Manual Therapy and Leg Length Discrepancies

Let's talk a bit about LEG LENGTH DISCREPANCIES.  The pictures below show a before and after shot from a single treatment using manual therapy and corrective exercise.

You might notice in the before picture, how her right hip bone (iliac crest) is "lifted" and higher than the left side.  It would be tempting to explain this posture by assuming she has a leg length discrepancy - that her right leg must be longer than the left, hence "pushing" her right hip up higher.

If that were the case, we would call this a TRUE LEG LENGTH DISCREPANCY: that one or more of the bones in the leg are truly longer than those in the other leg.  It would be a STRUCTURAL cause.

The vast majority of the cases we see in the clinic are not structural in nature, but rather are primarily FUNCTIONAL DISCREPANCIES: asymmetric alignment not caused so much by the length of bones, but by muscle imbalances, abnormal joint mechanics of the pelvis, and/or alignment of the feet and ankles.  The good news is these are VERY TREATABLE with manual therapy and corrective exercise.

In just one treatment session using soft tissue mobilization around the pelvis and hips, joint mobilization to her lumbar spine and pelvis, and corrective exercises to better activate her hip muscles, you can see in the after shot how that right hip is no longer higher than the left.  This confirms that in her case, this was a functional issue, not a true leg length difference.


Of course we all wouldn't mind being more symmetrical and balanced, but the real reason this matters is because these alignment issues lead to compensations throughout the body and directly impact how we move.  This altered and inefficient movement creates abnormal stress and strain on the body, that over time can lead to degeneration and PAIN.

To summarize then: it may be that your "knee pain" never got better with past therapies because treatments only focused on the knee, instead of taking a more global assessment of the body, perhaps to find that a functional leg length discrepancy exists, which led to the abnormal stress in the knee which then caused the pain.  Good manual therapy focuses on finding and treating the cause, not the symptoms.  That pain is likely to keep returning if you never remove the stressor.

-Drew Scrimgeour

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Drew ScrimgeourComment
Healthy Holiday Gift List

Happy Holidays from the Untapped Potential Physical Therapy Team!

Here is a list of some of our favorite therapy books and tools that promote health, flexibility, and strength. Cheers to a healthy 2019!

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BOOKS:

Taming Pain: Lessons from the Trenches by Cheryl Wardlaw, PT. This book is written by our beloved mentor Cheryl. She eloquently (and hilariously) writes for the patient’s perspective to better understand pain and learn practical, simple changes to your daily routine to help you feel your absolute best.

https://www.specializededucationalexp.com/products

It Starts with Food and Whole 30 by Melissa and Dallas Hartwig. Dallas Hartwig is a physical therapist that used a personal nutrition experiment to eliminate his chronic shoulder pain. These two books outline what he and his wife researched and discovered about the link between the food we eat, inflammation, and how it effects our overall health.

https://www.amazon.com/Starts-Food-Discover-Whole30-Unexpected/dp/1628600543/ref=sr_1_1?ie=UTF8&qid=1544626690&sr=8-1&keywords=it+starts+with+food

https://www.amazon.com/Whole30-30-Day-Guide-Health-Freedom/dp/0544609719/ref=sr_1_2?ie=UTF8&qid=1544626690&sr=8-2&keywords=it+starts+with+food




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TOYS (clockwise from the top):

Foam roller…our favorite is the AXIS Black Roller from OPTP. Using a foam roller is a great way to mobilize joints and soft tissue (increasing flexibility) and strengthening core muscles.

https://www.optp.com/AXIS-Black-Roller?cat_id=204

“Snowman with Hat” and “Peg” Soft tissue mobilization tools…use these tools to unwind soft tissue knots/trigger points in your legs, arms, and back muscles.

http://www.instituteofphysicalart.com/index.php/products/tools.html

Sink Plunger…this one might get a funny look or two…but it’s one of our favorites! This can be used to “plunge” soft tissue! Suction it to areas in the lower back, IT band, and shoulder blade regions and now you can mobilize the muscles and fascia in that region! Check out our Instagram/Facebook this Friday to learn more.

http://www.instituteofphysicalart.com/index.php/products/tools.html

SKLZ Dual Point Massager…great tool to work on the suboccipital muscles…those tiny muscles that connect your neck to your cranium. Do you get headaches/neck stiffness from sitting in front of a computer or in a car? This is the tool for you!

http://www.sklz.com/fitness/product-type/massage-tools/

Furniture Slider…this household item can be easily packed in a travel bag for workouts on the go! Check out this youtube with a demo of 20 ways to use the furniture slider for strengthening.

https://www.amazon.com/SuperSliders-4704095N-Reusable-Furniture-Sliders/dp/B001W6Q4VA/ref=sr_1_5?ie=UTF8&qid=1544627590&sr=8-5&keywords=furniture+slider

https://www.youtube.com/watch?v=114EUvXsd7g

The Body Disc…this amazing tool was created by one of our Certified Functional Manual Therapist colleagues Mark Marino PT. This can also be easily packed for on the go and is super light (4 oz!) Use it to increase flexibility and promote core stability.

https://www.bodydisk.com/










Drew ScrimgeourComment
The Role of Arm Swing During Running
You were born to run. Maybe not that fast, maybe not that far, maybe not that efficiently as others. But to get up and move, to fire up that energy-producing, oxygen-delivering, bone-strengthening process we call running.
— Florence Griffith-Joyner

As the fall season settles in, the running season is in full swing! There are races and cross-country running events every weekend at this point, and we could not be more excited to support our running/sprinting/power-walking athletes!

In running rehab and coaching, athletes often hear about the importance of foot and leg positioning as they make contact with the ground. Or that core muscles should be active to help stabilize their pelvis and hips. But did you know that the way a runner’s arms swing is also important?!

When a runner has a GOOD arm swing, this can help:

1) Core muscles to activate

2) Legs to be efficiently positioned when they hit the ground and when they lift off the ground

3) Decrease the overall energy required to keep running. Think less energy requirement means more endurance!

GOOD arm swings are with arms by your sides, even swings with the left and right arm, and fingers/wrists are gently controlled.

Here are some examples of common INEFFICIENT arm swings:

The “Cross Body” swing…the arms swing side to side across the front of the runner’s body.

The “Uneven Arms” swing…one arm swings up higher compared to the opposite arm.

The “Floppy Hands” swing…one or both hands excessively flop/wiggle when the opposite leg hits the ground.

The National Strength and Conditioning Association Journal recently published an article entitled “Role of Arm Mechanics During Sprint Running: A Review of the Literature and Practical Applications.” One study looked at the consequence of eliminating arm swing. When subjects’ hands were clasped behind their back there was a 4% increase in energy demand during running. When subjects’ arms were crossed in the front of the body there was an 8% increase in energy demand. And when subjects’ arm swing was eliminated all together by resting arms by their side, the step width variability increased by 9%! This shows us that the way our arms move affects how much energy we must spend to run and how consistent our steps are!

Here’s a quick and easy drill to work the efficiency of your arm swing during running:

  1. Place left arm on wall and right foot on floor (both will stay still during this drill).

  2. To work on right arm swing, drive right arm back while left leg straightens behind you.

  3. Then as left leg swings up (think toes up towards head), drive right arm forward, bending elbow. Hold only 1-2 seconds in each position.

  4. Repeat 30 times. Then proceed to opposite arm!

Good luck to all of our athletes this running season! And if you need help to improve your running mechanics, contact us today at info@untappedpotentialpt.com.



Article Link: https://www.researchgate.net/publication/324271038_The_role_of_arm_mechanics_during_sprint-running_a_review_of_the_literature_and_practical_applications