Dear All,
I do one day a week in a rehab team, we get many post hip replacement people that have an LLD. I have not kept stats etc but it appears that the greater the LLD after the surgery the less happy they are with the overall result. I believe it is not always clear in the first few months how much effect the LLD is going to have. There seems to be a lag effect where some seem to not have resulting pathology from motion patterns for quite some time and with others you can see assymetry of motion which while not desirable seems not to cause much trouble.
The main hassle is that the system ejects them from rehab and re-assessment before these issues become clear. I'd love to do a 12 month and 24 month follow up.
I have seen a number of young trauma victims, motor bike crashes etc, where more rapid and "aggressive" treatment.....lift the short one kind of immediately seems to be the answer, particularly with shank length where hip damage has been less of an issue.
In general I have developed the impression that dynamic changes to the "equilibrium" of gait in a given individual may take quite some time to manifest all the results of that change. I tend to think the more hip/spine stuff involved the more problematic it will all be......stating the obvious I'm sure.
Given that leg length varies from person to person and that in general children's legs are shorter, often considerably shorter, than adult legs it might be more appropriate to use a percentage leg length difference as the criterion for intervention.
For example if the longer leg length (inside leg or anterior sup. iliac spine to ground or malleolus?) is 50cm and the difference in leg length is 2cm the percentage difference is 2/50 x 100% = 4%. However if the longer leg length is 100cm and the leg length difference is 2cm the percentage difference is 2%.
One would imagine that all else being equal a percentage limb length difference would clarify the issue more effectively, unless, of course, the study cohort consisted of bilateral amputees?
Assuming that long legs are 100cm long then 2cm difference equals 2%
Assuming that short legs are 80cm long then 2cm difference equals 2.5%.
Do you really think that calculating percentage differences of, at most, 0.5% is worth the candle? After all it's not rocket science or even precision engineering.
With 2cm there is no doubt that things will limp along nicely.
Why, it came out so lovely! Reminds me of Alice's letter to her right foot. A today's person is ought to be different from a six years ago themselves, so it's normal to argue with one's own old views. And an (externalized) internal dialogue is a dialogue anyway and a way to go when it comes to the questions left in limbo.
Sorry Craig but they were not looking at anything as measureable as LLD (limb length discrepancy).
They were looking at supine LLA (limb length alignment/asymmetry) but not to measure it. No they were looking at it as evidence of joint subluxation/dysfunction.
Now that's not medical subluxation which can be seen on x-ray and is defined as a partial dislocation. We are talking about chiropractic subluxation which is ill defined and cannot be measured and certainly isn't recognisable to anyone other than a chiropractor because they and only they can pick up the 'vibe's.
The rationale goes something like this. The presence of LLA is evidence of the existence of the 'vibes'
and the cause of the vibes is the cause of the reduced quality of life and this is further evidence that chiropractic is a science because it measures things.