Dynamic leg length difference

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Hi all

I have a lady patient, 55yr old, long history for decades of chronic bilateral hip pain (great troch and also inguinal). Serology for inflammatory arthropathies are constantly normal. All MRIs constantly unremarkable. Numerous orthopaedic consultants and physiotherapists can't find anything remarkable. Physical therapy has never helped.

Her osteopath measured a long left leg (10mm) a few months ago and asked me to do a biomechanical exam. I found a long right leg (10mm) four weeks ago. On measurement today (lying supine / pelvic neutral / sternum to medial ankle) I found she's back to a long left leg by 10mm again.

Any ideas what's underpinning a functional leg length that's dynamically changing sides so often?

Cheers !!

 

Measurement error a possibility. ... but 20mm difference between you an osteopath is a lot!
If its important I would suggest a weightbearing x-ray to rely check accurately before proceeding

 

Her left leg in your right hand as you check...errors can happen

 

They can ... although the slow-mo videos taken of today v last month suggest the change too. The asis/psis points were raised on the right last time; left this time!

Any idea what can cause an LLD functional change so quickly? Especially as accompanied with bilateral hip pain too? What treatment and management is indicated in this unusual presentation?