Massage Works Dandenong Ranges

A major contribution for low back pain and lumbro-sacral dysfunction is structural leg length discrepancy. Examining structural leg length and hip posture since 2014, my observation is that a short right leg is a dominant genetic trait. Even or near even leg length is rare. The consequent distortion and strain on the pelvis impacts mobility of the lower limbs and spine, as well as, internal health.

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Evolutionary Adaptation

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My theory is a short right leg gave mother and child a greater chance of survival in prehistoric times. A structurally short right leg elevates the left hip, creates a right leaning tilt through the pelvis, shifting the centre of gravity in the torso slightly to the right and the hips make a counterbalancing shift to the left. The elevated and jutting left hip is the perfect perch for baby. We carry baby on the left hip freeing the strong right arm for work and defence. This was a survival characteristic for mother and child in prehistoric times. It was the most successful model. A structurally short right leg has become a dominant genetic trait. This is the only purpose for the right short leg. There is no other benefit. Quite the contrary, it becomes a liability as we age beyond the life expectancy of our prehistoric ancestors.

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Structural vs Functional Discrepancy

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Assessment of structural leg length is generally not included in medical examination, even in instances of lumbar injury where it is a major contributory factor. Much is made of functional leg length discrepancy by conventional therapists pulling legs or manipulating the spine and hips. This does not alter nor correct a structural discrepancy where bone length differs from side to side.

Interestingly, examination of most cases on the treatment table reveals the ankles are aligned. We walk on flat ground. The ground does not move to accommodate leg length discrepancy. Look to the pelvis for sign of permanent distortion and strain through the soft tissue and joints. The right leaning pelvic tilt imposes huge strain on the lumbar spine and encourages mild scoliosis impacting upper back and neck. Similarly, through energetic blockage and gait effects, lumbro-sacral distortion impacts lower limb function.

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Contributory Factors for Low Back Pain

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• Pelvic tilt, distortion and strain from structural leg length discrepancy.

• Postural anomalies developed through poor physical development and imbalanced activity levels.

• Current or historic lumbro-sacral injury.

• Energetic deficiency as described by Traditional Chinese Medicine from poor lifestyle habits and/or the effects of structural leg length generating a pelvic block impacting the Bladder meridian, in a sense, starving the Kidneys energetically. In TCM theory, an aching lower back is one of several symptomatic effects associated with Kidney deficiency.

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Assessment Observations

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There will be an initial assessment of pelvic alignment, scoliosis and structural leg length. Palpation of muscle tone reveals much about how we are managing this fundamental postural asymmetry. While every case is unique, there are four common patterns demonstrating how it is playing out through the body.

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Assessment objectives are to determine the contribution of postural anomalies, event or accidental impact, and differentiate between muscular and spinal/joint damage generating pain, inflammation, neurological symptoms and restricted range of motion. Referral for medical treatment where massage treatment is contraindicated is uncommon. Acutely injured cases typically consult a medical doctor before considering Remedial Massage Therapy.

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• Individual hip/ilium alignments in Sagittal plane;

• Palpate SIJ’s for tenderness and pain;

• In both standing and supine on the treatment table, assess relative positions of ASIS’s, Greater Trochanters and Malleolus left vs right in Frontal plane indicating comparative structural leg length discrepancy;

• Determine convexity of spinal alignment through the Thoracic and degree of associated dysfunction through upper quadrants of back...right convexity loading and straining upper right quadrant and left convexity the upper left;

• Note spinal Lordosis, Kyphosis and head carriage;

• Assess for rigidity through pelvis tractioning lower limbs from the ankles in supine;

• Assess muscle tone and pain palpating Piriformis, Gluteals, QL’s, spinal erectors, Rhomboids, Upper Trapezius, Occipitals, Hamstrings, Calves determining prominence of Lower Limb Mechanisms;

• Assess Hip Flexor tightness;

• Preliminary assessment for Kidney deficiency through pulse diagnosis and noting presence of accompanying symptoms of anxiety, dry mouth, constipation, insomnia, aching lower back, reduced vitality and endurance.

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Treatment

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There are many misconceptions about therapeutic massage. It is not merely a whole lot of blissful rubbing. Where a client starts pointing to various parts of their anatomy describing pain, dysfunction and injury, assessment is required. Massage treatment can be intense working deep into soft tissue releasing tightness, activating weakness, clearing stagnation, promoting circulation. This will be a mix of relaxation, relief and pain during treatment. It is not uncommon for temporary discomfort in days following which longer term benefits become apparent. As condition improves with subsequent sessions, post treatment discomfort ceases altogether.

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Where structural leg length discrepancy is the underlying causation for low back pain, a broad array of treatment and rehab methods are used. Spinal and sacral rotation and mobilisation exercises, rehab exercise to normalise hip alignment, application of Traditional Chinese Cupping, and conventional massage treatment are beneficial. Fascial release techniques, joint distraction and facilitated stretching targets deep held unconscious holding patterns that have developed through the pelvis. Where acute symptoms have developed, it like we always need to insert a thin adjusting heel lift under the short leg.

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Some cases are more difficult to treat than others. The sidedness of the case and degree of symptomatic acuteness do have an impact. Left and right sided symptoms may appear similar but the underlying mechanism side to side is very different. I describe this as the Left and Right Lower Limb Mechanisms associated with the First and Second Cardinal Signs of Short Right Leg Syndrome. There are articles describing this more fully on my websites. Then too, client engagement with treatment recommendations can impact outcomes…attention to rehab activity or managing use of a heel lift is necessary. Exercise is the best medicine.

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• Upper/Lower Back, Glute and Hamstring massage;

• Massage and/or Chinese Cupping to clear tightness and pain through Bladder meridian choke points at QL’s (BL23, BL25), Gluteals (GB30, BL53) and Iliac Crests;

• Massage and/or Chinese Cupping, lower back pattern plus Hamstrings (BL37), Calves (BL57), Popliteal (BL40, avoid in the presence of Baker's Cyst) and Achilles at the ankle (BL60, K3);

• Slide or static Cupping spinal erectors through to Levator Scapulae insertion to Superior Angle of the Scapula;

• Myofascial stretch through spinal erectors.

• Psoas release;

• Indirect Fascial Release through hips using lower limb as a levers;

• Facilitated stretching Hips, Glutes, Hip Flexors, Hamstrings;

• Consideration for supplementary strengthening and stretching exercise to correct postural anomalies and increase flexibility;

• Consideration for Spinal Rotation and Sacral Mobility exercises to increase flexibility through pelvis and spine;

• Consideration for Heel Lift Treatment in the presence of structural leg length discrepancy;

• Consideration for referral to Traditional Chinese Medical practitioner for assessment and treatment of Kidney deficiency.

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Where catastrophic injury has occurred and the use of strong pain killers and anit-inflammatories are necessary can be a contra-indication for massage treatment and physical therapy. It may be necessary to wait until acute symptoms have subsided before proceeding with Remedial Massage treatment.

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While dramatic enduring beneficial effects can be quickly achieved, for conditions that have taken decades to develop, it can be a process of months or years to completely unwind and resolve. In the longer term cases, much of this is self guided with periodic monitoring and/or Remedial Massage treatment. Unfolding in stages, condition improves until driving to the core of the issue. Affected joints may be problematic and require much mobilisation and appropriate nutritional supplementation to improve condition.

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There is no expectation of achieving perfect symmetry in our structure after being under the influence of gravity and leg length discrepancy for several decades. There is a certain amount of change that will not be undone. Nevertheless, even advanced cases facing the prospect of retirement from active life can be improved. This is my experience.