There is more than one way around a long leg…..
or…There are many compensations for a short leg
The 1st in a series…
You have heard us speak on LLD’s (leg length deficiencies) in previous posts here, here and here; but how about the compensations? What will you see visually?
We count about six common adaptations:
- pronation of longer side, supination of shorter side
- lean of torso to the short leg side
- circumduction of the longer leg around the shorter
- hip hike on long leg side (seen as contraction of hip abductors, obliques and quadratus lumborum on short leg side)
- excessive ankle plantar flexion on short side
- excessive knee bend on the long leg side
The thing to remember here is that what you are seeing is the compensation, not necessarily the problem. When one leg is shorter, something must be done to get the longer leg through swing phase.
Lets look at the pronation/ supination scenario:
We often (but not always) see increased pronation on the longer leg side, in the bodies attempt to shorten the extremity. This is often accompanied by posterior rotation of the ilia on that side, resulting in saggital plane imbalances. This, of course, puts the external and internal obliques, as well as quadratus lumborum on that side in a shortened position, decreasing their mechanical efficiency. This all contributes to a loss of hip extension and usually, a loss of ankle rocker.
How about transverse plane changes? The lower extremity spins internally which places the vastus lateralis in a position of mechanical advantage, and the gluteus maximus and middle and posterior fibers of the gluteus medius in lengthened position, decreasing their efficiency, while placing the anterior fibers of the medius and minimus in a position of increased mechanical advantage. These changes will often contribute to changes in the frontal plane, often causing a “shift” to one side during walking and running gait.
Frontal plane dysfunction will be determined by the degree of functional leg length discrepancy created, along with how the other compensations are playing out.
Wow! Really, six compensations for a short leg? There are many more, these are only the most common ones we see. You probably see others in your analysis we haven’t mentioned here.
Stay tuned for more on this subject in future posts!
We are THE Gait Guys. Not set on world domination, just foot and gait literacy…