Getting surgery is never fun. There are upsides, but also lots of possible complications and
mixed results. The enclosed 5-page summary highlights the information from the July 2021
article published in the BMJ (British Medical Journal). The ten most common elective
orthopedic procedures were studied to determine their effectiveness. This article argues for optimizing non-surgical management of the conditions before surgery and managing the patient’s expectations on what surgery might achieve.

Ten Procedures Were Studied:

Arthroscopy is a minimally invasive surgical procedure on a joint. The condition treated is bolded and italicized.

1. Arthroscopic ACL reconstruction for End-Stage Osteoarthritis
2. Arthroscopic meniscal repair of the knee for traumatic tears
3. Arthroscopic partial meniscectomy of the knee for degenerative tears
4. Arthroscopic rotator cuff repair Acute Rotator Cuff Tears (see our additional article on this)
5. Arthroscopic subacromial decompression for Carpal Tunnel Syndrome
6. Carpal tunnel decompression Subacromial Impingement Syndrome
7. Lumbar spine decompression Spinal Canal Stenosis
8. Lumbar spine fusion for Degenerative Disc Disease
9. Total hip replacement for End-Stage Osteoarthritis
10. Total knee replacement for End-Stage Osteoarthritis

Results:

Only 2 of the 10 surgeries showed superior results with surgical intervention.

• Surgically repairing the knee was superior to non-surgical treatment.
• Carpal Tunnel Decompression was shown to be better to relieve symptoms.

Final Thoughts:

• Like any medical procedure, do your homework before scheduling surgery. “Surgery is expensive and associated with considerable morbidity, increased risks of complications attributed to the surgical intervention, and excess mortality.”
• Research alternative options to surgery and give them at least a few months to work. Dr. Cerami note: “After the injury that nearly caused me to lose my left foot, I decided to use the LDS wound clinic instead of plastic surgery. It took 2 visits per week for 5 months and HBOT/FSM to close my open wound, but I was more comfortable with this decision compared to surgical alternative (8 hour surgery, 5 days in the hospital and 2 weeks with my foot above my waist).”

In 90% of the population, one limb is shorter than the other. While limb length discrepancy for the majority of this metric equates to less than half an inch, for others it is more severe. Those with leg length discrepancy especially are likely to experience lifestyle disruptions. Fortunately, there are treatments available at Utah Sports and Wellness to minimize the negative effects of the condition. 

What Is Leg Length Discrepancy?

A limb length discrepancy (LLD) is a condition in which one arm or leg is shorter than the other arm or leg. This length difference can appear minor, only a fraction of an inch, or range to much more significant disparities, even several inches. The margin of difference determines just how much the discrepancy alters lifestyle. In comparison to differing arm lengths, leg length discrepancies (lower limb length discrepancies) are more likely to have a significant effect on an individual’s daily routine. Effects are usually most severe in children and adolescents.

Causes

Limb length discrepancy has a number of causes. Some children are born with it. For others, the condition can be the result of injury or disease or other congenital dysfunctions. Identifying the cause can inform treatment methods. Some functional causes include foot pronation, muscle deactivation or contraction, and lumbar rotation, while more structural origins include uneven pelvis, femur, or lumbar vertebrae.

Sometimes disease or injury can shorten one leg in comparison with the other. Serious fractures, especially those which do not heal properly, can be to blame, as can osteomyelitis and other bone infections. Sometimes a cysts or tumor in the bone is at the root of the problem.

Leg length discrepancy is generally the result of the shortening of one leg, though leg elongation is a rare cause. Elongation may be caused by hemihyperplasia, where over-production of soft tissue or bone causes one side of the body to grow more than the other. This condition often coexists with vascular conditions like Klippel-Trénaunay-Weber Syndrome.

The Dangers of A Shorter Leg

The body does not like being imbalanced. When leg length discrepancy causes such imbalance, the body does what it can to adjust. This can lead to greater problems, including significant changes in spinal posture and deterioration of soft tissue and bone resulting in diminished postural stability. Disparity in the lengths of a growing child’s legs may contribute to the development of scoliosis.

It is important to keep the pelvis level, but patients with leg length discrepancy have both pelvis and sacrum tilted downward on the side of the shorter leg, which can accelerate deterioration of femoral head containment. The asymmetry leads to low back pain and, depending on size differential, limping and gait truncation and asymmetry.

The size difference between the two legs matters. A difference of as little as 3/8” can lead to knee pain in the shorter leg and increase its risk of developing osteoarthritis. Disparities closer to 3/4” or more increase the likelihood of pain and arthritis in both knees. The longer limb is 73% more likely to fracture, and the majority of necessary hip replacements are on the side with the longer leg.

Diagnosing Leg Length Discrepancy

Proper diagnosis is the key to correcting lower limb length discrepancy. There are three primary orthopedic tests to effectively evaluate the problem. X-ray testing may be required to determine the state of the bones. At Utah Sports and Wellness, we conduct one test on every patient that comes to the office to measure the harmony of leg lengths. The patient lays face-down, and one of our chiropractors checks the evenness of pelvic, hip, low back, and leg positioning. 

If a difference between the lengths of the left and right legs is found, it is noted, and our team establishes a treatment plan tailored to the patient. This plan will likely include lifestyle changes, muscle work, and chiropractic adjustments that are geared toward correcting the imbalance. 

Restoring Balance

The treatment for leg length discrepancy always depends upon the condition’s underlying cause and severity. Adjustments and muscle work are the most common means employed to retrain muscles and restore balance. Minute differences can also be mitigated with a small lift in one shoe, though this does not correct the problem and does nothing to help when shoes aren’t worn.

It is easier to correct limb length discrepancies when a patient is young. Posturing in children under the age of 15 can be corrected with monitoring (usually every 3-6 months) and making appropriate corrections. While corrective surgery is available for severe cases, pain relief and unifying growth can usually be achieved through chiropractic means.

With over 40 years of experience, we’ve seen our share of patients with back pain. Sometimes its been there for months or even years and sometimes it just happened over the last weekend. No matter how long the problem has been there we can usually fix it in a maximum of 4 weeks. Please consider the resources we use.

Muscle Activation and Chiropractic Adjustments

Chiropractic adjustments to the lower back have been shown to help alleviate low back pain for over 40 years (below). When we test and correct the 23 muscles that support the back, we get even better results.

Research:

1. Manipulation or Micro-Discectomy for Sciatica?
2. Spinal Manipulation for Subacute and Chronic Lumbar Radiculopathy
3. A Comparison of Physical Therapy and Chiropractic Manipulation
4. Chiropractic Maintenance Care
5. Chiropractic vs NSAIDS vs. Placebo
6. Disc Herniations are Safe to Treat with Chiropractic
7. Chiropractic Care vs Medical Care for Spine Pain

FDA Approved Laser:

• In 2018 the first and only Laser specifically to treat low back pain was approved by the FDA. The research summary says: The Erchonia FX635 is an effective tool for reducing chronic low back pain of musculoskeletal origin, progressively reducing low back pain over a 3-month period to minimal levels, including the last 2 months where no additional laser treatments were used.
• Low-Level laser Therapy for Treating Low Back Pain:12-Month Follow-up, Journal of Pain and Relief 2019

Exercises:

You’ll improve your chances of staying pain free in the long run with these 3 exercises.

• Goblet squats: 20-80 every day (2-5 minutes a day)
• Low back strengthening spinal muscles (5 minutes a day)
• Core strengthening using the Lumbar Disc Decompression Exerciser (5 minutes a day)