"Anatomical Short Legs and SOT"
From Dr. Charles Blum, President SOTOUSA
"Anatomical Short Legs and SOT
While most commonly anatomical short legs do not play a large part in SOT clinical encounters, being aware of its presence may help explain why SOT indicators are not clearing even in the face of what may appear to be accurate block placement. Cooperstein at the last SOT Research Conference illustrated this in his presentation on the anatomical short leg and pelvic blocking. [https://www.youtube.com/watch?v=UkZE6VpwzKM]
DeJarnette suggested that heel lifts should only be used with patients that had leg fractures post puberty or with patient with anatomical leg lengths that are symptomatic and SOT indictors improve with heel lifts. DeJarnette agreed with the current literature and did not routinely recommend heel lifts, however; if indicated, he noted we should start at 50% of the leg length difference with anatomical leg lengths and monitor patient’s progress before attempting any increase. He preferred to utilize functional assessments when determining anatomical leg length differences and expect that with pediatric anatomical asymmetry the body will often accommodate.
SOT uses specific methods of leg lengths assessments to determine block placement and once the blocks are placed we also utilize various indicators to corroborate accurate block placement:
With category one we commonly see some degree of Achilles heel tension as well as asymmetrical gluteal or sacrospinalis muscle tension, all of which will tend to modify during blocking.
With category two we use the arm fossa test as well as sensitivity at the medial/ lateral knee, inguinal ligament, and (unilateral) anterior scalenus muscle, which all should resolve during blocking.
With category three we assess points of greatest pain commonly along the sciatic nerve and sometimes focused at the gluteal region and mid-calf, which will diminish or resolve during blocking.
Since high tech methods are costly and offer ionizing radiation and traditionally used low tech assessments for anatomical leg lengths have limited validity we also can employ some functional methods to determine the value of heel lifts for patients with an anatomical short leg.
While not limited to the following, we can assess posture, motion, and muscle strength before and after placement of heel lifts – are there beneficial changes in function and/or posture? (1) A patient with an anatomical short leg may appear with equal leg lengths if their pelvis is "un-balanced" or with "un-equal" leg lengths if the pelvis is balanced. (2) Blocking is determined upon the proper categorization and assessing those indicators during blocking, with the presumption that proper treatment will cause those indicators to improve. (3) Be aware that with patients that have active indicators but have an anatomical short leg we may sometimes need to block opposite to the short leg to have a good response to care.
Cooperstein R. Heuristic exploration of how leg checking procedures may lead to inappropriate sacroiliac clinical interventions. Journal of Chiropractic Medicine. 2010;9(3):146-153. [www.ncbi.nlm.nih.gov/pmc/articles/PMC3188368/pdf/main.pdf]
Cooperstein R, Lew M. The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. Journal of Chiropractic Medicine. 2009;8(3):107-118. [www.ncbi.nlm.nih.gov/pmc/articles/PMC2732247/pdf/main.pdf]
Knutson GA. 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. Chiropractic & Osteopathy. 2005;13:11. [www.ncbi.nlm.nih.gov/…/a…/PMC1232860/pdf/1746-1340-13-11.pdf]
Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg- length asymmetry. Chiropractic & Osteopathy. 2005;13:12. [www.ncbi.nlm.nih.gov/…/a…/PMC1198238/pdf/1746-1340-13-12.pdf]"