my left foot. So the the right did not get much attention. Im thinking maybe this made the left one alot stronger and had all sorts of flow on effects. What do you think about this??
    Anyway from what Ive said do you have any advice??

    Cheers Tom

    • admin says:

      Hi Tom,
      As this is the internet, I am unable to offer specific advice to anyone.
      However, I would suggest you find someone in your local area who understands how to evaluate someone’s movement and go from there. I would recommend someone certified in SFMA or find a level 3 medical/health professional on the http://www.mytpi.com website.
      Good luck!
      Dr. Kevin

  20. [...] before there is any meaningful compensation.  You can read more about my feelings on it here.  Frankly, I don’t really care if someone has a minor leg length difference. I find it of [...]

  21. hulia says:

    thank you sooo much …. after months of osteo appointments …pediatrist and expensive shoe lifts i still had lower back pain finally after months of me moaning they sent me to a scan that showed deformity of femoral head on the left….:( wish i was just sent to a scan in the first place…

  22. Chris says:

    Thank you so much for this interesting article. It is so relevant to me! I am fairly sure I have a 10mm LLI (x rays and visual tests several times). I have been a runner for 30 years and at different times have run with and without correction.
    18 months ago I went back to orthotics with correction after discovering a cartilage problem in the longer leg. For about a year all was well and my running improved and felt more efficient. But I wasn’t stretching at the time and after about a year my hipflexor and psoas on the short side started to seize up. So I stopped using the orthotics and pulled my hamstring on the short side. 9 months on I am still seeing a PT and battling with the hamstring.
    My problem seems to be that my pelvis is rotated which various PTs think may be compensation for the LLI.
    I really don’t know whether to go back to the orthotics to help correct the pelvis (I am doing lots of exercises, having physio retch as well). Or will I continue to get hip problems? The physios generally say that they don’t know for sure what is best.
    I would be very grateful indeed for any advice about rotated pelvises!
    Many thanks

  23. Tina says:

    Hello
    My left leg is shorter about 2 cm and i limp, what exercises should I do? Not to limp? Please help me.

  24. Hayden says:

    My left leg is shorter by 4.5 inches shorter than my right, measured by a medical professional. I have been doing alot of running and after 1.5 to 2 mi I get a sharp pain in the ball of my foot. I try to push through but can only make it a quarter mile more. I don’t know what to do, I’m going to the police academy soon and am expected to be able to run 5+mi a day. I am afraid that I will be kicked out for having a short leg because the pain is to intense, the “push through it” people would be crying for sure. I’ve tried Spira shoes and they aren’t helping. I don’t have time for surgery or medicine. I couldn’t get into the military because of this and I don’t want to fail at this because I will be crushed and everybody will be disappointed in me. I also have a very noticeable limp. Used a lift when I was a kid didn’t like it. I walk on the ball of my foot that where the pain occurs when I run. What are my options as far quick term solutions???

  25. Bryce says:

    When I was 25 and in college (I’m now 32) I was having chronic low back pain. My right low back muscles were always inflamed. I was taking an athletic injuries class at the time and my instructor suffered from LLI and was undiagnosed until he was in his fifties. He walks with a major hobble and lots of pain. He said he wished he’d seen a physiatrist sooner. I wondered if this might be the cause of my back pain so I went to see a physiatrist in the area. He x-rayed my spine and pelvis and showed me the 12mm discrepancy on the x-ray. He suggested wearing a full size lift starting out at 6mm and increasing a little at a time but never actually reaching a correction of 12mm due to the triangle effect when using lifts (can’t remember what the triangle effect was all about.) I noticed after wearing the lift that my body was readjusting to the shift in weight. I would feel differences in my knees. But, miraculously, the pain and stiffness of my low back started to go away. 7 years later I have not had the pain I was feeling before wearing the lift. I do wonder about the long term effects of wearing a lift for so long. All I know is a shoe lift seems to have worked wonders for me.

  26. Dalton Baker says:

    Hi, I’m Dalton and am 17. I have been told by two psychiatrists that I my left leg is shorter then the right. The first diagnosis was last year and now another one just this week (I moved during the whole process so it messed things up). I also have low mobility in my neck, entire back and legs. My spin is apparently curving to the right side (with x rays I have a shorter femur and curved back is shown) and my back muscles are way out of alignment, along with a tight neck. Ever since I was younger, I always had felt odd when walking and doing things like parkour and such. I have lower endurance in running and was always fine in other forms of exercise though, being pretty active and muscular from 12-17. Now I’m experiencing even more pain but have gotten a heal lift and had some pain relived through it along with better running. Do you think I’ll be back to normal to where I can do squats, weights, pull-ups and climbing this month? Or is this a long process and will take a while for my muscles to be back the way they should be. One last note is that visually my hips are off, my clothes are a bit slanted, my right knee is higher then the left. Do you think I’ll grow out of it now, if not, will I be fine? And, I have never broken a bone, they are calling this a natural birth defect.

  27. Jackie Anderson says:

    Long story short. Hip replacement. Hip revision with metal bands around femur to help secure femur because stem that was put in from start was to big for bone structure and the fracture behind bottom band. Plate down femur, screws. My non affected hip is lower that affected hip and the difference in my standing when crated standing measuring hip to hip is 3/4 inch. Cause spinal curve and pain. I have a curve like I should and one side straight like a boys (on my sides) Can’t bare any surgeries and want to try a full foot lift in shoe (made like insert). What should I do? Thank you!!

  28. jody cotter says:

    I was sure hoping to get some good information from this web site but alas there is none to be found. It appears all you do is shoot down every other answer you can possibly find and you offer NOTHING viable to take home with us. It is a very long article just like you said. But actually it was all just an article that put down all the other solutions available. And did not provide a solution from your site. So I guess I am just saying how disappointed I am after reading this long page of negativity. What a waste.

    • Kevin Maggs says:

      Jody,
      Sorry you feel that way. The intent is to provide people with information that will help them avoid wasting their time with a healthcare provider who is convincing them to spend their hard earned money on a solution that has no merit. There are many different reasons that people have pain and discomfort, but pursuing a fix for a small leg length inequality is a waste of time and money in my opinion.
      I cannot provide a solution for everyone with pain because the cause is so widely different. You say I “put down all other solutions available” when really, I was just talking about leg length inequality.
      The post included references to research that I base my opinion on.

  29. Greg867 says:

    I was wondering if you wouldn’t mind sending me an email. I realize you can’t give advice (not asking you too). But I have a very unique interesting situation you might be interested in. Essentially body compensation for an anatomically short leg (pelvic torsion) that was “corrected” by a chiropractor and now I have unbearable pain symptoms yet I can’t get anyone to listen to me about this problem.

  30. Matt B says:

    Recently i had a leg injury from running which is a pain down one side at the back of the Knee/ Calf. I went to see a physio who told me i needed new insoles as the trainers i was running in were neutral. I was also told i would need to where a heel lift due to one leg being shorter by 25mm. The physio stated that as i do a lot of long distance running i will need to where this from now on. Is there any recommendations you can give.

    Thanks Matt

    • Kevin Maggs says:

      Hi Matt,
      Sorry, I am unable to give specific advice for individuals. I would suggest you get a couple different opinions before you take any actions like wearing a heel lift for the rest of your life. I doubt that your leg was shorter by 25mm when your weren’t injured, so how did it get 25mm shorter all of a sudden?
      Kevin

  31. Peter Simshauser says:

    Thank you for a very informative and insightful piece. I badly fractured my femoral neck seven months ago during IM training (cycling spill), two fixations were needed to set if properly, and my injured leg is slowly recovering but is approximately 1-2 cm shorter than my other. I’m about to be able begin running again (have been swimming and cycling — too much pain to run yet). Would be grateful for any practical insights as I begin running.

    • Kevin Maggs says:

      Hey Peter,
      Sorry to hear of the crash. Bummer, to say the least.
      In general, with an acquired LLI such as the one you have suffered from, there is usually some lift that is recommended, but as always, please consult with your healthcare provider team.
      Resuming training should obviously be done very gradually.
      Kevin

      • Peter Simshauser says:

        Kevin: Many thanks — very helpful to understand the general approach. I have a good team here in Boston helping me with my recovery (surgeon, PT and massage [the massage has helped tremendously]) and keeping me in line! “Gradual” hasn’t always been part of my workout vocabulary but it is now! Best, Peter

  32. Pamela Rockwell says:

    Can a heel lift help with snapping hip syndrome? I had a visual exam by a PT and he noticed that my left knee turned inward as I walked. We have since tried a heel lift and visually my knee does not appear to turn inward, but I still experience hip pain and there is still significant snapping.
    Any advice would be helpful.
    Thank you, Pamela

    • Kevin Maggs says:

      Hi Pamela,
      There are a multitude of dysfunctions that may be at the root cause of your snapping hip. I would suggest that you seek out someone who understands anatomy, biomechanics and rehab to find a solution. Without a proper one-on-one history and physical examination, I am not only limited in helping you, but it would be illegal for me to suggest treatments for you.
      Limited ankle dorsiflexion, femoral anteversion or retroversion, poor motor control in the hip muscles, poor motor control in the muscles of the torso, tibial torsion, acetabular anteversion or retroversion, poor/new training methods and activities are just a few of the things that I can think of off the top of my head that need to be looked at in snapping hip.
      Dr. Kevin

  33. Barbara says:

    Can spondylolesys cause LLI?

  34. Brooke Whitis says:

    This is a very informative post. I have always been told I had leg length discrepancy (when I was a young child it was very obvious, and they almost corrected it with a surgery then). They measure it just a little over an inch. I went to my orthopedic today, after not going for about 10 years. I’ve had some pretty serious knee pain in my left knee, where I have already had three surgeries (my longer leg). He goes on to tell me I’ll need TWO huge surgeries…. just by looking at xray…. (not doing any precise measurements), one to cut my bone out (the length of discrepancy) and the second to realigh my knee (since about 80% of force is hitting the outside of my knee, rather than 50/50. It seems extremely ridiculous….since right now I’m running 3-20 miles per week, etc. I teach a bootcamp, etc. He told me I should “never run again” and only bike (wiith little or no resistance)…and swim. Does that sound like I need a second opinion?

    • Kevin Maggs says:

      Hi Brooke,
      Yes, I would always suggest a second opinion before opting for major surgery. Legally, I cannot comment on what he told you, since your are not my patient, but I would agree that a second opinion would be a good idea.
      Good luck!
      Dr. Kevin

  35. Mike says:

    This was a very educational read for me. I’ve had issues with and uneven stride and uneven hips that has been steadily growing since college. It now hurts to stand for any extended length of time and I’m beginning to have problems with plantar fasciitis in my left foot. My lower right back is always tight and sore, the outside of my left hip is sore, and I experience quite a bit of sciatic nerve pain in my left leg when sitting or stretching. When I run the outside of my left leg hurts from my hip to my knee and in the past year has begun to pop on my knee when I walk. Running also hurts the inside of my right knee and my right calf feels far more stressed than my left calf, especially the inside of my right calf. After a a couple years of this, my right calf is now visibly larger than my left one. Finally, the arch on my right foot feels weak and seems to pronate more. I have two questions: Can a weak or over pronating arch cause a functional length imbalance and/or would a functional imbalance exacerbate an over pronating foot? Secondly, do you recommend any professionals in Eastern North Carolina (from Raleigh to the coast) to see about this? Years of attempting to fix the problem with Navy medicine have been fruitless.

    Thanks,

    Mike

  36. Army veteran says:

    I am saddened by the pain I suffer with. While in the Army serving in Iraq, X-rays showed that I have slight scoliosis and that there is something wrong with my hip. I was suffering from back pain which started after a fall and was aggravated with sit ups. I was also seen for a dislocated shoulder and had my knees looked at because of the grinding and pain. The doctor said I was falling apart. I was also diagnosed with planter fasciitis. When I got back stateside, after many emergency visits from back pain and a collapse, and MRI was done at the ER on post. The MRI showed a bulging disc. Later, I got a new doctor and he found that I also had a very bad UTI that had gotten to my kidneys and was overlooked by the hospital because they never did a urine test. Then my new doctor realized that my plea for help was not just an act but that I really was in pain. My request for an Army chiropractor was accepted and I finally got seen by a wonderful chiropractor who evaluated my X-rays and informed me that I also have a reverse curve in my neck and a rotated vertebra. I don’t even know what a rotated vertebra is and I’m guessing its a turned bone but lets face it, I’m all jacked up! So the chiropractor feels all my bones and joints and tells me that my hips are crooked and that my right leg is actually shorter BUT because of my crooked hips, my left leg sets up higher, making function as the shorter leg.
    So my problem is thy now, I am a veteran and treated at the Veteran’s Hospital and they just want to over look the real problems with my bones and send me to physical therapy. The problem is that any therapy, causes strain on other parts of my body. I did get a chiropractor finally, paid for by the VA health care BUT then this old man started to seem inappropriate when he asked if I was checking out men at my gym. Then this man’s comments of how flexible I am, started to seem like it was inappropriate when in configuration with his last question and his offer of continuing to treat me for free, if the VA would not find him anymore. I decided to just stop seeing this chiropractor and ask for a new one but then I was denied anymore treatment until I went to physical therapy again, even though I still had sessions left with chiro that I was approved for previously.
    So now I have moved to a new area and new Veterans Hospital and I am told that I still have to see physical therapy and also have to get all new X-rays and all new prescriptions. I use 10mg of flexeril at night and this helps keep the sever headaches at bay from my sore neck. When I get headaches, I throw up from the pain and recently threw up on myself while driving on the freeway.
    I just want to run again with no pain and go fast and be healthy and not have to take medications. I am only 31 and I have a 2 year old child.
    Please can you give me advice? I also have nerve damage in my left foot so when I wear closed shoes, they cause me pain and I actually prefer to run in the barefoot shoes.
    Thanks much!

    Amber

    • Kevin Maggs says:

      Hi Amber,
      Thank-you for your service in our military. I’m sorry to hear everything you are going through. It sounds like your conditions have many levels but physical function certainly sounds like something that needs to be addressed along with other aspects of your health.
      Personally, I think the best people to assess proper function are those who utilize the SFMA as part of a clinical assessment. You can find providers by looking for level 2 or level 3 medical certification through the TPI website here:http://www.mytpi.com/experts
      This is certainly not the entire clinical picture, but it would be a start.
      I hope that helps you get started, and thank-you again for serving our country.
      Kevin

  37. Aaron Fitzgerald says:

    Hello,

    This is by far the best thing I have read regarding this issue. I have been getting nowhere with my doctor, chiropractor, and physiotherapist.

    I am an industrial athlete (aka factory worker). I work about 50 hours a week on my feet and am constantly moving and pivoting. I cannot get off of my left side at all. Everything I do is by powering off of my left side. I’ve figured out that I can’t even really lean on my right side because it feels so unnatural. This has resulted in constant pain for me. My muscles are really stiff from my left shoulder all the way down to the inside of my left knee and there is a really sharp pain around my pelvis area. Lunges really help the sharp pain to temporarily go away, but I cannot completely get rid of it and the tightness never goes away. I have been dealing with this for a long time now without any results and I could really use any and all help or advice you might have. It has become really hard to get through the day and I can’t seem to get any medical professionals to understand the severity of what I’m going through.

    Thank you!!!

    Aaron

    • Kevin Maggs says:

      Hi Aaron,
      IMHO, if you’re getting nowhere with your healthcare providers, they may just be working on the wrong things. Personally, I think the best people to assess proper function are those who utilize the SFMA as part of a clinical assessment. You can find providers by looking for level 2 or level 3 medical certification through the TPI website here:http://www.mytpi.com/experts
      This is certainly not the entire clinical picture, but you’ve gotten nowhere with your current healthcare providers and it’s better than what I can for you over the internet.

  38. Aaron Fitzgerald says:

    I also notice that I sit and lay down on my left side so I think my pelvis is out of whack. So I don’t know if my left leg is shorter or if my pelvis and/or tight muscles are causing the feeling of a shorter leg.

    Thank you, and guidance would be greatly appreciated!!!

  39. Wesley says:

    Hi my name is Wesley I have a problem with my right leg .My parents noticed it when I was 12 years old so I went to a specialist but they said it was common so I let it go. Since then, I grew about foot and a half. My leg has grown with me but it is still shorter than my right leg . Back then, only once in a while I felt a dull pain but nothing serious. I decided to compensate for the difference in length by using a heel lift .Ten years later I noticed my leg was getting skinnier , weaker and the pain was getting constant .So I went to a specialist Again.What I found out was that My right leg is now shorter about a one inch then my left leg . As a result this affects my lower back, also movement of my right hip causes constant pain. My right knee is bending inward . I also have a problem with my ankle. It is starting to bend inward too . I have a constant pain that radiates through my whole leg. Sometimes I have no feeling in my leg at all . I also noticed that my right leg Is skinnier than my left one and I don’t want problems when I am older. Is there any solution for what I’m going through?

  40. Sarah says:

    Hi Kevin,

    Thank you so much for such helpful information you put together over here!

    Over the past year, I have been slowly experiencing different symptoms on one leg only (right leg) including pain/soreness around achilles tendon, outside of ankle, outer edge of the foot, heavy and tired leg, swollen knee, and these symptoms are all on my right leg only.

    I have seen different podiatrists and chiropractors, and they all believe my right leg is longer than my left; some say it’s anatomic, others say it’s functional (that my pelvis is tilted toward left). And as you may have guessed, they all suggested different treatments.

    Before I go any further, first I would love to be correctly diagnosed by a knowledgeable expert and learn if I do have LLI and if yes, which LLI and what treatment plans are right for me.

    Could you please recommend someone in Atlanta, GA area? I am also willing to travel to any neighboring state if that’s what it takes. I just would like to know what it is that I have and hope in a near future that I can engage in any physical activities without any pain or discomfort.

    Thanks so much in advance for your help!

  41. Chris says:

    Hi, I have a 1.8cm true leg length discrepancy confirmed through ct snanogram and it is causing me many aches and pains. I have been offered femoral shortening on my longer leg. Do you have any advice you could give me and whether you think it’s worth the surgery? Iam a personal trainer and training is my life. It effects me everyday and is really getting me down.

    Thanks

    Chris

    • Kevin Maggs says:

      Chris,
      Most research doesn’t really support the idea that at 1.8cm anatomic LLI is correlated with injury or pain. In addition, if this is truly your anatomy (not from a fracture or surgery) you’ve had this for quite some time, so why is this now causing problems? It is always difficult to label a cause->effect with anatomic anomalies. How does anyone know that it is THE cause of your pain? Some would suggest trying some other conservative therapies first, before undergoing surgery. Alternatively, one could try a shoe with a build up midsole in the short leg to see if that alleviates the symptoms. Please keep in mind that I am not suggesting or diagnosing you do any of these, as that would be giving treatment advice to someone without a complete history and examination – which I am not.

  42. Bryan says:

    Hi Kevin, great blog! Glad I found it. I am a CMT also certified in FMS that works primarily with endurance athletes. Had a client come in this evening that stumped me a bit (which I am pumped about). She is a sophmore D1 cross country runner who has re-developed pain in her right hip at right hip extension. She is confident that one leg is shorter and told me she has been wearing a heel lift (not a fan) since her senior year of high school. Easy enough, so I thought. Here is where my brain started to hurt: 1) the leg that presents short is her right but the lift was made for her left. 2) left hip/gluteals don’t have near the same tone or flexibility but she feels like the left moves much better. 3) in a walking gait (haven’t seen her run yet) her right knee seems to hyper extend a bit on foot strike and hip joint itself laterally pops (no pain, been doing it for years).
    I am trying to get info on the original report that brought on the heel lift. Seems like the lift was given off of an observation and masked the original problem which is still there and now there’s more problems. I wish I could just mobility, stability and positioning where needed and call it good.
    Can you bring any clarity to this case from your experience or give some leading questions? What would you look for? Thanks in advance.

  43. Lyn Chambers says:

    I am hoping for some guidance from someone.
    About 7 years ago I had a horse riding incident. My horse spun around and I basically stayed in the same spot. This resulted in what was diagnosed as ‘deformed cartilage’ in my left hip. I could, and probably should have, gone and had it scraped out, but I never did. Finally after my last horse passed away I decided to get it done. It was getting more and more painful. The Doctor took x-rays only to find out that I was bone to bone, with arthritis and a bone spur and needed a THR. I still waited another 2 years as I just turned 53 this past year and didn’t want to have it done too early. In about April this year I decided enough was enough. I couldn’t work out anymore and everything, including horse riding, was becoming more painful. I had a very successful surgery on July 10th, 2014. Dr. Jimmy Chow was my surgeon and he used the “Supercapsular Percutaneously-Assisted Total Hip, or “SuperPATH”. It involves sparing the surrounding soft-tissue (muscles and tendons). This technique builds a traditional hip implant in-place, without having to cut any muscles or tendons. Additionally, this is done without having to dislocate-relocate the hip during the surgery, a common element to all other hip replacement surgery techniques (such as the anterior, posterior, lateral, or 2-incision approaches). Potential advantages are:
    • Shorter recovery time – many patients can be discharged from the hospital within 23 hours
    • No activity limitations
    • Less pain
    • Decreased dislocation risk
    • Less scarring
    • Easier exposure for future revision surgery
    • More natural feeling hip”
    I started PT a week after the surgery. My biggest problems to date have been all soft tissue, atrophy, weakness, loss of range of motion. I have never had much ROM – ever – and not working out for several years had taken its toll.
    So, here’s where it gets interesting (finally). I was experiencing discomfort/pain when doing a one leg balance on a foam pillow (and some other excercises), but only on the surgery (L) leg. I was demonstrating to my husband as I was beginning to get frustrated with my progress. (I am not very patient in the healing department). I had also noticed that if I tried to stand up with my feet together either my left knee wanted to bend or my right heel wanted to come off the ground. My husband noticed that my legs are not the same length from the knee down. My tibia are different lengths. (Of course I understand that they have been this way since birth but I really feel this difference since the surgery.) Not being a professional he took the best measurement he could. He measured each leg from the back of the heel to the inside and outside of the crook of my knee. He measured a half inch difference. I told my PT person who promptly said “That’s not a measurement” and measured from hip to ankle bone while I was lying down. She measured 1cm and said I should get shoe inserts made, but not for 6 months as everything is still settling. Then someone else who was in PT for years said I should get shoe inserts right away as my hips are off and it’s slowing down the healing and putting strain on my back muscles. Every time I get the hands on work at PT it’s always super tight up into my lower back on the left hand side. Having read your article I am afraid to get inserts as it sounds like it can just create more problems down the road.
    I want to heal as best I can. I understand 1cm is not a lot but like I said it’s very noticeable during my recovery. Left leg was the THR and it is the longer one. I constantly want to stand with all my weight on the R leg when standing still and bend that left knee.
    I am just hoping you or someone on this site can give me any advice on what I should and shouldn’t be doing. I realize I am only 11 weeks post surgery but I really want everything to heal as well as possible.
    Thank you so much.

    • Kevin Maggs says:

      Lyn,
      While I empathize with your pain and your concerns, it is not my place to dispense treatment advice without a doctor/patient relationship. Sorry.
      I do agree with your statements that the tibia has always been asymmetrical, 1 cm total is not a significant amount and you are only 11 weeks post surgery. Please keep in mind that the main idea of the blog post was to point out that in general, these leg length measurements have poor reliability and validity. So, you need to keep a healthy skepticism when someone measures leg lengths.
      Good luck going forward and be sure to stay compliant with the prescribed rehab from your PT.
      Kevin

  44. Christine says:

    What about if I was born with a congenial hip. My right e.g. is definitely shorter as there is a noticeable ’tilt’ to one side when you look at my waist. I am very active and notice that when I hike in the mountains I end up with a pain just below my left knee and only experience pain on the descent. I believe that I swing my right leg slightly out to compensate for the discrepancy. Would a full shoe lift help?

    • Kevin Maggs says:

      Hi Christine,
      Assuming you meant congenital hip, and also assuming you meant it hip dysplasia. Pain in the knee could be many, many things, not necessarily caused from the hip anatomy, but also by the motor control in the hip or even anatomical or function issues in the ankle. I would suggest that you be evaluated by a competent ortho, chiro or physio who is well versed at functional (SFMA) and diagnostic evaluation, and rehab. If they truly feel it is a LLI, then yes, a full shoe lift might be the best option
      Kevin

Leave a Reply