Short Right Leg Syndrome - Conflict with Existing Dogma

I have just had an extended Messenger conversation with a much more highly trained practitioner than I about Short Right Leg Syndrome.

He agrees anterior rotation of the hip functionally adjusts leg length...rotation about the SIJ causing the acetablum to rotate about a radius of approximately 120mm...moving posteriorly and superiorly, pulling the leg upwards I estimate by up to 5mm.. If leg lengths are even, such an action would cause a left leaning tilt in the pelvis (left side dropping 5mm) and result in some degree of left sided scoliosis...rib cage bulging on the left and flattened out on the right. This can be seen and felt more readily through the altered rib shape than actually sighting the scoliotic curvature in the spine...mild scoliosis.

The catch is, this is not what we see in clinical practice. Yes, postural anomalies of the hip are predominantly left sided unilateral forward rotation. However, rather than the expected left sided scoliosis, in virtually all cases I observe right leaning pelvic tilt and right sided scoliosis. This can only happen if the right leg is structurally shorter than the left by an amount greater than the functional adjustment caused by the left hip’s anterior rotation.

I propose the hip rotation occurs when the contra-lateral leg is structurally short as we feel uncomfortable with the tilt through our pelvis putting unwanted stresses through the spine. We learn to unconsciously flop the hip forward and absorb a portion of the leg length difference. We feel more comfortable and it protects the spine. This is good.

This proposal is supported by my observation the postural hip anomaly will resist attempts to normalise its position through treatment and rehabilitation exercise/stretching until an adjusting prosthetic wedge is inserted beneath the heel of the structurally short leg.

My associate is unable to accept this logic. Citing the teaching of Travell and scientific studies carried out demonstrating headache and TMJ dysfunction are brought about exclusively by, “...the brain’s protective reactions and until cause of it is identified and eliminated I don’t pay ANY attention to what you worry about.” His belief, the left hip’s anterior rotation in some way results from the TMJ dysfunction and is unrelated to structural shortening of the right leg. He refuses to even consider the frequency with which the right leg might be short (roughly 3 out of 4 presenting clinically) and makes no comparative assessment of right vs left structural leg length.

I put it the cause of "the brain's protective reaction" is the structurally short leg and the reaction is hip rotation reducing pelvic tilt and protecting the spine to some degree. Back, neck, TMJ and headache symptoms can largely be attributed to the mild scoliosis caused by the right leaning pelvic tilt. Lower limb symptoms result from left hip rotation affecting the SIJ and right hip rigidity disrupting hip rhythm. Overall, it is a complex condition with three cardinal signs that can manifest a broad array of conditions varying from negligible to the most crippling symptoms.

Our conversation has come to a fruitless end. However, it did give me another insight to the condition and a little more logic for explanation to others (see paras 2 & 3, above). Pictured is classic scoliosis with short right leg, elevated left hip, right leaning pelvic tilt, right sided scoliosis, elevated right shoulder. Most cases I encounter are much milder than this and clients are not aware they have the condition yet may still experience acute symptoms. Hip rotation is not illustrated in this view but you will have seen that image previously in earlier articles.

First published 4 March 2020