Haims column: Leg length discrepancies can cause back pain
We live in a world of inconsistencies. Nothing is absolute or perfect. Even though we may have been made in God’s image, we are not perfect.
Take a good look at the faces of people around you. Most people are not symmetrical. Whether it’s an ear or an eye lower than the other, this type of asymmetry is nothing more than visual and thus somewhat inconsequential. However, when pertaining to our body’s skeletal symmetry little differences can cause profound effects.
A difference in symmetry can mean that a building tilts to one side and may eventually break apart (maybe not the Tower of Pisa). Or, in a less catastrophic example, a restaurant table with a bent or uneven leg may cause a pen to roll off the side or cause an annoying wobble while dining. Such nuances are somewhat inconsequential.
However, when the human body is out of symmetry, the consequences can be severe and sometimes, difficult to diagnose. When symmetry is off and back pain is felt, diagnosis can be exceedingly challenging.
Remember the children’s song, “Dem Bones?” “The leg bone’s connected to the knee bone, The knee bone’s connected to the thigh bone, The thigh bone’s connected to the hip bone, Now shake dem skeleton bones!” When our skeletal symmetry changes from injury, stress, overuse, muscle or tendon strain, other parts of our bodies may be affected.
While feeling lower back pain is not uncommon and is often resolved with physical therapy, exercise, inflammatory medicine or even a visit to a primary care physician, when such attempts for resolve are ineffective, many people find their lives are greatly impacted.
Over the years, we have assisted a number of clients who have had hip or knee surgeries. While not too frequently, a number have complained that after months of recovery and physical therapy, they experience pelvic and lower back pain.
A number of years ago my mom had a hip surgery. She had fallen and sustained a fracture in her femur. She underwent a procedure called a Locked Intramedullary Nailing (IMN). It’s a pretty common procedure and has a pretty good success rate. However, she too complained of back pain. This got me to thinking — could these two things be related?
As it turns out, there is a correlation between IMN and back problems. According to a recent article published in the National Center for Biotechnology Information (NCBI) 20-43% of these procedures cause leg length discrepancy (LLD). While leg length discrepancies are common in most people, sometimes subtle changes can cause discomfort.
Often, when LLD occurs from an accident, the change to one’s symmetry can cause gait mechanic changes, pelvic obliquity (where one side of the pelvis is higher than the other side), and different types of scoliosis.
I reached out to Dr. Don Corenman at the Steadman Clinic to learn more about LLD and suggestions about addressing solutions. Dr. Corenman explained that, in general, when LLD is less than 2 cm, many people find that the difference may not affect their well-being and quality of life. When LLD exceeds 2 cm, a sole insert lift of ½ the height difference often provides relief. However, when LLD exceeds 4 to 5 cm, people are more likely to experience lower back pain and are more susceptible to injury.
In some cases, LLD can cause the pelvis to tilt, which can cause the L5 vertebrae to tilt. When this happens, many people may feel sharp pain in the lower back or numbness and a tingle of pins/needles that radiates down the thigh and towards the back of the calf.
Depending on the cause and location, people who experience back pain after a hip or knee surgery may benefit from seeing a spine specialist and getting a pelvic and hip X-ray called an AP pelvis view. Pelvis AP views are helpful in assessing LLD and other symmetry abnormalities that may cause back pain.
LLD can occur after pelvic and knee procedures for various reasons. It would be prudent to seek counselling pre-operatively about this potential risk and possible effects on your overall outcome.
Judson Haims is the owner of Visiting Angels Home Care in Glenwood Springs, Basalt, Aspen and the surrounding areas. He is an advocate for our elderly and is available to answer questions. His contact information is, http://www.visitingangels.com/comtns, 970-328-5526.
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