<span style="font-weight: 400;">Ever had a question spinning around in your head for ages? A client issue that you just can’t work out?</span>

&nbsp;

<span style="font-weight: 400;">Me too! I had a couple of things bugging me for a while and so I spent some time reading research papers about leg length discrepancy (LLD), pelvic function, sacro iliac joint (SIJ) pain, symmetry of the pelvis, methods of measuring LLD etc. </span>

&nbsp;

<span style="font-weight: 400;">Now as a Biomechanics Coach™ I found it interesting that so few of the papers I found related simply to function, or how to correct it. Almost all the papers were connected to ‘clinical’ findings or ‘medical’ issues and ‘symptoms’.</span>

&nbsp;

<span style="font-weight: 400;">Well why on earth would you do a research study on something that isn't already a ‘problem’? </span>

&nbsp;

<span style="font-weight: 400;">Well….actually to </span><i><span style="font-weight: 400;">prevent</span></i><span style="font-weight: 400;"> the problem might be a good reason, right?!</span>

&nbsp;
<h2><b>The Problem</b></h2>
&nbsp;

<img class="aligncenter size-full wp-image-2815" src="https://www.biomechanicseducation.com/wp-content/uploads/2017/06/Screen-Shot-2017-06-18-at-20.24.53.png" alt="screen-shot-2017-06-18-at-20-24-53" width="842" height="608" />

<span style="font-weight: 400;">So imagine all of your clients for a moment… yep ALL of them, past and present! </span>

&nbsp;

<span style="font-weight: 400;">Ok now ask yourself how many of them were without any pain, previous injury, moved really well, had full capacity to squat, lunge, pull and push easily? </span>

&nbsp;

<span style="font-weight: 400;">It is my bet that, like mine, most of your clients (maybe all of them for some of you) have something they find is a niggle, a limitation or impedes their movement.</span>

&nbsp;

<span style="font-weight: 400;">When our clients come to us we have some kind of initial consultation where we ask questions to understand how we are going to help our clients to get fit, lose weight, build muscle, move better, avoid symptoms and clinical problems, pathology and pain. Some of us may use postural assessments and range of movement tests too. </span>

&nbsp;

<span style="font-weight: 400;">What we really need a series of objective physical screens for each joint and structure of their body, this allows us to monitor their progress and KNOW what actually helps them to move better. </span>

&nbsp;

<span style="font-weight: 400;">Screen - Exercise - Re-screen</span>

&nbsp;
<h2><b>Preparation for Movement</b></h2>
&nbsp;

<img class="aligncenter size-full wp-image-2814" src="https://www.biomechanicseducation.com/wp-content/uploads/2017/06/Screen-Shot-2017-06-18-at-20.22.27.png" alt="screen-shot-2017-06-18-at-20-22-27" width="526" height="548" />

<span style="font-weight: 400;">So ask yourself...</span>

<span style="font-weight: 400;">Do you wonder about some of your clients and whether you have done the right thing with them or chosen the right exercises simply because of their physical limitations, eh?</span>

&nbsp;

<span style="font-weight: 400;">Have you ever thought a 5 minute treadmill warm up may not be adequate?</span>

&nbsp;

<span style="font-weight: 400;">Ever wondered if there is something you should do when your client explains they have been told they have a leg length discrepancy?</span>

&nbsp;

<span style="font-weight: 400;">Have you ever considered if their back pain related to that leg length discrepancy?</span>

&nbsp;

<span style="font-weight: 400;">Maybe you thought “</span><i><span style="font-weight: 400;">well everyone has a leg length discrepancy...it’s normal right?</span></i><span style="font-weight: 400;">”</span>

&nbsp;

<span style="font-weight: 400;">Well these are questions I used to ask myself and I really wanted to understand these things better. This is when I really became a </span><i><span style="font-weight: 400;">human movement</span></i><span style="font-weight: 400;"> geek!</span>

&nbsp;
<h2><b>The Cause/s</b></h2>
&nbsp;

<span style="font-weight: 400;">The key component that can often be missing is a true </span><i><span style="font-weight: 400;">preparation for movement</span></i><span style="font-weight: 400;"> programme which, due to our lifestyles, is vital for long term physical health. The lives we now lead is amongst technology, gadgets, a lot of sitting and equipment that all make our lives ‘easier’, less effort, quicker and in fact, </span><span style="font-weight: 400;">less active than ever.</span><span style="font-weight: 400;"> The body is TRYING to evolve to this sedentary routine but can’t do it quick enough and so we are experiencing all sorts of compensatory problems. </span>

&nbsp;
<h2><b>Leg Length Discrepancy</b></h2>
&nbsp;

<span style="font-weight: 400;">Anyway my project was because I wanted to understand </span><i><span style="font-weight: 400;">the relevance</span></i><span style="font-weight: 400;"> of a leg length discrepancy (LLD), based on as much evidence as possible.</span>

&nbsp;

<span style="font-weight: 400;">I found papers that discussed pelvic position, structural leg length discrepancy (SLLD), even functional leg length discrepancy (FLLD) and some looked at whether the LLD affected lower back pain (LBP).</span>

&nbsp;

<span style="font-weight: 400;">My question was - does the evidence tell us that a LLD affects low back health? And is there a difference between SLLD and FLLD and their influence on back health?</span>

&nbsp;
<h2><b>Structural Leg Length Discrepancy</b></h2>
&nbsp;

<span style="font-weight: 400;">SLLD - or structural leg length discrepancy.</span>

&nbsp;

<span style="font-weight: 400;">An example of this is the individual's femurs are genetically different in length, therefore creating a structural difference that cannot be changed without surgical intervention. </span>

&nbsp;

<span style="font-weight: 400;">Another example might be someone who has broken a bone and therefore now has a structural difference caused by the trauma.</span>

&nbsp;

&nbsp;
<h2><b>Functional Leg Length Discrepancy</b></h2>
&nbsp;

<span style="font-weight: 400;">FLLD - or functional leg length discrepancy.</span>

&nbsp;

<span style="font-weight: 400;">This is discussed often in research papers and describes a twisted or rotated pelvis, around the SIJ which creates the appearance of a LLD. Should the dysfunction causing the rotation or twist be removed, the LLD can also disappear. Hooray!</span>

&nbsp;
<h2><b>How do we know if we have either an SLLD or FLLD?</b></h2>
&nbsp;

<span style="font-weight: 400;">Good question! In podiatry, it is my understanding that if there is a LLD that is less than around 11mm it is classed as clinically ‘insignificant’.</span>

&nbsp;

<span style="font-weight: 400;">Also, in the research, it almost always seems to be assumed there has a to be a clinical significance, if there is a LLD present. </span>

&nbsp;

<span style="font-weight: 400;">While in my very limited experience as a Biomechanics Coach™ most LLD’s (and they are more often than not, UNDER 11mm) are FLLD that are NOT clinical and can be addressed/corrected with simple exercises. The presence of a FLLD also seems in many cases to coincide with the degree of low back pain they experience.  </span>

&nbsp;
<h2><b>Why Does Function Leg Length Discrepancy Coincide With Low Back Pain?</b></h2>
&nbsp;

<span style="font-weight: 400;">Let me give you the lowdown about what I found out:</span>

&nbsp;

<b>Pelvis</b>

&nbsp;

<span style="font-weight: 400;">There is evidence from Rose McDonald's work when she was head physio at Crystal palace athletics club, that the hips/pelvis are at least partly responsible for 60% of lower limb injuries from a biomechanical point of view.</span>

&nbsp;

<span style="font-weight: 400;">Also in my 10 years experience of using pelvic muscle anti spasms, particularly on the hip rotators, flexors and extensors, it has has had a huge impact on all of my clients, in particular the appearance of a FLLD.</span>

&nbsp;

<span style="font-weight: 400;">Their range of movement (ROM) improves, pain is reduced, strength has increased, they report feeling more stable and overall feel they move better. They certainly get better results in the screens I do!</span>

&nbsp;

<span style="font-weight: 400;">This is also mirrored in what all qualified Biomechanics Coaches™ report with their clients. </span>

&nbsp;

<span style="font-weight: 400;">Now I am confident many of you reading this now have had success with making clients feel less low back pain. Yet this common issue is rife and still only an add on course for L3 PT’s! How many people do you know who have ever experienced some kind of low back pain? Exactly, our basic training should have compulsory screens and preparation exercises these days since we are intrinsically physically different to how we were when PT education was researched and designed. </span>

&nbsp;
<h2><b>A Solution</b></h2>
&nbsp;

<span style="font-weight: 400;">Better preparation for movement first, BEFORE the warm up even! Yes BEFORE the warm up! A warm up is a warm up, this does not necessarily set the body up to move again and undo those static compensations and adaptations. We need to get moving more freely FIRST - THEN warm up.</span>

&nbsp;

<span style="font-weight: 400;">A common issue or adaptation like a FLLD can addressed often very simply in less than 5 minutes with an easy to do technique like this one below. Download your FREE muscle energy technique by clicking below.</span>

<b> </b>

<a href="http://bit.ly/2jrj9NK" target="_blank" rel="noopener">FREE Muscle Energy Technique </a>

&nbsp;
<h2><b>How do you know if they have a FLLD OR SLLD?</b></h2>
&nbsp;

<span style="font-weight: 400;">This can be really quite simple - KNOW that their pelvis is fully functional! However if you don’t know how to assess for a functioning pelvis then this might be a challenge SOOOOO you could attend a Pelvic Biomechanics workshop to learn a whole series of pelvic assessments AND a whole series of techniques, including specific strength and conditioning work, to improve your clients pelvic function.</span>

&nbsp;

<span style="font-weight: 400;">If this would be of interest to you, <a href="http://bit.ly/2svUc5o" target="_blank" rel="noopener">click here</a> to find out more and fill in your name to show your interested in a spot on this fascinating 2-day workshop.</span>

<span style="font-weight: 400;"><img class="aligncenter size-large wp-image-2810" src="https://www.biomechanicseducation.com/wp-content/uploads/2017/06/Screen-Shot-2017-06-19-at-11.13.10-1024x509.png" alt="screen-shot-2017-06-19-at-11-13-10" width="1024" height="509" />
</span>

<a href="http://bit.ly/2svUc5o" target="_blank" rel="noopener"><span style="font-weight: 400;">Click here to find out more about the Pelvic Biomechanic Workshop.</span></a>

&nbsp;

<span style="font-weight: 400;">In the meantime please feel free to read away to your heart’s content some really interesting papers listed here ;</span>

&nbsp;

<span style="font-weight: 400;">And as always …….keep moving freely!</span>

&nbsp;

<span style="font-weight: 400;">Rachel</span>

&nbsp;

<span style="font-weight: 400;">If you have any questions, feedback, want to discuss this topic further or you want to find out about our courses, just pop me an email on: rachel@biomechanicseducation.com, I’d love to hear from my readers :-).</span>

&nbsp;

<b>References;</b>

&nbsp;

<span style="font-weight: 400;">Allyn.L e al, 1984, Leg length discrepancy assessment:accuracy &amp; precision of 5 clinical method of evaluation</span>

&nbsp;

<span style="font-weight: 400;">Arumugam et al (2012) Effects of eternal pelvic compression o form closure, force closure &amp; neuromotor control of the limbo-pelvic spine.</span>

&nbsp;

<span style="font-weight: 400;">Beattie et al (1990) Validity of derived measurements of leg length differences obtained by use of tape measure </span>

&nbsp;

<span style="font-weight: 400;">Calvilla et al, 2000, Anatomy and pathophysiology of the SIJ</span>

&nbsp;

<span style="font-weight: 400;">Cibulka (2002) Understanding SIJ movement as a guide to the management of a patient with unilateral low back pain</span>

&nbsp;

<span style="font-weight: 400;">Connell (2007) A case study report - concept of assessment &amp; treatments of anterior knee pain related to altered spine &amp; pelvic biomechanics </span>

&nbsp;

<span style="font-weight: 400;">Cooperstein, Lew (2009) The relationship between pelvic torsion &amp; anatomical leg length inequality</span>

&nbsp;

<span style="font-weight: 400;">Cummings et al (1993) The effects of imposed leg length difference on bone pelvic asymmetry </span>

&nbsp;

<span style="font-weight: 400;">Cusi (2009) Paradigm for assessment &amp; treatment of SIJ mechanical dysfunction</span>

&nbsp;

<span style="font-weight: 400;">Dillen et al (2008) Hip rotation ROM in people with &amp; without LBP who participate in rotation related sports.</span>

&nbsp;

<span style="font-weight: 400;">DonTigny (1985) Function &amp; pathomechanics of the SIJ</span>

&nbsp;

<span style="font-weight: 400;">DonTigny (1989) Anterior dysfunction of the SIJ as major factor in etiology of idiopathic Low Back Pain syndrome</span>

&nbsp;

<span style="font-weight: 400;">Duff et al (2000) The reliability &amp; validity of the ‘tape’ &amp; ‘block’ methods for assessing anatomical leg length discrepancy.</span>

&nbsp;

<span style="font-weight: 400;">Forst et al (2005) The SIJ; Anatomy, physiology &amp; clinical significance </span>

&nbsp;

<span style="font-weight: 400;">Fryer (2004) Methods used by members of the Australian osteopathic professional to assess the SIJ</span>

&nbsp;

<span style="font-weight: 400;">Fryer (2005) Factors affecting the inter-examiner &amp; inter-examiner reliability for supine medial malleoli asymmetry</span>

&nbsp;

<span style="font-weight: 400;">Goode et al (2008) 3 dimensional movements of the SIJ </span>

&nbsp;

<span style="font-weight: 400;">Gurney  (2001) Leg Length Discrepancy</span>

&nbsp;

<span style="font-weight: 400;">Hungerford et al (2003) Evidence altered lumbo-pelvic muscle recruitment in the presence of SIJ pain</span>

&nbsp;

<span style="font-weight: 400;">Jacob, Kissling (1994) The mobility of the SIJ’s in healthy volunteers between 20-50yrs</span>

&nbsp;

<span style="font-weight: 400;">Kasis et al (2008) External fixator assisted acute shortening wit internal fixation for leg length discrepancy after retool hip replacement </span>

&nbsp;

<span style="font-weight: 400;">Kiapour et al (2012) Relationship between limb length discrepancy &amp; load distribution across SIJ </span>

&nbsp;

<span style="font-weight: 400;">Krawiec et al (2003) Static innominate asymmetry &amp; leg length discrepancy in asymptomatic collegiate athletes</span>

&nbsp;

<span style="font-weight: 400;">McCaw, Bates (1991) Biomechanical implications of mild leg length discrepancy</span>

&nbsp;

<span style="font-weight: 400;">McGrath (2004) Clinical considerations of SIJ anatomy; A review of function, motion &amp; pain</span>

&nbsp;

<span style="font-weight: 400;">Middleton-Duff et al 2000, The reliability and validity of the `Tape' and `Block' methods for assessing anatomical leg-length discrepancy, Harcourt Publishers Ltd</span>

&nbsp;

<span style="font-weight: 400;">Pel et all (2008) Biomechanical analysis of reducing SIJ shear load by optimisation of pelvic muscle &amp; ligament forces</span>

&nbsp;

<span style="font-weight: 400;">Preece et al (2008) Variation in pelvic morphology may prevent the identification of anterior pelvic tilt </span>

&nbsp;

<span style="font-weight: 400;">Richardson et al (2001) The relation between the TVA, SIJ mechanics &amp; low back pain</span>

&nbsp;

<span style="font-weight: 400;">Sabharwal, Kumar (2008) Method of assessing leg length discrepancy </span>

&nbsp;

<span style="font-weight: 400;">Santaguida, McGill (1994) The psoas major muscle; a 3 dimensional geometric study</span>

&nbsp;

<span style="font-weight: 400;">Sturesson et al (1999) A radiostereometric analysis of movements of the SIJ’s during standing hip flexion</span>

&nbsp;

<span style="font-weight: 400;">Suter et al (1999) Decrease in quadricep inhibition after SIJ manipulation in patients with anterior knee pain</span>

&nbsp;

<span style="font-weight: 400;">Takasaki et al (2008) The influence is increasing SIJ closure on the hip &amp; lumbar spine extensor muscle firing pattern</span>

&nbsp;

<span style="font-weight: 400;">Van Der Wurff et al (2006) A multitest regimen of pain provocation tests as an aim to reduce unnecessary minimally invasive SIJ procedures.</span>

&nbsp;

<span style="font-weight: 400;">Van Der Wurff et al (2000) Clinical tests of the SIJ </span>

&nbsp;

<span style="font-weight: 400;">Vleeming et al, 2003, Stabilisation of the SIJ in vivo: verifications of muscular contribution to force closure of the pelvic</span>

&nbsp;

<span style="font-weight: 400;">Vleeming et al (2012) The SIJ: An overview of its anatomy, function &amp; potential clinical implications</span>

&nbsp;

<span style="font-weight: 400;">Winderden et al (2003) Stabilization of SIJ in vivo</span>

&nbsp;

<span style="font-weight: 400;">Woerman et al (1984) Leg length discrepancy assessment; Accuracy &amp; precision in 5 clinical methods of evaluation</span>

&nbsp;

<span style="font-weight: 400;">Woodfield et al (2011) Interexaminer reliability of supine leg checks for discriminating leg length discrepancy</span>

&nbsp;

<span style="font-weight: 400;">Wylde et al (2008) Prevalence &amp; functional impact of patient perceived leg length discrepancy after hip replacement</span>

&nbsp;

<span style="font-weight: 400;">Would you like to learn how to assess pelvic function?</span>

<a href="http://bit.ly/2svUc5o" target="_blank" rel="noopener"><span style="font-weight: 400;">REGISTER YOUR INTEREST HERE</span></a>