Read on Twitter
πππ πππ§π ππ‘ ππ’π¬ππ«ππ©ππ§ππ² - A Thread
A common assessment taught in rehab schools.
LLD (anisomelia) defined as a measurable difference b/w the length of lower extremities, & often blamed for numerous issues related to pain/dysfunction due to the asymmetry. [1/9]
![πππ πππ§π ππ‘ ππ’π¬ππ«ππ©ππ§ππ² - A ThreadA common assessment taught in rehab schools. LLD (anisomelia) defined as a measurable difference b/w the length of lower extremities, & often blamed for numerous issues related to pain/dysfunction due to the asymmetry. [1/9]](https://pbs.twimg.com/media/EqgN8UOXIAAPR17.jpg "πππ πππ§π ππ‘ ππ’π¬ππ«ππ©ππ§ππ² - A ThreadA common assessment taught in rehab schools. LLD (anisomelia) defined as a measurable difference b/w the length of lower extremities, & often blamed for numerous issues related to pain/dysfunction due to the asymmetry. [1/9]")
A common assessment taught in rehab schools.
LLD (anisomelia) defined as a measurable difference b/w the length of lower extremities, & often blamed for numerous issues related to pain/dysfunction due to the asymmetry. [1/9]
Flawed premise: a structural observation = a βproblemβ resulting in symptoms necessitating intervention.
Recall: Pain is a complex experience that cannot be reduced to simple anatomical observations that might superficially seem problematic.
[2/9]
Recall: Pain is a complex experience that cannot be reduced to simple anatomical observations that might superficially seem problematic.
[2/9]
Measuring LLD: Many folks perform assessments for LLD in clinics/gyms via visual assessment, palpation, tape measures, or blocks (pelvis leveling). Overall, the available research evidence demonstrates such approaches ineffective. [3/9]
A more accurate assessment would be done via imaging, X-ray or CT scanogram. But recall, just because we can observe and measure doesnβt mean βproblemβ.
How readily identifiable are LLDs in the general population?
[4/9]
How readily identifiable are LLDs in the general population?
[4/9]
Gordon and Davis set out to answer this question in their 2019 article - Leg Length Discrepancy: The Natural History (And What Do We Really Know)
Finding: Approximately 90% of the population has an LLD. On average, a 5.2 mm difference has been observed.
[5/9]
Finding: Approximately 90% of the population has an LLD. On average, a 5.2 mm difference has been observed.
[5/9]
Looking at Knutson 2005 - 10% of the population has equal lower limb lengths,~50% has a 4 mm LLD or less, and ~90% has a 10 mm LLD or less.
Does a particular LLD tend to matter more regarding pain and dysfunction? Not necessarily. [6/9]
Does a particular LLD tend to matter more regarding pain and dysfunction? Not necessarily. [6/9]
Gordon and Davis argue for a potential threshold of clinical relevance at 3 cm.
The likely scenarios in which we may be curious about LLD are acquired contexts such as post-traumas (e.g. fractures) or joint replacement. [7/9]
The likely scenarios in which we may be curious about LLD are acquired contexts such as post-traumas (e.g. fractures) or joint replacement. [7/9]
The often touted functional LLDs lack evidential support and are often argued for based on fallacious reasoning in attempts to validate an intervention. We also do not have supportive evidence to screen folks universally for LLDs.
[8/9]
[8/9]
Finally - shimming and/or shoe inserts are not typically necessary in this context generally speaking. Turns out we are adaptable and capable of coping with various observable βasymmetriesβ.
Hopefully this provides some clarity. [9/9]
![Finally - shimming and/or shoe inserts are not typically necessary in this context generally speaking. Turns out we are adaptable and capable of coping with various observable βasymmetriesβ. Hopefully this provides some clarity. [9/9]](https://pbs.twimg.com/media/EqgO0CMXAAIqbAB.jpg "Finally - shimming and/or shoe inserts are not typically necessary in this context generally speaking. Turns out we are adaptable and capable of coping with various observable βasymmetriesβ. Hopefully this provides some clarity. [9/9]")
Hopefully this provides some clarity. [9/9]
