LEG LENGTH DISCREPANCY (LLD) ASSESSMENT & TREATMENT CONSIDERATIONS . The initial concern for an osteopath is to determine structural vs functional . Note that below is a guideline for assessment, but that may differ depending on the presenting complaint, as discussed in the lecture, e.g. Cx Px w/LLD · Standing: o This will be the first suggestion as to the presence of a LLD o Static landmarks - iliac crest (IC) height, coronal plane curvature, arch of foot, hip rotations o Relevant MS Screen tests - SFT, Stork, Hip drop, trunk sidebending · Seated: o Relevant MS Screen tests - seated trunk rotation o Compare IC height - if the opposite IC is superior than in the standing position, it may indicate a compensatory anterior innominate and thereby structural LLD, e.g. superior R IC standing, w/superior L IC seated may indicate a structurally short L leg o Regional/intersegmental assessment as indicated by MS screen · Supine: o Measure ASIS > medial malleoli, umbilicus > medial malleoli to determine relative leg length discrepany o Compare tibial vs femur length o Regional/intersegmental assessment as indicated by MS screen: " squish test for lumbo-pelvic rotation " hip rotation · SIJ mobility · pubic symphysis " chronic myofascial shortening - iliopsoas, hamstrings, TFL · Prone: o Regional/intersegmental assessment as indicated by MS screen " hip rotation " Sx torsion assessment - landmarks + passive ROM · chronic myofascial shortening - iliopsoas, QL, piriformis · Treatment: o Note that patients may exhibit a compensatory scoliosis in the presence of LLD however, a true scoliotic curve should be approached with caution as the biomechanics can be very complex! the treatment of scoliotic curves will be addressed next semester with the thorax o If functional: " treatment of somatic dysfunction as indicated should lead to negative findings with static landmarks and MS screen " the list of common causes from the lecture will give you some ideas of where to start, but remember that it is often not black and white:
· innominate rotations/shears · Forward/backward sacral torsions · Dysfunctions of the Lx spine, hip, knee or ankle joints · Unilateral pes planus · Chronic myofascial shortening (hamstrings, TFL, hip external rotators, QL, iliopsoas) · OA hip, knee, ankle o If structural, consider: " is it within the limits of what should be manageable? · YES - why isn't the system coping? Is the body compensating the way you would expect (Zink's common compensatory patterns)? . NO - do they need additional support in the form of lift therapy or surgical intervention? " was the onset during childhood or adulthood? . OMT: LS, TL, CT junctions, lumbo-pelvic region, lower limbs " also consider exercise to improve neuromuscular control and hence compensatory capability " unresponsive to Rx? Consider lift therapy with ongoing supportive treatment " remember that symmetry is not equal to function " aim to reach a point of balanced tissue tone with good ROM through the relevant joints, give the body some time to process the