Expert: Dr. J. Shawn Leatherman - 7/31/2008

Question
I had an mri scan about 6 months ago which revealed a partial tear in my right adductor (groin). Subsequently my physio noticed I had a leg length difference (shorter on the side of torn groin). I also have noticeably more muscle on the erector spinae of the affected side, a sensation of tightness or wanting to cramp on the affected side(ql?), intermittent pain at specific intercostal points, that can be relieved by presing hard against them and more recently intermittent pain like a stitch on the ribs of the affected side. Ultrasound ruled out gall stones. Are these typical symptoms that can accompany lld's?

Answer
Dear Benjamin,

Having a short leg is common (this has been the focus of large research conducted on military personnel) but most people don't even know they have it, because often it doesn't cause problems for a long time.  There are two types of short leg:  functional and structural.

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

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

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

Concerning your symptoms:  the problems you have described are more likely to be related to compensation patterns while walking due to the torn adductor than being due to the short leg...if the short leg truly exists at all.  It sounds like muscular imbalances and contraction on the right side is the main issue.  Your physio should be concentrating on those issues as well as rehab for the torn adductor.

Now if you really want to find out if the leg is structurally short, then you need to get to a doctor who actually understands how to measure for it and when it is appropriate to utilize a heel lift or not.  Most medical doctors could care less about a short leg unless it is over an inch in difference, but many chiropractors look for these things regularly.  Make sure that you follow the recommendations on rehab from the physio you are seeing as this may just be functional in nature.  If you are not attaining improvement, then I would suggest that you get an exam form a sports certified or CBP certified chiropractic physician.  You can look for one in your area off their respective websites:  www.acbsp.com , www.idealspine.com.  Good Luck Benjamin.

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