Extremities – Posture Videos

Leg Length Difference: Clinical Significance | Posture Doctor

My right leg is 9mm shorter than my left. This is called leg length inequality; also known as leg length deficiency, leg length insufficiency, or short leg. This was diagnosed reliably from x-ray, whilst I attended Chiropractic University over two decades ago.

X-Ray is the only reliable means for measuring leg lengh inequality. As a result of my short leg, I have an associated lumbar scoliosis and a history of disc degeneration in this region of my spine. Ugh!

Personally, and clinically – after years treating patients with leg length inequality, having regular manual adjustments and wearing a heel lift – I believe my chronic back pain was largely associated and caused by my leg length asymmetry. The medical research however, may contradict my self-diagnosis.

Leg lengh inequality

Prior to the 1970s, the data on leg-length inequality (LLI) was found to be unreliable in terms of accuracy of leg length measurement from x-ray.

A review by Gary Knutson – published in 2005 in Chiropractic and Osteopathy, used LLI data from 1970-2005. All the studies reviewed were selected because they used accurate radiological methods to determine anatomic LLI. Those that failed to used accurate radiological methods were excluded from his review.

Leg-length inequality (LLI) is a topic that has been examined extensively in the research. Several questions have remained largely unanswered regarding leg-length inequality and include: how common is LLI, what is the average amount of LLI, what are the effects of LLI? The purpose of Knutson’s review was to highlight current research to answer these questions.

Prevalence of leg-length inequality

Several studies using precise radiographic method data, were combined giving a subject size of 573, with a LLI range of 0–20 mm. The mean or average LLI was 5.21 mm. What’s interesting is that most Chiropractors who treat LLI, start using heel lifts at 5mm. It seems, the science backs this up.

It seems a much higher percentage of the population has LLI closer to 5 mm.

Four of the studies reviewed by Knutson measured subjects by gender and no difference between male and female was found, suggesting that gender plays little role in the amount of LLI.

The data also demonstrates no preference for left or right leg, which fascinates me. Many musculoskeletal diagnoses have a one-sided inclincation. Thoracic scoliosis to the right makes up 85-90% of all adolescent scoliosis; stroke more frequently affects the left-side of the brain and 90% of the world’s population is right-handed!

Seven of the Knutson’s studies identified subjects that had LLI as being symptomatic (subjects = 347) or asymptomatic (subjects = 165). Symptoms included knee and hip problems and low back pain (mostly within the last 12 months).

What I find amazing, is that there is no statistical difference between these two groups; suggesting that the average LLI is not correlated to symptomatic problems, like low back pain.

Note: There will always be individual exceptions. Just because research fails to show a correlation between leg length inequality and back pain, does not mean a relationship doesn’t exist.

Effects of LLI

The most common effect of anatomic LLI is rotation (twist) of the pelvis – often referred to as pelvic torsion. Knutson explains that in the standing position, the weight of the body in the pelvis (on the short leg side) induces a downward force towards the feet. With asymmetry of the leg-lengths, the pelvis, being pushed down on the femoral head (hip), must then rotate or torsion.

So if you have a left short leg, it is likely that your pelvis drops down to the left and twists right, or away from the short leg side. This is how we measure it on x-ray:

Here you can see a very clear LLI on the left side. The result is a downward force toward the left femoral head of the hip, with a right torsion or twist through the pelvis. This would mean that your pubic bone (green dot) would be visualised to the right of your gluteal fold (white dotted line) on x-ray.

The amount of pelvic torsion from this left LLI is measured by the distance between pubic symphysis joint and gluteal fold; illustrated by the green arrow.

Further Resources: Scoliosis Exercises You Can Do From Home

With larger amounts of leg-length inequality (greater than 22mm), subjects in this study developed flexion of the knee on the long leg side. This is the body’s clever way of attempting to level up the pelvis.

Other effects of LLI and pelvic torsion demonstrated in the research literature, include postural scoliosis, wedging of the 5th lumbar vertebra and bone traction spurs (osteoarthritis).

Clinical significance

Knutson’s research attempted to quantify what ranges of LLI are clinically significant, that is, associated with back pain, injury, muscle strength asymmetry or other physiologic changes.

Chronic low back pain and LLI

Chronic low back pain affects about 21% of the population. One would expect this percentage to be higher if LLI caused low back pain, given that 50% of the population has LLI of 5.2 mm or more.

As you can see, the correlation between LLI and chronic low back pain really becomes demonstrable when LLI is above 15 mm.

In this study Dr Oro Friberg notes that relatively small amounts of LLI may only be clinically significant relative to certain conditions such as prolonged standing or gait, such as with daily work, marathon runners, military training and sporting activities.

In this study Gofton and Trueman found a strong association between LLI and osteoarthritis (OA) on the side of the anatomically longer leg. I often explain it to my students in this way: The longer leg hip joint gets impacted with increased load, as forces are pushing upwar; much as forces are pushing downward (with gravity) on the short leg side.

In their study, few subjects were aware of any difference in leg length. The authors acknowledge that many with LLI fail to develop this condition, suggesting that other factors may also be important.

LLI conclusion

In summary, childhood-onset leg-length inequality appears to have little clinical significance up to 20 mm. Past the ~ 20 mm point, structural changes may cause compensatory muscular contractions.

The purpose of Knutson’s paper was to review the research regarding leg-length inequality; prevalence, mean magnitude or size, effects and clinical significance.

The prevalence of leg length inequality seems almost universal and was found to be ninety per cent of the population. The average magnitude of LLI was small and found to be 5.2 mm. Based on the research reviewed, small childhood-onset LLI under 20mm (under normal situations) does not seem to be clinically significant.

It seems the body is well able to compensate for minor LLI of up to 2cm. However, as a Posture Doctor who has spent years treating 100’s of people with LLI (including myself), I feel much more research is needed to convince me.

Until such a time, I will continue to help those of you with LLI and your associated postural distortions; to bring your pelvis back towards a neutral orientation, and to decrease active muscular compensations, through use of heel lifts, effective exercise programs and manual treatment.

Important Test For Brain Health – One Leg Balance | Posture Doctor

An important test for brain health is the ability to balance on one leg. Researchers found that the inability to balance on one leg for longer than 20 seconds was associated with vascular disease in the brain, specifically small areas of tissue death (mini strokes) without symptoms.

I made a new friend recently. She, like me, is 50 (something) and a bit of a tomboy, in that she has been active and sporty all her life. Then just over a year ago, she had a car accident and four days later when trying to answer a question at work, nothing came out of her mouth. She just couldn’t find the words. Moments later, she said to her colleague: I think I’ve hurt my brain.

There is a lot of current online buzz about brain health. Listening to CBC Radio this morning they were talking about particulate matter – from city pollution – and the cognitive impact.

Then I happened upon this study that found that an important test for brain health is the ability to balance on one leg. Yasuharu Tabara, Ph.D., and lead study author and associate professor at the Center for Genomic Medicine says that:

Individuals showing poor balance on one leg should receive increased attention, as this may indicate an increased risk for brain disease and cognitive decline.

The study consisted of 841 women and 546 men, with average age of 67. To measure one-leg standing time, participants stood with their eyes open and raised one leg. They performed the leg raise twice and the better of the two times was used in the study analysis. Small blood vessel disease of the brain was evaluated using magnetic resonance imaging.

The researchers found that the inability to balance on one leg for longer than 20 seconds was associated with vascular disease in the brain, specifically small areas of tissue death (mini strokes) without symptoms. They noted that:

34.5 % of those with more than two lesions (infarctions) had trouble balancing.
16 % of those with one lesion had trouble balancing.
30 % of those with more than two micro bleeds had trouble balancing.
15.3 % of those with one micro bleed had trouble balancing.

“One-leg standing time is a simple measure of postural instability and might be a consequence of the presence of brain abnormalities,” said Tabara.

Although this study is not saying that poor balance causes brain disease and/or cognitive decline, the inability to balance for at least 20 seconds, may suggest brain abnormalities. So poor balance suggests poor brain health, but can improving balance improve our brain health as we age? Now that’s a great research question!

Personally, I like to err on the side of caution with my own health. I’m not comfortable with pill popping and I’m definitely not waiting for signs of aging (other than my quickly greying hair and ever-creasing skin argh). I’ve incorporated balance exercises into my daily posture routine.

Get the balance right

Balance shouldn’t be a concern just for the elderly who are more prone to falls (and the serious complications those falls can cause). Balance training is important for anyone who wants to age well, avoid falls, improve athletic ability, coordination, stamina and overall fitness and health.

If you haven’t thought much about maintaining, or improving your balance, now is a good time to start.

In order to have good balance, we rely on the information given to our brain from three main body systems: our ears, the nerve endings in our muscles, and our eyes (vision).

As children, we develop balance climbing trees (where I spent many hours climbing up, up, up to collect long forgotten bird nests), riding our bikes, walking and running on uneven surfaces and playing sport and games. As adults, we seldom think about balance and rarely practice it.

When was the last time you climbed a jungle gym with your kids, walked along the slim surface of a forest log or tried to balance on one leg whilst brushing your teeth with the opposite hand (I love this one)?

The eyes have it

Your sense of vision is a big part of good balance. Vision works hand in hand with the inner ear to maintain balance. If you move your eyes or take vision out of the equation altogether, it’s harder to balance. You might be surprised how challenging it is to simply stand with your eyes closed. We play around a lot with removing vision during some of the more advanced balance exercises in our posture school.

Better balance means better coordination, POSTURE, core strength, agility and athletic skill. You even burn calories using balance training!

Balance training is good for people of every age, so don’t be afraid to start incorporating balance exercises into your daily workouts. Everyone can benefit from balance training and even better if our ability to balance keeps our brains young, sharp and disease-free!

Try walking off-piste

Dupuytren’s Nodules: 3 Natural Remedies – Posture Doctor

I have Dupuytren’s Disease. Your Posture Doctor’s body is far from perfect. I wanted to share my diagnosis because many of you have journeyed with me since I left private practice to take my posture tips online, full-time.

About three months ago, I discovered a small lump in the palm of my hand. Having had a similar lump in my plantar fascia a year ago, I assumed my overly tight tendons have some calcific build-up.

Dr Paula Moore’s Dupuytren’s Nodule

I’ve also got a bunion on my right big toe – maybe you’ve seen my bunion mobilization videos – and an anatomical short leg that gives me functional scoliosis. I also have a video explaining the mechanism of short-leg scoliosis.

I’ve had chronic headaches since my early 20s, and I believe the underlying structural cause was initiated by an accident I had at age 9 when I was hit in the head with a wooden baseball bat, receiving eight stitches. Fortunately, my ongoing posture work keeps them at bay.

As a result of having an anatomical short right leg with scoliosis and being crazy active in sport up until university, I eventually had a disc herniation (slipped disc) while I was in practice as a chiropractor many years ago.

I FEEL YOUR PAIN!

When I tell you that I know what it is to have problem posture and understand the frustration that regaining attractive upright posture takes time – there is no quick-fix solution – I MEAN IT! I feel your pain.

The imperfections of my body are, in many ways, the bane of my life, and yet I know they are also my gifts. For if my body alignment and health were perfect, I most likely wouldn’t have become a Chiropractor or gone on to study the physics of posture.

It has become my absolute mission to correct my own posture, and along the way, I’m continually reminded of my student’s struggles and humbled by my own.

Dupuytren’s Disease

Dupuytren’s Disease is a disease of collagen tissue dysfunction. It is genetic. My grandfather had it. My grandfather was a supreme court judge in Canada. I am certain he was the man, the word gentleman was modeled after. In fact, we called him Grandfather as children. He even wore a dress shirt on our picnics and enjoyed smoking his pipe as we played in the sand.

Apparently, as a child, I used to hold my hands with my fingers bent, just like he were. He had Dupuytren’s contractures on both hands. I was not particularly eager to hold his hand crossing the street because his bent fingers felt funny to me.

Last night I Googled, ‘nodule in the flexor tendons of the hand,‘ and Dupuytren’s Nodule popped up. I don’t know why I hadn’t immediately clued in, but I hadn’t.

There isn’t a lot known about Dupuytren’s Disease. The treatment options are minimal and invasive:

Treating the symptoms or cause?

Just like posture, you can treat the symptoms (forward head posture, for example, with a chin tuck) or the cause (the structural alignment in the neck – after x-ray diagnosis).

Oddly, Dupuytren’s Disease doesn’t really worry me. Do I need my hands?! Obviously, yes, I’m extremely active and write a lot. I could have an injection and watch the early sign (nodule) perhaps disappear. I know, however, that this approach fails to address the cause of Dupuytren’s. The problem is collagen. I am very interested in the WHY. Why is my collagen running amok?

WHY IS YOUR POSTURE THE WAY THAT IT IS?

Do you want to use a quick-fix youtube video exercise? I have plenty of those posture videos for you online. Or, do you want to address the underlying cause of your posture issues, and jump on board for the long run, and correct your posture for good?

Magnesium and Dupuytren’s Disease

I did some more research. This time I Googled, ‘Dupuytrens Nodules nutrition.’ I found Magnesium and Dupuytren’s Disease.

The article explained that my mother was a gene carrier for Dupuytren’s (thanks, mum), but more interesting to me was that some people had responded to topical Magnesium treatment. However, I realize that topical is still a symptom-based approach. I read on …

How does magnesium help?

The article explains that in Dupuytren’s Disease, collagen cells shrink or contract and that calcium is needed to allow this to happen.

The cell’s pulling mechanism requires calcium. In theory, magnesium might block the cells from pulling on the tissues by reducing the effect of calcium … magnesium might make the cells relax and allow a finger to loosen.

My next step …

Get magnesium levels tested! I’m going for a lab test tomorrow. The author goes on to explain:

Laser for Dupuytren’s Disease?

The next thought that I had was recalling my mother’s success with laser for her Plantar Fasciitis. I next Googled, ‘laser for Dupuytren’s.’ This is what I found:

A Toronto Chiropractor had some success using Low-level laser therapy and Graston Technique. The theory goes that laser stimulates tissue repair and promotes proper soft tissue alignment as it heals. This is controversial, but it’s got to be better than cortisone injections, which can degrade and further damage tissues over time.

Pairing the physical tissue breakdown of laser with the myofascial release used in the Graston Technique makes sense to me!

What is Graston Technique?

Graston Technique is a patented form of manual therapy that uses stainless steel tools to perform tissue mobilizations. It is a kind of soft tissue mobilization used mainly by manual practitioners – Chiropractors, Osteopaths, Physical Therapists, etc.

What am I going to do about my Dupuytren’s Disease?

I’m going to take action. Many of you, reading this post, have followed me for several years – Read my posts, watching my videos, and maybe even tried some of my exercises. But how many of you have committed fully to your posture correction and long-term health?

Enroll – International Dupuytren’s Data Bank

What is the difference between those of us who dabble and those who really create change in our lives?

It’s simple, but it’s not necessarily easy …

ACTION

Dupuytren’s Disease action plan

Done! Do I feel worried about my Dupuytren’s? Not really. Taking action gives me freedom from worry. When I am proactive about my health, I know I am doing everything I can to have the best healthy future possible.

Paula’s Dupuytren’s Nodule

I want to be skiing at 80, not checking into a nursing home.

What about you? Are you a victim of your circumstance or the doctor of your destiny … I hope the latter.

Further Resources: Posturecise (Level 1) – How to create a healthy posture habit for life

Foot Pain: Causes, Symptoms and Exercises – Posture Doctor

When the fascia fails to offer the appropriate shock absorption, too much pressure on your feet can damage or tear the ligaments; the fascia becomes inflamed, and the inflammation causes pain and stiffness.

What is plantar fasciitis?

Plantar fasciitis means pain in the bottom of the heel. Plantar is the sole of the foot; Fascia is the tissue; and itis is Greek for inflammation. For example, colitis is literally colon inflammation.

The plantar fascia is a thick ligament (ligaments attach bone to bone) that connects your heel to the front of your foot. It supports the arch of your foot and helps you walk.

What are the symptoms of plantar fasciitis?

The major complaint of those with plantar fasciitis is pain on the bottom of the foot near the heel. It usually affects just one foot, but it can affect both feet. Some people describe the pain as dull, while others experience a sharp stabbing pain.

The pain is usually worse in the morning when you take your first few steps, although it can also be triggered by long periods of standing or rising after a period of sitting. Climbing stairs may also be difficult due to heel stiffness. The pain is usually worse after exercise, not during.

Who gets it?

Plantar fasciitis a very common orthopedic complaint. Your plantar ligaments experience a lot of compression in your daily life. These ligaments act as shock absorbers, supporting the arch of the foot, unless the mechanics of your feet are altered in some way.

You’re at a greater risk of developing plantar fasciitis if you are:

Weight – being overweight increases the pressure on your ligaments – especially if you have sudden weight gain, for example, during pregnancy.
Types of exercise – Activities that place a lot of stress on your heel and attached fascia. Long-distance road runners – off road runners are at less risk – jumping sports and ballet dancing for example.
Occupation – a job that requires being on your feet most of the day, such as working in a factory or a restaurant, and even teachers.
Foot mechanics – Having very high arches, flat feet or tight Achilles tendons.
Shoewear – Sudden change to your usual shoewear.

Active men and women between the ages of 40 and 70 are at highest risk, and it is also slightly more common in women.

What helps?

Home treatment:

Initial home treatment includes staying off your feet and applying ice for 15 to 20 minutes, three or four times per day to reduce inflammation. Using generic arch supports in your shoes (bought at most drug stores) and doing some soft tissue work and stretching exercises may also help to relieve pain.

Soft tissue work:

Soft tissue work may help to break up sticky tissue adhesions and stimulate healing. Use ice after each session.

Exercises:

Picking up a towel: Sit on a chair and put one foot on a towel. Now grip the towel with your toes and try to pick it up. Hold it for 10 seconds. Repeat five times.

Time required: approx. 2 minutes

Ball massage: Roll a tennis ball quite firmly back and forth over the sole of your foot. Treat the whole sole of your foot from forefoot to heel. Ouch – heads up, this is painful!

Time required: approx. 3 minutes

Achilles stretch: Find a sloping driveway or hill. Look for an angle approximately 45 degrees. This stretch is often shown on stairs, but I prefer to support the heel. If you have a carpenter in the family, have them DIY a stretch block for you.

Time required: 3 minutes

In-clinic treatment

You may benefit from seeing a podiatrist who specializes in custom-made orthotics. They can also recommend appropriate shoewear and exercises.

Your doctor or healthcare practitioner may also recommend ultrasound or Low level laser therapy (LLLT) which is painless and non-invasive; plus my mother swears by laser treatment, after her acute fasciitis resolved with just one session!

Further Resources: Balance Exercises You Can do From Home