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Treatment Work - Conditions

Short Leg Syndrome (Contracted PSOAS)

Every time I hear/read about someone with one leg shorter than the other, the first question that comes to my mind is "is it structural or functional?" Specifically, is one leg structurally shorter in that there is a MEASURED, physical difference in bone length, one leg to the other? Or is it functional, such that supine on a table, the heels don't line up against each other? Treatment options and protocols are considerably different, one type versus the other. In addition, there is also a difference in approaches taken to "fix" the problem, depending on type of health care provider that you are seeing. I can think of a number of possible causes for both, including skeletal, muscular, fascial, visceral and ligamentous. I can also think of a number of possible, complimentary treatment protocols. Reference points are the soles of the feet, ankle bones (medial malleoli), knees and hips. Braces, orthotics and “adjustments” simply address specific symptoms. They do nothing to fix the root problem. Another one of my pet peeves – address the symptom and ignore the problem.

One possibility is a unilateral shortening of the Psoas. A second could be a chronically contracted Quadratus Lumborum muscle on just one side (this, by the way, would also contribute to a scoliotic posture as the body compensated to keep the head in a mid-line position). A third could be a jammed SI joint causing a pelvic tilt or rotation. And a fourth could be contractures in any of the muscles that abduct the hip (pull it out and away from the body)? Then, of course, there is always the possibility of fascial restrictions that cause any of the above muscles to dysfunction. In deference to your chiro, we can’t forget that you could have subluxed lumbar vertebrae. There could also be visceral issues such that some of the ligamentous attachments at the posterior abdominal wall exert an anterior and/or lateral pull on specific vertebral segments. ANY of the above fascial and/or muscle dysfunctions could exert sufficient force over time to sublux the lumbar vertebrae or screw up the SI joint.

A couple of things have really been driven home for/to me in the last couple of years taking continuing ed classes. The main one is that the human body is a SYSTEM, made up of interrelated sub-systems. Dysfunction in any one of those sub-systems has potential to affect ALL of them – and the CAUSE is quite frequently totally unrelated to the SYMPTOM. The other thing is that the more specialized ANY “provider” gets, the greater their tendency to view ALL problems through whatever set of glasses they themselves wear, both in terms of diagnosis and treatment. Chiros are notorious for this because they tend to view EVERYTHING as a function of spinal misalignment. But the tendency is not limited to Chiros – it is more common than I like to think about and it cuts across all of the health care fields. I see exactly the same mind-set in various bodywork modalities.

Let's start with specific location. The full name is the iliopsoas, consisting of the psoas major and iliacus muscles. Psoas Major originates on the bodies and transverse processes of the lumbar vertebrae. It inserts on the lesser trochanter of the femur (a bony protrusion on the inside of the femur, just below the head of the femur). The iliacus originates on the iliac fossa (the entire inner surface of the pelvic bone). It also inserts on the lesser trochanter of the femur. Both muscles flex, laterally rotate, and adduct the hip joint.

When dysfunctional, they can be the source/cause of all kinds of problems. They can contribute to lower back pain as well as cause a posture of anterior pelvic tilt. If you look at someone side-on, the ASIS (Anterior Superior Iliac Spine) of the pelvis should be in direct vertical alignment with the pubic symphysis – lower center point of the pubic bone. With anterior pelvic tilt, the ASIS (top of the pelvis) is anterior or forward of that vertical line, causing the arched back posture. A posterior pelvic tilt is just the opposite. The pubic bone is ahead of the vertical line and the top of the pelvis is toward the rear, causing an abdomen thrust forward posture. Anterior pelvic tilt and lordosis are just two of the effects of a contracted PSOAS. Because of the direction of force that they exert when contracted, they can also contribute to hip subluxation problems

The first photo below shows where I place the one hand along the spine. The next three show successive hand positions on the front of the body.

Short Leg Syndrome (Contracted PSOAS) Short Leg Syndrome (Contracted PSOAS)
Short Leg Syndrome (Contracted PSOAS) Short Leg Syndrome (Contracted PSOAS)

What particularly saddens and infuriates me (depending on my mood when I think about it), is a study I read about that was released in 2002. In brief, it discussed the prevalence of legs of unequal length contributing to osteoarthritis, not only of the knee but the hip as well. The main recommended treatment was prescription of special orthotics to correct the leg length differential. One more case of treating the symptom and never finding the cause.

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