Expert: Dr. J. Shawn Leatherman - 12/12/2006

Question
Approximately one year ago I was diagnosed with IT Band syndrome. This happened after training for my first triathlon (at age 38). I was already in better than avergae shape, but I think I caused the IT problem by training too hard, too often, too soon.

About 5-6 months ago while seeing a chiropractor for the IT issue, he diagnosed me with a 7mm leg-length discrepency with my right leg being shorter. Within appx. 2 months of wearing the 7mm heel lift in my right shoe, I began having chronic low-back pain (never severe), and also have chronic tightness in the right hip/pelvic area.

I am now wondering if this is a warning sign that I should NOT be using these heel lifts, or if it just takes several months for the rest of the body to adapt to the new lift? As it stands now I am ready to pitch the lifts and go back to the way I was before as I rarely had back problems prior to this .....

Thanks  

Answer
Dear Kevin,

First of all there is a thing such as an anatomical leg length discrepancy and a heel lift can help this, but only when needed, and only when utilized properly.  Many patients have leg length differences measure on weight bearing x-ray, but not all need heel lifts...I think they are overused.

Heel lifts should be used to balance the spine, not the legs...for instance, you had IT band syndrome...if your 38, then your leg has been short for years...if it is truly short (measure correctly), it did not cause the IT band syndrome.  Over training and tight IT band is the likely cause.  

Some Chiropractors take x-rays of the pelvis without squaring the pelvis to the x-ray tube and the film...this will create the illusion of a rotation of the pelvis, and possibly a height difference on the film when it is not actually there.  This is called projection error.  This applies to the femur heights as well.  So the first thing is that the pelvis must be square and you must be standing on a level surface to evaluate a short leg.  If you are analysing something for biomechanical consideration this is important, if you are just looking for pathology, then small rotations are not a big deal.

Now, lets say your leg is short 5mm...so what.  If the sacral base of the spine is level and the spine is in a perpendicular orientation to the base, then you don't need a lift at all.  Why would I want to lift the legs and then tilt the spine off to one side or another...that could cause some muscle imbalances, pain and altered weight bearing.  Now your body has to work harder to resist gravity and level the eyes to the horizon.

Bottom Line is that, I would agree that the lift is probably the source of the pain.  Conversely you may actually need a lift, often I see combinations of sacral unleveling as well as leg length unleveling, but they must be factored together...you may only need a 3mm lift to balance the spine.  Devils advocate:  lets say that you don't need a lift at all...were your arches looked at, did the doctor look to see if the feet are excessively pronated or supinated (rotation inward or outward), these issues should have been addressed...especially for a triathlete.  In our clinic we asses foot biomechanics in runners and athletes.  When we find significant problems we refer them out to a local Podiatrist who works with the athlete to design foot orthotics for their training shoes...I have a good working knowledge of foot biomechanics, but the podiatrist is really the expert.

Lastly, was the IT band addressed with myofacial work along the course of the IT band as well as in the Tensor Fascia Lata (top part of the IT band).  If not, it should have been, and you should be utilizing stretches specific to the IT band...they are easily found on the internet. Training for a triathalon is very hard on the body and small changes in the biomechanics of gait (walking/running), as well as the Q angle at the knee can have a profound effect on pain.  (Q angle is a measurement at the knee in relation to the kneecap)  Strengthening exercise of the quadriceps can be performed (specifically the vastis medialis obliques) to correct it.  Again this can easily be found on the internet...Sports med sites.

I would suggest that you take the heel lift out, and have a consult with the doctor who gave them to you...sometimes they just cause problems.  Discuss the above issues or get a second opinion from a Sports Trained Chiropractor:  www.acbsp.com.  I really think this is more of a functional issue than a structural issue.

Respectfully,
Dr. J. Shawn Leatherman