Short Right Leg Syndrome Assessment in the Context of Remedial Massage - Two Signature Traits

 

The two Signature Traits of SRLS are an elevated left hip and elevated right shoulder. It was considering the advantages and disadvantages of these Traits that led me to realise evolutionary adaptation of prehistoric hominid species developed the genetic dominance of a short right leg that we have today. That is, it gave mother and child in prehistoric times a greater chance of survival with baby secure on the elevated left hip, bag of provisions over the elevated right shoulder, and dominant right arm free for defence and work. This was the most successful model. These Signature Traits are the first sign of a short right leg.

 

It takes little imagination to see that where a leg length difference exists, one hip will be elevated over the other. It may not be readily visible but, viewed from the front in a standing position, close examination of relative ASIS heights will typically reveal a 5mm to 10mm difference. I do so placing a finger tip on each ASIS and eyeballing it. It requires a good eye to determine which is higher and by how much. I have many years experience measuring and aligning in assembly and construction and am quite confident at this task. It is a fine judgement and many will not be sure but it is very easy to employ a 600mm level with eyeglass and bubble to improve accuracy. The height difference sighted does not necessarily reflect the actual Leg Length Difference (LLD) owing to compensating movement and distortion through the pelvis which is the body’s natural mechanism to cope with a LLD. I estimate it is less than the actual LLD.

 

If I had access to X-Ray equipment, I could make a more definitive statement about this observation of hip elevation and leg length. It is one of several indicators that a LLD may exist. It is not necessary to determine a completely accurate LLD in order to treat the condition. Choosing a correcting heel lift size is not a direct function of LLD. Heel lift size is more dependent on the amount of adjustment will the body accept. After many decades walking on the planet, the musculo-skeletal structure has made much compensation for the condition. Mild scoliosis in the spine physically distorting the shape of vertebrae. It is not possible to realign the body into perfect symmetry. This is not going to happen. The aim in treatment is to release strain on the soft tissue sufficiently so that compensating distortions through the pelvis and spine are normalised to a degree, weight bearing is improved, energy/Qi flow resumes. 

 

Similarly, viewed from the rear in a standing position, the gluteal crease at the top of the leg will be higher on the side of the long leg. 

 

Crude measurements of leg length can be made against the wall or door frame of distance from sole of foot to top of the femur utilising a carpenter’s square and pencil to mark the height.  I do not normally attempt to do this. It is difficult to do with accuracy and when I have attempted to do so, I would judge the accuracy to be not much better than +/- 5mm. Where the LLD is typically between 5mm and 20mm, this degree of inaccuracy makes the measurement’s usefulness questionable...particularly where determining the size of a corrective heel lift is not a function of the LLD. Comparative assessments of the legs side by side are more revealing and useful.

 

The resulting right leaning tilt through the pelvis puts the foundation of the spine at the sacrum on a tilt. The vertical axis of the lumbar vertebrae is forced to tilt causing a mild right leaning scoliosis which in the majority of cases leads to right convexity through the thoracic and elevation of the right shoulder giving more secure purchase of a shoulder bag. Clients confirm their left bra straps are always falling off…similarly, the off the shoulder look is usually to the left.

 

Two questions that come to mind drafting this are: firstly, in the rare cases of scoliosis with a right leaning pelvic tilt but a left convexity through the thoracic, does this elevate the left shoulder; and, I need to make a study of x-ray results taken of standing subjects from the sides to better understand the effect of hip rotation on relative ASIS positions and pelvic tilt