This essay will explore the causes that claim the appearance of supine leg length discrepancy (LLD) is a sign of lower back Somatic dysfunction by reviewing the sources that support or deny the validity of such claims.
Digiovanna states that” Somatic dysfunction is an impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures and related vascular, lymphatic and neural elements.
Eileen L. DiGiovanna, Stanley Schiowitz, Dennis J. Dowling
Lippincott Williams & Wilkins, 2005
Leg length discrepancy (LLD) affects about 70% of the general population, and can be either structural, that is when the difference occurs in bone structures or functional which is because…show more content… The therapist initially compares the positions of the two medial malleoli to see if there is a difference between these two bony landmarks. The patient is then asked to sit up while keeping their legs extended. The positions of the two medial malleoli are compared again to see if there has been any noticeable change.
Gibbons states that if there is a posteriorisation of the innominate bone, the leg that appeared shorter in the supine position will now appear longer with the sitting up motion.
When a LLD is detected in the supine position, a leg length difference could also be due a contracted quadratus lumbar muscle. One indication of a contracted QL is for the hip to be higher and the leg to appear shorter on that side which is known as pelvic obliquity.
A pelvic obliquity due to a hypertonic QL can increase compressive forces on the facet joints on the side that has the higher pelvic position. Because of lateral flexion of the lumbar spine there can also be decreased space of the intervertebral foramen on that concave side of the lumbar curve. This decreased space in the intervertebral foramen can lead to an increase in nerve root compression which may lead to lower back pain. ( Reference this !…show more content… There seems to be evidence to show that a LLD can cause scoliosis of the lumbar spine.
A study carried out by Raczkowski JW, et al found that a leg length discrepancy of more than 3 cm caused distinct gait and posture disorders. The results showed that the bigger the discrepancy the more distinct an affect on posture.
They also found that even small differences in leg length affects postural symmetry. They further state that a small discrepancy in leg length causes pelvic obliquity in the frontal plane, which in turn causes scoliosis in the lumbar region.
Raczkowski JW
Dalton highlights the effects of a scoliotic curve due to a LLD. He states that there will be compensations include shortening of the quadratus lumborum on the long side, and a shortening of scalene, levator scapulae, sternocleidomastoid, and upper trapezius muscles on the contralateral side. These muscular adaptation pattern helps maintain erect head position to keep the eyes
