Limb Length & Hip Pain

When it comes to the legs, most of us have probably never given any thought to whether they are equal in length and if not, what problems that may cause. In a 2019 systematic review, researchers found that only about 1 in 10 adults has lower limbs that are of equal length! Among the remaining 90% of adults, the difference in leg length is usually less than a centimeter. Can such a small discrepancy be a problem and if so, what can be done to address it?

A 2017 systematic review identified a “significant relationship” between anatomic leg length discrepancy and gait deviation, especially with a greater than 1 cm LLD, with even greater impact observed as the discrepancy increases. Researchers found that compensatory changes occurred in both the long and short leg and throughout the lower limb with sagittal plane deviations to be the most common compensation (such as bending the long leg knee in attempt to equalize limb length). The review also noted that frontal plane compensations occur in the pelvis, hip, and foot in the presence of such a small LLD.

Another study identified leg length discrepancy as a significant and important risk factor that creates excessive abnormal mechanical joint loading, which can lead to premature osteoarthritis in the knee, hip, and lumbar spine. This study focused on “mild LLD” (less than 2 cm) and examined the accuracy of various methods used to measure LLD.

Doctors of chiropractic often assess leg length in patients, especially those presenting with knee, hip, and low back complaints. If LLD is identified, it can usually be corrected with the use of heel lifts, combined heel-sole lifts, and/or foot orthotics. The concept of balancing the spine and pelvis has been a tenant of chiropractic since its inception. As time and scientific studies evolve, the importance of LLD is now reaching other healthcare professions with collaborative efforts in researching its significance when managing and preventing neuromusculoskeletal conditions.

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