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Post by robertisaacs on Oct 24, 2008 7:41:35 GMT
Limb Length Discrepancy.
1. How do you measure it?
2. How important do you feel it is?
3. Do you correct it?
4. Do you correct the entire discrepancy?
5. How reliable do you feel your measurements are?
6. What considerations do you have in terms of functional / structural LLD?
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Post by TimVS on Oct 24, 2008 10:45:52 GMT
I'll have a go then
There you go
(The clinician advanced cautiously across the open ground nervously clutching his hastily scribbled case studies and was immediately cut to ribbons by a withering crossfire from the waiting Lewis machine guns of the infamous and battle hardened Academic Brigade.)
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Post by robertisaacs on Oct 27, 2008 12:53:45 GMT
Love the quote Tim ;D Got a source for that? Got a reference? Have you? Ay? I tend to use a pelvic level and not much else. Quite honestly i just don't know! I used to know it was vitally important and "corrected" enthusiastically. However of late i have started to question myself. We know that the correllation between longer limbs and pronation is not supported in trials so although pronation may shorten a limb we cannot claim that it pronates TO shorten the limb. We know that most people are not symmetrical. Do we know they should be? Only if it bears on symptoms. If for eg there is proximal pain or LBP or similar which may be caused by a significantly unlevel pelvis. Or if the LLD is HUGE. Never in one go and rarely at all. How reliable are any of them? I think it is vastly more important to check the functional LLD. If for EG one foot is pronating more, measures longer and the pelvis is level i think there is a risk involved in correcting it with a heel raise alone (or indeed in reducing the pronation) I would be interested in peoples views on this. As i say i no longer take the obvious for granted so i'd like to know your reasoning. Thanks tim! Regards Robert
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Post by ianl on Oct 27, 2008 20:17:11 GMT
Quote: 1. How do you measure it? I tend to use a pelvic level and not much else.
Tend to go the same way but with my old hands. Have done all the other magic ways of measuring in the past but still came back to pelvic levels. Of course there are times when you might want to look at getting an Xray for some folks.
Quote: 2. How important do you feel it is?
Pretty well do it with each biomech pt I see. Having physios alongside it is useful for when I refer for postural rehabilitation. Looking at it also gives me chance to consider pelvic rotations that may be involved.
Quite honestly i just don't know! I used to know it was vitally important and "corrected" enthusiastically. However of late i have started to question myself. We know that the correllation between longer limbs and pronation is not supported in trials so although pronation may shorten a limb we cannot claim that it pronates TO shorten the limb. We know that most people are not symmetrical. Do we know they should be?
I think it is a case of each person requires their own intervention program so be aware some of the evidence but be prepared to go with what gets pts a satisfactory result. Nothing is written in stone and the variables of the individual are there to challenge assumptions and research!
Quote: 3. Do you correct it? Only if it bears on symptoms. If for eg there is proximal pain or LBP or similar which may be caused by a significantly unlevel pelvis. Or if the LLD is HUGE.
Here I go with two things:
i) Not always a need for total correction. Half a correction has been shown to produce as good a pelvic function as full correction (Prof Jim Richard's I think). So it confimrs for me that actually going up to a half is a pretty safe intervention, which is often what people do any way.
ii) There is no minimal. On occasions as little as 2mm has benefited a pat of mine.
Quote: 4. Do you correct the entire discrepancy? Never in one go and rarely at all.
Agree with that and at times it would be a whole shoe build rather than heel a raise
Quote: 5. How reliable do you feel your measurements are? How reliable are any of them?
Zilch. An empirically based guestimate over time really.
Quote: 6. What considerations do you have in terms of functional / structural LLD? I think it is vastly more important to check the functional LLD. If for EG one foot is pronating more, measures longer and the pelvis is level i think there is a risk involved in correcting it with a heel raise alone (or indeed in reducing the pronation)
As someone who has an anatomical 5mm shortening on the right I have about a 4mm raise under the heel. This proves helpful for me.
The functional one is certainly worth giving a look at and fits in with the point earlier about doing it on each biomech pt as it may be something to refer on to physio's etc, especially if your own intervention gets only a 60% improvement.
It might be an interesting play time event at T3. Cheers Ian
I would be interested in peoples views on this. As i say i no longer take the obvious for granted so i'd like to know your reasoning. Thanks tim!
Regards Robert
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podmum
Full Member
"There is no dark side of the moon"
Posts: 169
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Post by podmum on Oct 28, 2008 8:36:24 GMT
Thanks for the posting chaps.............given me plenty to ponder before rectifying a LLD of approx 1" (metal work included!). Podmum
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Post by robertisaacs on Oct 29, 2008 8:09:36 GMT
Seems a bit... simple to me . I guess it depends at what level the pathology exists. If it is below the pelvis then there might be compensations by that point which make it look even. One of the big things for me with LLD is whether the symptoms are asymmetrical. If so i think you HAVE to look at LLD if only to be sure you do no harm. If there is a structural LLD which is accomodated by a lower pronatory range on the longer limb then cheerfully whacking a pair of supports in could conceivably cause problems? Another point perhaps worth raising while we're on the subject is what to do with a patient with an unlevel pelvis which has been there for years and years who has bony change in the spine. In this situation could leveling the pelvis cause harm? I think so. Regards Robert
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Post by dtt on Oct 29, 2008 8:25:02 GMT
Hi All And so do I !! I personally avoid any asymptomatic LLD for that very reason you open a can of worms that unless you specialise in hip / back can prevent continuance of treatment so I leave well enough alone. Symptomatic LLD I usually refer on to a Chiropractic / Osteopath for opinion treatment and build their recommendation into the orthotic Works for me anyway Cheers D
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