The Guru talks leg length discrepency: ankle, lower limb, pelvis & thoracic spine are all key

October 10, 2014

Hi there,

I am currently being treated for ongoing back pain which started 2 years ago after tripping and hurting my ankle in the gym, which appeared to heal well, but resulted in recurring hamstring strains and lower back muscle spasms. I have seen various osteopaths, chiropractors  and physios all with differing opinions and all with limited results. (although all agree my pain is muscular as opposed to joint)

The pain has gradually got worse although it is now a lot more specific. (right SI joint, Right hip)

I have now been told that i have a tilted pelvis and an approximate 1 inch leg length discrepancy (right side longer & hip higher & tilted forwards). I am being referred to a podiatrist for a possible shoe insole, but am not entirely happy that this will solve the problem as i only had these injuries once i hurt my ankle. Both the orthopedic consultant and physio seem uninterested in the ankle as although it still aches it is deemed stable & therefor unlikely the cause of the problem.

Likewise previous chiropractor have never mentioned the leg length and or tilted pelvis (and i certainly hadnt visibly noticed it, only complaining of feeling twisted when walking after injuring my ankle). Any advice would gratefully  received as i feel at a loss as to what i should try next. (i should add that i was an extremely active fitness instructer & regularly trained with weights, i currently do no cardio due to hip pain, and barely any resistance training due to it causing more pain).

Many thanks

October 10, 2014

Hi Natalie

How frustrating, especially as you’ve got the added nowse of being a gym instructor.

I would take was any physio, OS, chiro, osteo opinion with a huge dose of salt, if after 2 years you’ve still got ongoing pain after such an obvious traumatic event. In my opinion patients never lie – they just don’t need to, but the practitioner often twists and bends what you say to fit their diagnosis. This is practitioner centric care – about making them sound good, but it has to be patient centric – about getting you better.

I must say that same about LLD – who hasn’t got one and who cares? We can adapt brilliantly. The only ones I’ve ever corrected are those of elite level athletes and patients who spend all day on their feet, and its only been considered after Xray telemetry. Eye balling just doesn’t cut the mustard! What if your LLD is a tiny bit bigger or smaller than’s been measured, with a device in your shoes you short leg will now be long or it won’t be the correct length….leave it alone!

Twisted pelvis are the cult of those who are desperate to find something wrong. It sounds impressive, your minds eye can see it and at last someone has found the problem, but the truth is it’s not the magic bullet. It just can’t be. Even if you do have one it has to happen because of something else, it can can’t occur in isolation…if it can really happen at all!

It’s interesting that they all agree that the pain is muscular, despite any of them managing to get you better. Muscle is super cool tissue – it heals beautifully. Just like if you cut yourself and leave the scab alone, give it 4 months and you won’t see or feel any evidence that you has a soft tissue issue. Muscle has to be exactly the same UNLESS you keep picking at the scab (on the cut!) or your keep disturbing muscle but vigerous, uncontrolled stretching or strengthening or it’s something that feels like muscle, but is not….and this is key.

Maybe, just maybe you’re muscle is being “instructed” by your brain to switch on and protect underlying joint(s) that have too much movement and not enough control of their joint motion (not gross range of body part movement). I think this is miles more plausible, and after all despite all your well intentioned care, nothing is getting you better.

Your ankle is key, your lower limb control is key, your load transference through your pelvis is key and your thoracic spine posture is key – don’t chase symptoms, find and deal with the cause.

Let me know which part of the country you’re in and i’ll see if I can dig up a good name or too….

The Guru

Six Physio

Guru Responded

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