October 2007

The short leg syndrome ‑‑ Part 1

by Dr. Howard Loomis

In previous columns, I have discussed an easy‑to‑learn‑and‑apply system of examination that I refer to as the "second" factor in chiropractic. The exam is designed to indicate when visceral dysfunction is the underlying cause perpetuating musculoskeletal problems. Problems of this nature very common in our profession, but sadly are seldom recognized. We know that structure and function cannot be separated when attempting to find the cause of a patient's symptoms because anatomy strongly influences physiology and they are indisputably linked neurologically.

In May, I described how to identify the patient's structural side of weakness. It is interesting to note how often the patient's symptoms, history of previous injuries, and even surgery correlate with the side of structural weakness. In 1983, Friberg reported that it is important to correlate the patient's symptoms to the type of biomechanical stress ("Clinical Symptoms and Biomechanics of Lumbar Spine and Hip Joint in Leg Length Inequality," Spine 8(6):643‑651):

A. MUSCLE pain can occur from either stretching on the long‑leg side or compression on the short‑leg side.

B. DERMATOMAL symptoms most often result from torsion stress, and if located on the side of disk bulge, surgery was not usually necessary.

C. VISCERAL symptoms indicate an organ unable to adequately perform its role for maintaining homeostasis. Any visceral dysfunction produces muscle contraction and trigger points in the muscles that share spinal innervation with the stressed organ/tissue. For example, organs located on the side of the structural weakness are primarily affected in any syndrome.

Following the May column, I wrote about how to determine visceral organ involvement using muscle contraction within the abdominal musculature. This month, I return to structure and in particular how to identify the side of structural weakness and its cause and its many ramifications. The short leg is only an effect of this weakness and not the cause we should be searching for.

1. Begin by Observing Foot Flare

Stand at the patient's head and observe the angle that the feet form with the floor. This can be used to characterize the angle the sacrum forms with the hips. This angle is a very important factor in the body's ability to resist gravity or mechanical stress. After all, the entire weight of the body is transferred down the spine onto the sacrum, where it breaks in half and is transferred through the sacroiliac joints, into the hips and down the legs. A mechanical fault here causes stress throughout the body. This leads to not only compensatory muscle contractions, but also to nutrient deficiencies, particularly minerals.

>> Normal Angle

Both feet should be slightly everted equally and form about a 60‑degree angle with the floor.

>> Increased Angle

When both feet are flared beyond the normal angle, the sacrum has tipped forward. All of the normal spinal curvatures are now increased. This creates mechanical stress in the lumbosacral area of the spine and often manifests itself with symptoms associated with parasympathetic dominance.

>> Decreased Angle

When both feet are vertical, or close to vertical, the sacrum has tipped backward. All of the normal spinal curvatures are now decreased or straightened. This creates mechanical stress throughout the spinal and particularly in the upper cervical area. This stress often manifests as symptoms of sympathetic dominance.

2. Side of Weakness

Regardless of the angle formed by the feet when the patient is supine, one foot may lay out more than the other (everted). This often is the side of the patient's symptoms and even past surgery. Regardless, it indicates that there is structural weakness in the patient's body and has great significance in our system of analysis.

The most everted side is the side of stress. Even if one foot is inverted and the other is vertical, the vertical side is more everted and indicative of greater structural stress.

3. Measure Arm Length

With the patient in the supine position, the examiner grasps the patient's arms above the wrist. Extend them over their head and lightly traction towards you. The elbows should be straight and the arms as parallel to the floor as comfortably possible. If this is not achieved, there is muscle contraction and possibly ligament shortening in the shoulders or elbows.

Next, bring the palms together and measure the relative length of the arms to each other.

>> If the arms are the same length, the test is negative.

>> If the elbows straighten to the same angle and there is a difference in the length, you should suspect muscle contractions affecting the thoracic spine, many times caused by a digestive disorder. This finding will almost always be accompanied by a loss of the normal kyphosis in the mid‑thoracic spine. (Pottenger's Saucer).

Next time, I will conclude this discussion of the short leg syndrome and move to the foot of the table and begin checking the lower extremities.

(Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison, WI 53719 or by phone at 1‑800‑662‑2630. Visit his website at http://www.loomisenzymes.com .)