{"id":16463,"date":"2023-05-30T10:31:59","date_gmt":"2023-05-30T08:31:59","guid":{"rendered":"https:\/\/www.physiotutors.com\/?p=16463"},"modified":"2023-05-30T10:38:06","modified_gmt":"2023-05-30T08:38:06","slug":"leg-length-difference","status":"publish","type":"post","link":"https:\/\/www.physiotutors.com\/leg-length-difference\/","title":{"rendered":"Leg Length Difference \u2013 Does it matter?"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Your back pain, shoulder pain, and neck pain are all coming from your leg length difference. Sounds plausible right? But does a leg length difference really matter and how big does the leg length difference need to be to really play a role?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Prefer watching instead of reading? Then check out our YouTube video below:<\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Leg Length Difference - Does it matter?\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/Hom82hkEg0k?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">In our daily practice, we come across a plethora of patients who blame their leg length discrepancy for their knee, hip, or low back, shoulder, and neck pain. Many of them were informed about the leg length difference by their general practitioner, specialist, or physiotherapist. This can create a worrisome attitude and fear that their situation might lead to poor alignment of the pelvis, spine, and even higher in the body. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\">My first question to patients is usually: How was this leg length difference measured? A study from <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/125393\/\" target=\"_blank\" rel=\"noreferrer noopener\">Fisk and Baigent (1975)<\/a> has shown that clinical assessment of leg length discrepancy is unreliable and that true discrepancy can only be measured reliably by X-Ray. Yet, still, almost 50 years later physiotherapists and other professionals are telling their patients that they have a leg length difference after they have measured it or after they have performed the <a href=\"https:\/\/www.physiotutors.com\/wiki\/weber-barstow-maneuver\/\">Weber-Barstow maneuver<\/a> for example.<\/p>\n\n\n<div class=\"quote-with-background\" style=\"\">\n    <div class=\"quote-with-background__in\">\n\n        <svg width=\"30px\" height=\"25px\" viewBox=\"0 0 30 25\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">\n            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">\n                <g id=\"08-blog-redesign\" transform=\"translate(-191.000000, -2974.000000)\" fill=\"#7973FF\" fill-rule=\"nonzero\">\n                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">\n                        <g id=\"\u201c\" transform=\"translate(111.000000, 81.000000)\">\n                            <path d=\"M6.4,25 C4.42666667,25 2.86666667,24.3743344 1.72,23.1230032 C0.573333333,21.871672 0,20.2609159 0,18.2907348 C0,17.2790202 0.173333333,16.2539936 0.52,15.215655 C0.866666667,14.1773163 1.49333333,12.513312 2.4,10.2236422 L6.48,0 L12.8,0 L10,12.5399361 C11.9733333,14.0841321 12.96,16.001065 12.96,18.2907348 C12.96,20.2076677 12.3466667,21.8051118 11.12,23.0830671 C9.89333333,24.3610224 8.32,25 6.4,25 Z M23.44,25 C21.4666667,25 19.9066667,24.3743344 18.76,23.1230032 C17.6133333,21.871672 17.04,20.2609159 17.04,18.2907348 C17.04,17.2790202 17.2133333,16.2539936 17.56,15.215655 C17.9066667,14.1773163 18.5333333,12.513312 19.44,10.2236422 L23.52,0 L29.84,0 L27.04,12.5399361 C29.0133333,14.0841321 30,16.001065 30,18.2907348 C30,20.2076677 29.3866667,21.8051118 28.16,23.0830671 C26.9333333,24.3610224 25.36,25 23.44,25 Z\" id=\"Shape\"><\/path>\n                        <\/g>\n                    <\/g>\n                <\/g>\n            <\/g>\n        <\/svg>\n       <div class=\"quote-with-background__content heading-three\">\n            <p class=\"heading-four\">90% of the population has a leg length discrepancy and 60% have a leg length difference of 5mm or more!<\/p>\n       <\/div>\n       <div class=\"quote-with-background__info\">\n                   <\/div>\n    <\/div>\n<!--    <div class=\"quote-with-background__background\">-->\n<!--        <svg width=\"100%\" height=\"100%\" viewBox=\"0 0 849 447\" version=\"1.1\" preserveAspectRatio=none xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">-->\n<!--            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">-->\n<!--                <g id=\"08-blog-redesign\" transform=\"translate(-80.000000, -2893.000000)\" fill=\"#F1F5FD\">-->\n<!--                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">-->\n<!--                        <polygon id=\"Rectangle\" transform=\"translate(424.500000, 223.500000) scale(-1, 1) translate(-424.500000, -223.500000) \" points=\"0 99.703192 849 -4.43831367e-13 849 347.296808 0 447\"><\/polygon>-->\n<!--                    <\/g>-->\n<!--                <\/g>-->\n<!--            <\/g>-->\n<!--        <\/svg>-->\n<!--    <\/div>-->\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">Then I will continue to ask my patients: Out of a hundred people, how many people do you think have a leg length discrepancy? A review by <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\/\" target=\"_blank\" rel=\"noreferrer noopener\">Knutson et al. (2005)<\/a> estimates that around 90% of the population has a leg length discrepancy. Of those 90% almost 60% have a leg length difference of 5mm or more.<br><\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"949\" height=\"636\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/05\/image-7.png\" alt=\"Image 7\" class=\"wp-image-16465\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Now let\u2019s say that a patient has had an X-Ray confirming a clear leg length discrepancy. Can this have an influence on his or her ankles, knees, hips and back, etc.?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">First of all the aforementioned review showed that the effect of an anatomic leg length difference is rotation of the pelvis, often referred to as pelvic torsion. In most cases, the innominate bone rotates anteriorly on the side of the shorter leg and posteriorly on the side of the longer leg in patients with a leg length discrepancy up to 22mm. But is this pelvic torsion related to low back pain? The evidence from different studies included in the review shows that neither pelvic torsion nor pelvic unleveling or pelvic obliquity is related to low back pain. <\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img decoding=\"async\" width=\"1912\" height=\"1005\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/05\/pelvic-torsion-animation.jpg\" alt=\"Pelvic torsion animation\" class=\"wp-image-16468\"\/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">So now we have one question left to be answered: When does a leg length discrepancy really play a role? In other words, when is it clinically significant?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">There are quite a few studies that have tried to answer this question. For more details, we would like to refer you to the review of <a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\/\" target=\"_blank\" rel=\"noreferrer noopener\">Knutson (2005)<\/a><br>In conclusion, the result of taking different papers into account is that a leg length difference of up to 2 cm is probably not clinically significant.<\/p>\n\n\n<div class=\"quote-with-background\" style=\"\">\n    <div class=\"quote-with-background__in\">\n\n        <svg width=\"30px\" height=\"25px\" viewBox=\"0 0 30 25\" version=\"1.1\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">\n            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">\n                <g id=\"08-blog-redesign\" transform=\"translate(-191.000000, -2974.000000)\" fill=\"#7973FF\" fill-rule=\"nonzero\">\n                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">\n                        <g id=\"\u201c\" transform=\"translate(111.000000, 81.000000)\">\n                            <path d=\"M6.4,25 C4.42666667,25 2.86666667,24.3743344 1.72,23.1230032 C0.573333333,21.871672 0,20.2609159 0,18.2907348 C0,17.2790202 0.173333333,16.2539936 0.52,15.215655 C0.866666667,14.1773163 1.49333333,12.513312 2.4,10.2236422 L6.48,0 L12.8,0 L10,12.5399361 C11.9733333,14.0841321 12.96,16.001065 12.96,18.2907348 C12.96,20.2076677 12.3466667,21.8051118 11.12,23.0830671 C9.89333333,24.3610224 8.32,25 6.4,25 Z M23.44,25 C21.4666667,25 19.9066667,24.3743344 18.76,23.1230032 C17.6133333,21.871672 17.04,20.2609159 17.04,18.2907348 C17.04,17.2790202 17.2133333,16.2539936 17.56,15.215655 C17.9066667,14.1773163 18.5333333,12.513312 19.44,10.2236422 L23.52,0 L29.84,0 L27.04,12.5399361 C29.0133333,14.0841321 30,16.001065 30,18.2907348 C30,20.2076677 29.3866667,21.8051118 28.16,23.0830671 C26.9333333,24.3610224 25.36,25 23.44,25 Z\" id=\"Shape\"><\/path>\n                        <\/g>\n                    <\/g>\n                <\/g>\n            <\/g>\n        <\/svg>\n       <div class=\"quote-with-background__content heading-three\">\n            <p class=\"heading-four\">A leg length difference of up to 2 cm is probably not clinically significant<\/p>\n       <\/div>\n       <div class=\"quote-with-background__info\">\n                   <\/div>\n    <\/div>\n<!--    <div class=\"quote-with-background__background\">-->\n<!--        <svg width=\"100%\" height=\"100%\" viewBox=\"0 0 849 447\" version=\"1.1\" preserveAspectRatio=none xmlns=\"http:\/\/www.w3.org\/2000\/svg\" xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\">-->\n<!--            <g id=\"Design\" stroke=\"none\" stroke-width=\"1\" fill=\"none\" fill-rule=\"evenodd\">-->\n<!--                <g id=\"08-blog-redesign\" transform=\"translate(-80.000000, -2893.000000)\" fill=\"#F1F5FD\">-->\n<!--                    <g id=\"Group-7\" transform=\"translate(80.000000, 2893.000000)\">-->\n<!--                        <polygon id=\"Rectangle\" transform=\"translate(424.500000, 223.500000) scale(-1, 1) translate(-424.500000, -223.500000) \" points=\"0 99.703192 849 -4.43831367e-13 849 347.296808 0 447\"><\/polygon>-->\n<!--                    <\/g>-->\n<!--                <\/g>-->\n<!--            <\/g>-->\n<!--        <\/svg>-->\n<!--    <\/div>-->\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\"><br>The human body is perfectly able to compensate for this difference, mostly through passive structural changes such as mild scoliosis, facet angulation changes, and changes in muscle length. Only past the 2cm point, active muscular compensations take over. At last, it\u2019s important to realize that a discrepancy of this size is only found in around 1 out of 1000 people.<\/p>\n\n\n<div class=\"cta\" style=\"\">\n    <div class=\"cta__in\">\n        <div class=\"left\">\n            <div class=\"cta__content text-color-light\">\n\t\t\t\t\t\t\t\t\t<h2 class=\"own-size\">Orthopedic Physiotherapy of the Upper &#038; Lower Extremities<\/h2>\n\t\t\t\t\t                <p>Boost Your Knowledge about the 23 Most Common Orthopedic Pathologies in Just 40 Hours Without Spending A Fortune on CPD Courses<\/p>\n                                        <div class=\"cta__button\">\n                                <a href=\"https:\/\/study.physiotutors.com\/course\/orthopedic-physical-assessment\/\" class=\"button button-five\" target=\"_self\">\n                                    Enroll Now                                <\/a>\n                            <\/div>\n                                    <\/div>\n        <\/div>\n                        <div class=\"right\">\n                    <img decoding=\"async\" src=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2022\/10\/Extremity-course-mockup-full.png\" alt=\"\"\/>\n                <\/div>\n                <\/div>\n<\/div>\n\n\n\n<p class=\"wp-block-paragraph\">So in case someone has a leg length difference of more than 2cm, how is this treated? What we often hear and also see on social media is that practitioners try to reverse pelvic torsion by manipulating the sacroiliac joint. My first question about this procedure would be: Why would you want to change the pelvic torsion in the first place? If the pelvis is equalized, I would expect other structures to have to take over the job and compensate even more, for example, the facets or muscles.<br>Second of all, we have learned that a manipulation of the SIJ is never able to change the position of the innominate bones on the sacrum. If you would like to learn more about this, check out our video on <a href=\"https:\/\/www.youtube.com\/watch?v=jP2psvU5wJk\" target=\"_blank\" rel=\"noreferrer noopener\">SIJ myth-busting<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">The only treatment that makes sense and can be of value is heel lifts to compensate for the discrepancy. So in case you find a leg length difference of 2cm or more, it makes sense to possibly refer this patient to a podiatrist.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">As always, thanks a lot for reading!<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Kai<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<h2 class=\"wp-block-heading\">References<\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/125393\/\" target=\"_blank\" rel=\"noreferrer noopener\">Fisk, J. W., &amp; Baigent, M. L. (1975). Clinical and radiological assessment of leg length.&nbsp;<em>The New Zealand Medical Journal<\/em>,&nbsp;<em>81<\/em>(540), 477-480.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC1232860\/\" target=\"_blank\" rel=\"noreferrer noopener\">Knutson, G. A. (2005). Anatomic and functional leg-length inequality: a review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance.&nbsp;<em>Chiropractic &amp; osteopathy<\/em>,&nbsp;<em>13<\/em>(1), 1-10.<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/16080787\/\" target=\"_blank\" rel=\"noreferrer noopener\">Knutson, G. A. (2005). Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry.&nbsp;<em>Chiropractic &amp; Osteopathy<\/em>,&nbsp;<em>13<\/em>(1), 1-6.<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":35,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"7073,9516,5115,6501,5178,7043","_relevanssi_noindex_reason":"","footnotes":""},"categories":[189,2142,195],"tags":[2149,2145,2146,176,2150,2148,2147],"tracking_tag":[],"class_list":["post-16463","post","type-post","status-publish","format-standard","hentry","category-ankle-foot","category-diagnosis-imaging","category-lumbar-sij","tag-heel-lifts","tag-leg-length-difference","tag-leg-length-discrepancy","tag-low-back-pain","tag-orthotics","tag-sacroiliac-torsion","tag-si-joint"],"acf":{"sections":[{"acf_fc_layout":"featured-related","heading":"Related blog posts","subheading":"","content_editor":"","featured_or_related":"related","posts":null,"button_type":"internal_link","button_label":"","button_style":"button-one","button_internal_link":"","button_anchor":"","button_url":"","button_file":null}]},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.2 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Leg Length Difference \u2013 Does it matter? An evidence-based blog<\/title>\n<meta name=\"description\" content=\"Leg Length Difference is often blamed as a cause for knee, hip and low back pain. But is this true? Read on to learn what the evidence says!\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.physiotutors.com\/leg-length-difference\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Leg Length Difference \u2013 Does it matter? An evidence-based blog\" \/>\n<meta property=\"og:description\" content=\"Leg Length Difference is often blamed as a cause for knee, hip and low back pain. But is this true? Read on to learn what the evidence says!\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.physiotutors.com\/leg-length-difference\/\" \/>\n<meta property=\"og:site_name\" content=\"Physiotutors\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/facebook.com\/physiotutors\" \/>\n<meta property=\"article:published_time\" content=\"2023-05-30T08:31:59+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-05-30T08:38:06+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.physiotutors.com\/wp-content\/uploads\/2023\/05\/image-7.png\" \/>\n<meta name=\"author\" content=\"Kai Sigel\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@physiotutors\" \/>\n<meta name=\"twitter:site\" content=\"@physiotutors\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/leg-length-difference\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/leg-length-difference\\\/\"},\"author\":{\"name\":\"Kai Sigel\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/#\\\/schema\\\/person\\\/5747048d67d5d4bc0eff854d057937bc\"},\"headline\":\"Leg Length Difference \u2013 Does it matter?\",\"datePublished\":\"2023-05-30T08:31:59+00:00\",\"dateModified\":\"2023-05-30T08:38:06+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/leg-length-difference\\\/\"},\"wordCount\":804,\"publisher\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/leg-length-difference\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.physiotutors.com\\\/wp-content\\\/uploads\\\/2023\\\/05\\\/image-7.png\",\"keywords\":[\"heel lifts\",\"leg length difference\",\"leg length discrepancy\",\"low back pain\",\"orthotics\",\"sacroiliac torsion\",\"SI joint\"],\"articleSection\":[\"Ankle\\\/foot\",\"Diagnosis &amp; Imaging\",\"Lumbar\\\/SIJ\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.physiotutors.com\\\/leg-length-difference\\\/\",\"url\":\"https:\\\/\\\/www.physiotutors.com\\\/leg-length-difference\\\/\",\"name\":\"Leg Length Difference \u2013 Does it matter? 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