♪ Bob and Brad ♪
♪ the two most famous ♪
♪ physical therapists ♪
♪ on the internet. ♪
(indistinct chatter)
- Hi folks!
I'm Bob Schrupp, physical therapist.
- Brad Heinneck, physical therapist.
- Together, we are the most famous physical therapists
on the internet.
- In our opinion of course.
- Quit interrupting me, Brad.
- I'm sorry.
- Today, Brad, what, you wanted to talk about,
the big lie about leg length discrepancy or differences.
Ah, when there's actually a difference
between one leg and the other one leg is longer ah,
and this is kind of an area that's ripe
with scandal maybe or problems.
- Well, it's misunderstood.
I think some people, they, you know
they go to the doctor, the chiropractor
the therapist, whatever, ah, the person, you know
they look at 'em and a couple minutes, oh my goodness
you got a leg length difference.
We better get on this right away.
Perhaps we can get you some custom inserts in your shoes
or maybe even build up the soles on one shoe,
to get you straightened out.
Otherwise you're gonna have back problems your whole life.
And it's gonna, you're gonna turn your life upside down.
We gotta get you straightened out.
- And, and a lot of times that might not be the case
and we're trying to save you some money here.
- Right.
- Cause we're gonna show you alternatives.
- Right.
- Ones you can try.
- There are cases where you need
to get a custom shoe sole put on there.
- Right.
- But we, just hold on and we're gonna show you,
the exact how how the leg length should be measured.
- Right.
- But it all entails,
and how many different ah, ways-
- Ways. There are there-
- There are for errors.
- Yeah.
- Lots of ways for errors.
And you're gonna find out in the next 10 minutes
what we're talking about.
First of all, leg length difference,
the average person
when they took a random sample of thousands of
people that random difference or the,
the average difference was 1.1 centimeter,
on the average person.
- Yeah. And that's average.
- Yeah.
- So you find all the people that are normal.
So that, I mean, it's, it's really not that
unusual to have a difference between the legs.
- Right.
A lot of times you're born with it
your body adapts it over time.
- Or over time, you may
one knee may have wore out more than the other.
- Exactly.
- And therefore that leg is gonna be shorter, um.
- So, having a leg leg difference may not be a big deal.
It depends on how much it is.
And what's, what's it affecting in the chain
in your knee, your hip, your back, et cetera.
- Before we move any further, Brad
I just noticed a couple people joined us.
- Sure. Well, I see 327 Bob.
- Wow.
- They're-
- It's a big day.
- It was a big topic.
- They wanna know about the leg lengths discrepancy.
But anyway, Brad, in case you are new to our channel
please take a second to subscribe to us.
We provide videos on how I stay healthy, fit pain free,
and we upload every day and please like us on Facebook.
- Right.
- We need to be liked.
- Right. We we're looking for that companionship.
- Yeah.
- Anyways, leg length difference.
There is one instance where I do get
after it pretty quickly more aggressively.
And that's like, example someone had a trauma,
really severe break, a new knee, a new hip
that things didn't go well.
And abruptly one day they had this leg length
- That was level.
- Level.
And then the next day, literally after surgery
it changed a half an inch to an inch.
You know, I've seen that before.
- Yeah.
- That that I'm gonna treat a little bit differently.
- Yeah, cause that's a great discrepancy.
I mean, that's a, a large difference.
- And a very short time.
- Right.
- One day.
- And generally when your body has to adapt to that
it does not like it, and does cause problems.
- Right. Exactly.
As far as measuring, you're gonna see a lot
of people, a lot of doctors, therapists, chiropractors.
They're gonna have you lay down first
either on your stomach or on your back.
And I'm gonna, we're gonna go through a complete assessment
and the errors and the complications that come in,
that are involved with measuring leg length difference.
So, we'll go that right now, Bob.
- Sounds good.
- Okay, so here we are assessing leg length
discrepancy or difference in the supine position.
In other words, the patient laying on their back.
I do have some tape here.
I'll just explain what that,
what that's there for.
Lonnie did not,
is not there for her makeup and decoration type of a thing.
That's that'll come later.
- [Bob] It looks very fashionable.
- [Brad] It does.
It does.
That's a nice pink.
Okay, so first thing you get the person laying down,
on a nice flat plinth like this.
And if someone does this and they look
at the bottom of your heels
and assess that for leg length difference, chances are
they do not know what they're doing and it's not,
that's not the way it's done.
- [Bob] Yeah, exactly.
You, you right away, you're gonna know a novice.
If, if they're doing that.
- [Brad] Exactly, right.
Ah, if you look at this, it looks like her left one is
is a little bit longer, but you know
it could be something in the shoes.
As matter of fact, I just put the shoe in
and it got even.
- [Bob] Yeah.
- [Brad] One good reason we don't do that.
Okay, just relax, Lonnie.
So, that's not an acceptable way to do it.
The next one to do it is compare the medial Manus
which is the ankle bone here and here.
- [Bob] Both on the inside.
- [Brad] Yep. On the inside.
And you're gonna take your thumb
and go underneath and go up till you feel it.
And that's why I have the pink tape there.
Just so you get a good visual of, of where that is.
I'm a little bit off here.
We'll just move that a little bit.
I don't wanna get Lonnie all excited there
if that hurts her ankle.
So there we are,
and then typically they lift up-
No, just relax, Lonnie.
Don't let let me do all the work.
I should say, let me do all the work.
Pull out a little bit and we go down and we assess in here.
It looks pretty even.
Well, there you go.
No leg length difference, but there's a few things
that you really have to take an account.
Lonnie, can you shift your hips?
Lonnie's not gonna do anything but shift her pelvis.
And now all of a sudden the way we've got almost
a two centimeter leg length difference.
- [Bob] Yeah. Lonnie still looks fairly normal.
You know, when I look, when I look at her.
- [Brad] She looks pretty normal, anyway.
(Bob chuckles lightly)
- [Brad] Sorry Lonnie.
- [Bob] Yeah. She hiked her, she hiked her hip on one side.
- [Brad] Right.
- [Bob] And now it looks like the right leg is a lot longer.
- [Brad] Exactly.
And there could be many reasons for that.
- [Bob] Yeah.
- [Brad] It could be cause she's got some tight muscles.
She's got her back problem.
- [Bob] She could have a scoliosis. I mean-
- [Brad] Yeah.
- [Bob] I mean it could be a lot of things.
- [Brad] It could be she could have been born that way.
You really don't know.
- [Bob] Yeah.
- [Brad] The other thing is now, well, can you just relax?
We'll even up your pelvis a little bit.
If I do this,
she's even, but if I do this and I go over a few inches,
now all of a sudden she's got a two centimeter
leg length differences because I went from here to here.
- [Bob] Yeah. If she's not lined up, you know
if the legs aren't lined up with the trunk.
- [Brad] Right.
- [Bob] That alone can make it look like the leg is longer.
- [Brad] Exactly.
So this takes a lot of skill
and a lot of experience on the,
on the part of the practitioner, the therapist,
the chiropractor,
whoever may be assessing leg length difference.
This is not an easy task to do accurately.
Now you can also measure it.
- [Bob] So are we saying Brad, that really
that way is not a, a way to do it, correct?
- Right. Well, you can do this and get information from it.
But if that's the only way you are assessing
the leg length difference and you're gonna make a
you conclusion from that-
- [Bob] You could, you could be fooled easy.
- Right.
You take this information and add it up,
with some of the other things we're gonna talk about.
- [Bob] Okay.
- [Brad] One of the common things and when I was
in physical therapy school, oh a few years back,
from the umbilicus,
(tape measure spools loudly)
the belly button down to the medial Manus,
the distal end of it, or the far end.
And then you would measure both.
- [Bob] So again, that's the, the ankle bone on the inside.
- [Brad] Exactly.
- [Bob] So from the, the belly button
to the ankle bone on the inside.
- [Brad] Right, exactly.
To the bottom side of the ankle bone.
The belly button, you know, you wanna get the same point
cause we're talking with the centimeter or two here.
So there's a lot of room for error in this as well.
- [Bob] Sure.
- [Brad] So that's not a really acceptable,
and they came up with a better option is to go to the ASIS,
which is that part right on the pelvis bone,
where it's a little pointy right there.
And so you're going from a bony point
to a bony point and this is considered to be more accurate.
However, you can see there could be, you know
and if she shifts her hip this way
it doesn't matter near so much as what we talked
about before with the visual and the pink tape.
But there's still, especially if the person,
you know, Lonnie's pretty thin.
If you have someone that's pretty heavy.
- [Bob] You're gonna have trouble finding that marker.
- [Brad] Right, and you could be a centimeter two off,
just on that landmark.
- [Bob] Yeah.
- [Brad] As well as down here.
- [Bob] You need some palpatory skills to, to, to do this.
I mean, this is not something you're gonna be able to do,
at home.
- [Brad] Exactly.
So once again, this takes a lot of skill and not, you know
practice, knowledge and experience to, to get all this.
So you get a good feel for, for it.
And, and then you still don't know
if you have the right leg length difference,
because remember, like we mentioned earlier
the average leg length difference
on the average person is 1.1 centimeter,
and most of them have no symptoms.
So, if it's off a little bit, the body's adapted to it.
You know, they were born that way typically.
Okay Bob.
So, we just looked at how to assess leg length difference,
in a supine position.
Now, we're gonna look at weight bearing
because really when it comes down to it
you need to assess it in weightbearing
and studies have shown, you know, I've looked
did some research on this and, and they all say
you need to stand up because that's
that's where it's happening.
- One of the more accurate ways.
- It does mean, things-
- More accurate.
- Right.
Well, functionally you, it doesn't matter-
- Right.
- If your legs are longer another when you're laying down.
It does though when you're putting weight through,
and walking.
- Yeah and everything settles down, you know, I mean.
- That's gonna cause the problems in the knee
the hip or the back.
- Sure.
- Is the weight bearing not laying down.
If your leg is one inch longer
it doesn't matter if you're sleeping like that.
But it does when you're walking or running.
- Right.
- Why don't you stand up Bob?
So standing weight bearing is the way to test it
so you can check it, laying down, get your assessment there.
Oh, this one looks a bit longer
but see if it's consistent with weightbearing.
- [Bob] Right, I think it might be helpful,
just to show real quickly.
(wheels scrapping the floor loudly)
What we're doing here is, we're we're gonna be measuring
on top of the pelvis here.
- Right, I like the way you think Bob.
(Bob chuckles softly)
That is, because here,
I'm gonna be putting my fingers right here
on the top of his pelvis
right there on the iliac crest, we call those.
Okay, so that's gonna give us an idea
of that leg length,
(wheels scrapping loudly against the floor)
and Lonnie's got a good angle right there
and you you're gonna find out, you know, Bob's a thin guy.
I can go up there.
I can feel those bones right there and I'm gonna push in
and right there, can, how does that look Lon?
Does it look like it's even?
- [Lonnie] Yeah.
- Okay. Yeah. Don't be shy back there.
(Bob laughs softly)
Okay, now bend one knee slightly Bob.
Okay, you see a leg length difference?
- [Lonnie] Yeah.
- But he doesn't have a leg length difference.
He just bent one knee and some people
it is hard to see if their knee is bent.
If they're very obese or if they have some abnormalities
in their legs or their hips, it's hard to tell sometimes.
- [Bob] And they may not be able to straighten
that knee either.
- Exactly. Right.
- [Bob] So.
- So there's a lot of things.
Now, if Bob is standing there
and he looks like a very healthy person
and he is locked up straight normal posture.
And I look at, look
at 'em and I say, boy, it looks pretty good.
I'm gonna give them an artificially long leg
by putting this half inch, lift your whole leg up, Bob.
Let's just put your whole foot on there.
Okay. And so now I know I changed it.
I lifted this leg up artificially
by an inch and we should be able to see that.
And I think it's pretty clear.
And you can see that yourself, but now this is pretty ideal.
Bob's healthy.
There's no problems with him.
He's thin.
But if you take someone that's rather obese
maybe they have knee problems, arthritic
which oftentimes people do.
You can see how this-
- It get a lot harder to, to find those those points.
- Exactly.
So the best way technically to get a leg length difference
and this is done through studies is to get a full body scan.
It's it's not a typical x-ray we're not gonna get into that
but you're standing, they scan your body
and then you can measure the bony structures
very accurately, it's costly, time consuming.
- And when, and we're not gonna recommend that really.
- When it boils down to it, it's not gonna change,
the the final treatment anyways,
because what's gonna happen is,
if you're having a leg length problem
you go through all the assessments and you think, yeah,
I really think the right one's three centimeters longer.
It just looks like that.
And you're, you're giving it your best guess,
what I do is I take that leg length difference
and I divide it by two.
So that would be 1.5 centimeters.
And then I'm gonna put a temporary
or a trial lift under the heel of the shorter leg.
- And I do the same thing.
So yeah, let's just to make it easy.
Let's say Brad, it was one inch difference.
- Sure. Right.
- We'd cut it in half, a half inch is how much we'd correct.
- Right, exactly.
- So.
- And then you let the person go for a day or two,
and you tell 'em this, if feels better, fine,
if it started to create pain, you know, a day into it
just stop don't force yourself to walk.
- If it starts taking away their pain or, you know
it made a difference.
A lot of times I just do Brad is,
I'll cut a piece of carpet even.
- Sure.
- Or some little piece of foam
and I'll put it in their shoe.
And like I said, because it's only for a couple days
it doesn't have to be anything that's really elaborate.
- You just cut right into the floor,
and take a piece of carpet?
- I do.
(Brad laughs loudly)
You should see our carpet,
has all little heel marks cut out of it, so-
- Yeah, anyways, yeah,
you can use, you know, I've used cardboard in the past.
- Oh cardboard yeah.
And then, you know, then if you find out,
that it really did help, then you can go out
and sometimes you can just buy something from the store.
You don't need anything custom made generally.
- Right.
- Unless it's a lot.
- Right.
- Then you may need to have this shoe built up.
- Right. Exactly.
Yeah. That, that, that gets into money.
So, you know, we're talking
to the people here that are doing these at home.
- Right.
- I know in the clinic
I don't take a piece of cardboard out and do it, but I
I have some material that's made for it.
- Right.
- But there's no nothing saying you can't do this at home.
If you do not have the funds to, to do it or-
- Yeah.
And give it a try and see if it helps.
- Right.
- What's what's, the lost.
- If it feels much better you clearly feel better.
Your back ache went away, your knee pain is better.
Whatever it is,
it's very, very clear.
- Yeah. Don't spend a lot of money on this,
unless you know clearly that it's gonna help.
- Right.
- That's that's our bottom line here.
- Right. We're we're yeah.
We're gonna get the doctors and the podiatrists all excited,
the chiropractor's gonna-
(Brad chuckles quietly).
- Yeah. Everybody doesn't like us already
so that doesn't really matter.
- Yeah. So take care.
- [Bob] Thanks.