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Leg length inequality, a hidden cause of back pain

IF YOU HAVE ONE LEG that is longer than the other, be it from growing unevenly or the result of trauma (like a fractured leg that didn’t heal correctly), you may be experiencing low back pain as a result. 

Standing on uneven legs causes a tilt in your pelvis.   Remember, a tilted pelvis can cause your lumbar spine to curve, which can cause a strain or sprain in the low back (lumbar spine).

Tilted pelvis from a leg length discrepency

An example of a leg length discrepancy causing a pelvic tilt would be if your right upper leg is shorter than your left; this would cause your right pelvis to tilt down, as shown in the Figure above.

Can you see how this can cause low back pain?

Another example would be if your right lower leg is shorter than your left. Then your right knee will be lower than your left, and this imbalance can cause knee pain. Plus, the right pelvis will tilt down on this lower leg. This will cause your spine to curve to the right and strain or sprain the low back (lumbar spine).

One way to correct this is to put a heel lift in the shoe worn on the foot of the short leg.

Happy heel lift

Your eyes like to be level with the horizon, so to keep your head level so you can see straight, your body has to compensate for your pelvic tilt by curving. This can occur anywhere in the spine. If the compensation of the tilted pelvis occurs at the lumbar (low back) spine, this can cause low back pain. To curve the low back, one side has to constantly contract the muscles, which is a strain on them. They will become tender to touch as these overworked muscles produce more metabolic waste (lactic acid) that burns.

Plus, when a muscle is held in a constantly contracted state, the lymphatic vessels are unable to drain this waste, and nutrient-filled blood is unable to flow in. This vicious cycle leads to low back pain. Over time, this strain speeds up the degeneration of the spine at these points of tension. 

Checking Your Leg Length (a hidden cause of low back pain)

If you have low back pain, have a chiropractor check out your leg lengths. 

If the chiropractor discovers you have a true anatomical leg length discrepancy, only wear a heel lift if the difference is below your knees (Figure above). You should feel an improvement in your back pain within a couple of months.

If the leg length difference is in one of your thighs, wearing a heel lift can help your back, but it will make your knees uneven, which stresses them and can speed their degeneration (Figure below). You don’t want to trade an old problem for a new one.

Not happy heel lift

You have the right to have both a lower and upper leg bone difference. In this case, you may need a heel lift to make your knees even, but not enough to completely level off your pelvis.

This is why it is important to not just eyeball a leg length discrepancy or go by a pelvic X-ray alone. Before wearing a heel lift, measurements need to be taken of both your upper and lower leg bones. This is done by a scanogram.  A scanogram is nothing more than an X-ray (or CT scan) of your lower extremities. Talk to your health provider(s) to help determine what the best options are for you.

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