There are two main reasons for a difference in leg lengths, an anatomical difference in leg lengths and a functional difference.
An anatomical leg length difference may be caused by a fracture of the femur or the tibia and fibula that healed shorter, or by a congenital malfor- mation such as club foot. The treatment is usually a heel lift or shoe insert to make the hips level.
A functional leg length difference is caused by a torsion of the pelvis where one side of the pelvis is rotated forward relative to the other side. This causes the hip socket to drop on the side that is rotated forward, making that leg appear to be longer. Causes of this pelvic torsion include standing with the weight borne by one leg, carrying things on the hips, accidents and injuries, and by sitting on a wallet in the back pocket. The reason this functional leg length discrepancy is so significant is that it effects the way the sacrum sits between the two sides of the pelvis. The sacrum is like the keystone of an arch, and it is also the base of support for the spine. Therefore if the sacrum is tipped it effects everything above it. Pelvic torsion will also effect the hips, knees and ankles since they will track differently when walking or running.
To measure leg lengths I shake out the legs so that the client is laying flat on the table, then I bring the legs together and compare the level of the medial malleolus on either side. If the medial malleolus is not visible because of fat, fluid retention, or the client is wearing socks, then I place my thumbs on the same point of the medial malleolus on either side and then compare how my thumbs line up.
Techniques 49 through 55 are different ways of correcting pelvic torsion through stretches and working with the soft tissue. They do not need to be done in order as any one of them may be effective for a particular client. I find it helpful to have a variety of techniques since every client is different in what they respond to. If you are not able to get a correction with these soft tissue techniques you may want to refer your client to someone who can manipulate the skeletal structure, such as a good naturopath, chiro- prator, or osteopath. These techniques also can be a good adjunct for someone who is already receiving manipulative treatment.
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