SUMMARY OF SHORT RIGHT LEG SYNDROME

Two Signature Traits

Elevated left hip

Elevated right shoulder

 

Anthropological Perspective - Evolutionary Adaptation Theory

Short Right Leg Syndrome (SRLS) is a dominant genetic trait in Homo Sapiens. It is the result of evolutionary adaptation giving a mother and young child a greater chance of survival in prehistoric times. The two signature traits of SRLS enables baby to be securely carried on the elevated left hip, shoulder bag of provisions securely carried on the elevated right shoulder, freeing the dominant right arm for work and defence. It can be deduced our ancestors were predominantly right handed. Otherwise, we would be seeing short left legs. We do not see short left legs.

 

Three Cardinal Signs

First Cardinal Sign - Anterior Rotation of the Left Hip, Sagittal Plane

Anatomical adjustment functionally shortening the long leg.

Tight left hip flexors.

Binding SIJ through Spanish windlass effect.

Blocking energetic flow down backline of left lower limb from glutes to plantar fascia.

Causing a subtle thickening and tightening through the connective tissue frequently mistaken for inflammation.

This subtle condition can degenerate to acute dysfunction, pain and injury.

Second Cardinal Sign - Rigid Right Hip

 

The pendulum effect...momentary hesitation before footfall forcing right hip to hold with each step taken. 

Right leaning pelvic tilt distorting the geometry of the lumbar disk spacing into a slight wedge shape and forcing disks to bulge slightly to the right.

Tight Adductor Magnus and QL's

Restricted ROM at ilio-femoral and sacro-iliac joints

Restricted flexibility through the right hip readily noted tractioning legs from ankles...right hip wooden and immobile, left hip soft and giving.

Heightened chance of injury due to reduced flexibility.

 

Third Cardinal Sign - Mild Right Leaning Scoliosis

 

Right leaning pelvic tilt in Frontal plane

Foundation of spine angled to right

Convexity to the right.

Asymmetric costals, right bulging, left flattened.

Right spinal erectors through middle Thoracic more highly developed and tight

There are rare exceptions where, despite a right leaning pelvic tilt, a double switchback occurs low in the spine causing left sided scoliosis and left convexity through the Thoracic despite right lean in the pelvis...bulging left costals, flattened on the right. 

 

Compensatory Pattern Through the Pelvis and Lumbar Spine

 

Anterior rotation left hip in Sagittal plane

Right leaning pelvic tilt in Frontal plane

Right leaning scoliosis.

Injury and Dysfunction Biomechanical Effects

With few exceptions, biomechanical issues contributing to pain and injury are generally secondary to issues resulting from energetic effects caused by SRLS. This may explain why minor postural anomalies through the pelvic region are overlooked as the fundamental cause for many conditions. My reading of conventional  practitioners assessment of some lower limb conditions are an over thought catalogue of minor anatomical aberrations. These are sublimated when the pelvis is attended to and energetic flow resumes.

The primary exception sighted in practice is right sided lumbar disk bulging. Caused by right convexity of the lumbar spine, rarely catastrophic and usually mild in nature but part of the common lumbro-sacral pattern of tightness and tenderness palpating the right QL's. Loading and/or an event can result in varying degrees of dysfunction up to and including acute disk injury.

Naturally, there is direct biomechanical stress through upper back and neck from mild scoliosis. Similarly, due to ignorance of the fact SRLS is so pervasive, theories for spinal conditions exist finding causation in temporal mandibular joint and cervical vertebrae conditions generating dural drag, etc., down the spine. These theories should be reviewed taking into account pelvic distortion and effects from a short leg working up the spine.

The Nature and Specifics of Energetic Blockage/Inhibition

Chronic physical stress on the soft tissue of the pelvis and lumbar spine caused by a leg length difference inhibits energetic flow in three ways. Firstly, Qi flow in the Du and Ren Meridians and vitality of the Root, Sacral and Plexus Chakras is inhibited. Secondly, Qi flow in the organ channels for the Kidney, Urinary Bladder, Stomach, Spleen, Liver and Gall Bladder passing through the pelvic region to and from the lower limbs is inhibited. Thirdly, flow of protective Wei Qi to the lower limbs through the connective tissue around muscles, bones and under the skin similarly inhibited. 

First Order Energetic Effects

Where energetic flow is inhibited or blocked due to postural anomalies, overwork, injury, attacking pathogens (cold, heat, wind, dampness) or emotional factors causing pain, injury and dysfunction to the soft tissue of the limbs and torso restricting mobility. This is primarily due to inhibited Wei Qi flow. It is analogous to the "nebulous communication" along fascial meridians referred to by Rolfing practitioners.

Left Lower Limb Mechanism

Anterior rotation of left hip binding the left SIJ causing an energetic/Qi block and consequent thickening and tightening down backline of limb from glutes to plantar fascia.

Right Lower Limb Mechanism

Two factors contribute to right sided mechanism being lumbar dysfunction and the Pendulum effect on gait.

 

The Pendulum effect resulting from the shortened right leg's effect on gait causing momentary hesitation and a lightened footfall with each step. The left foot plants directly with confidence. The right foot hesitates and a holding pattern develops about the hip. Adding to this is Frontal plane pelvic tilt widening right side spacing between lumbar vertebrae and reducing left side space encourages lumbar disk bulging to the right. Rarely catastrophic but sufficient to cause tenderness and tightening in the right QL's.

 

The combination of these two factors cause the right hip from lumbar region to the acetablum and adductors in the groin to tighten. Tractioning and compressing from the ankle reveals an unmoving wooden hip. Whereas, the left hip is flexible and giving. The right SIJ can be painful to palpate and stuck. This causes energetic block, tightening and thickening down backline of lower right limb.

Lumbar Mechanism

Scoliosis has been studied extensively and my insights are rudimentary at best. Many fields of therapeutic practice overlook the effect of energetic blockage through the pelvis and lumbro-sacral region on the spine. Misalignment of the pelvis tilts the spine's foundation causing scoliosis, generates chronic soft tissue stress inhibiting energy flow. Where energy flow is blocked, thickening and tightening occurs restricting mobility through back and neck.

Thoracic Mechanism

Scoliosis with right sided convexity will cause spinal erectors through the thoracic on that side to be tighter and more highly developed than the left and vice versa for the rarer left sided convexity cases. Associated dysfunction and pain behind that shoulder blade is common.

 

Injury and Dysfunction Resulting from First Order Energetic Effects

 

The combination of characteristics defined by gait, activity type/levels/load, prior injury, flexibility, core integrity can induce a mild underlying pattern to morph into acute pain, dysfunction and injury. Lower limb conditions encountered include: Piriformis Syndrome and Sciatic Pain, chronic Hamstring, Calf and/or Achilles tightness, pain, dysfunction or injury such as Chronic Compartment Syndrome or what I describe as unforced hamstring injury on the sporting field or Achilles rupture; and Plantar Fasciitis.

Back conditions resulting from scoliotic strain have an obvious biomechanical explanation but they too are affected by energetic blockage causing thickening and tightening of the connective tissue. This contributes to restricted motion of the spine, particularly rotation in the Transverse plane. Often accompanied by high degrees of tightness and discomfort/pain in the upperback, neck and shoulders which is the bread and butter of the massage therapy industry. There is a tendency for right sided mild lumbar disk bulging causing tightness and tenderness through the right QL's. I have noted a correlation between the right SIJ dysfunction and this right sided lumbar condition.

 

Second Order Energetic Effects

 

Where energetic flow is inhibited or blocked due to postural anomalies, overwork, injury, attacking pathogens (cold, heat, wind, dampness) or emotional factors that can have an adverse effect on metabolic health such as digestion or fertility. These are internal medical conditions beyond my scope of practice. I suggest in relation to SRLS, these effects are due to inhibited Qi flow to the Du and Ren meridians and the organ channels of the lower limbs and reduced Chakra vitality in the lower abdomen.

 

Injury and Dysfunction Resulting from Second Order Energetic Effects

 

Either through advancing age, reduced mobility and flexibility or when an overlaying lumbro-sacral injury compounds the energetic block at the pelvis, lower limb degradation accelerates. Reduced lower limb strength and mobility. Lower limb circulation inhibited leading to fluid retention, meridian pain, joint pain, and increasingly reduced lower limb function over time. This is an outcome I have encountered in practice. There is a sidedness to this effect where the Second Cardinal Trait of rigidity through the right hip predisposes that side to be more affected.

 

Additionally, in TCM theory, inhibiting Qi flow can have a direct effect on metabolic function and vitality. It may be coincidental, but apart from improved lower limb function and reduced back pain, I have observed a correlation between commencing heel lift treatment for SRLS and improved digestion and vitality. It would appear to be a beneficial side effect. The metabolic health outcomes that can be influenced by SRLS are better considered by a TCM practitioner. It is beyond my scope of practice to consider diagnosing and treating internal health conditions.

First published 16 May 2021 at https://www.facebook.com/MassageWorksDandenongRanges