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LLD/Behavioural problems

Discussion in 'General Issues and Discussion Forum' started by MBrooksbank, Sep 30, 2014.

  1. MBrooksbank

    MBrooksbank Member

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    Hi everybody. This may seem a little bit of a strange request. I would just like to ask if anyone has had patient contact which may have suggested possible correlation between behavioural problems and LLD.

    Thank you

  2. No....
  3. Funny you ask. I've always noticed that people with LLD tend to walk in circles, the greater the LLD, the tighter the circle.....:rolleyes:
  4. Peter

    Peter Well-Known Member

  5. Grover

    Grover Member

    I've had patients that were horrible people who complained that the orthotic dispensed did not address their LLD. It is usually another practitioner ("rival" Pod, D.C., etc) trying to throw us under the bus saying the device is not soft enough and/or did not compensate for the 2mm LLD they measured.

    It should be a correlation not a causation.

    Peter Grover Greaves D.Ch.
  6. efuller

    efuller MVP

    If a parent brought in his child and wanted to know if the child's limb length discrepancy was causing behavioral problems in the child, I'd say you have a behavioral problem with the parent.

  7. Craig Payne

    Craig Payne Moderator

  8. Boots n all

    Boots n all Well-Known Member

    l would personally see about 5 clients a week with an LLD.

    Some new clients, some old clients with another few pair to modify.

    These guys are happy that they are listened to and someone is there to help, l tend to find them to be a very happy and great-full client base, great to train the young ones with.
  9. Tkemp

    Tkemp Active Member

    Can you claify what you mean by "behavioural problems" please?
    I have seen children who refuse to play sports, or have reduced physical activity due to knee and hip pain resultant from LLD. In addition, this pain has lead some children to be more 'grumpy'. I would not consider these to be "behavioural problems".
    Older patients with OA changes, whose pelvis and spine no longer have adequate ROM to help compensate for a LLD, have increased discomfort and can also be slightly more irritable.
    Again, I would expect this to be a normal response to physical pain, which is resolved with treatment of the LLD.
  10. Micharm

    Micharm Welcome New Poster

    Hello Mark, Simply Yes. I have some experience with people who are intellectually disabled and these people may have a degree of communication difficulty. So given that a LLD may be the underlying cause of pain/discomfort and that the individual may have an expressive communication deficit then it may follow that the behaviour observed is a combination of discomfort/pain and or frustration. The behaviour may not seem in keeping with the degree we may consider reasonable but then if you had pain/discomfort and discomfort and were unable to communicate and seek remedy then I would suggest that you may be showing some unsocial behaviours yourself.
    Give them time and they will appreciate your interest. If it is not the cause then you can at least look elsewhere with confidence.
  11. MBrooksbank

    MBrooksbank Member

    My apologies for the late response. My initial post was in relation to the following patient:

    Patient referred to me for back pain approx. 12/12, I noticed big LLD at least 2cm (previously undiagnosed) and I provided a raise to equate for this.

    Patient attends for review a number of weeks later, still has back pain but no longer requires medication for ADHD... yes I know, your sceptical. Patient unequivocally states the symptoms subsided the moment he initially wore the raise. He seemed so genuine, so I investigated and found little info

    I reviewed again, this time he tells me his nephew has/had ADHD and was prescribed a raise for another problem he had and guess what happened? ADHD no longer a problem. At this point I asked one of my colleagues (Dr Sarah Reel) if she could search literature to investigate whether there be possible correlation between LLD and ADHD. This was her response:

    Hi Mark
    I’ve had a dig around regarding ADHD/leg length inequality. It doesn’t look like anyone’s researched into this although the links below suggest there may well be a correlation. I think it might be worth pursuing.

    1) http://www.torquerelease.com.au/JVSR-Bedell-3.pdf
    (see bottom of page 2)

    2) http://www.medhelp.org/posts/Orthopedics/Mix-matched-leg-length-discrepancy/show/922515

    3) http://gorevelation.com/wp-content/uploads/ADHD-Case-Study-Hodgson-Vaden-1.pdf
    This is an interesting case study that tests a chiropractic method called Torque release technique. It seems to have a positive effect on the symptoms of ADHD. There are 4 cases detailed and leg length discrepancy is measured. A chart of Case 4’s results is detailed on page 23. Leg length discrepancy was measured in mm but doesn’t describe the method used. However it seems before treatment the discrepancy was 9mm and after it was 5mm – quite a difference! But the treatment concentrates on the spine and seems to level the whole body:

    ‘Total postural deviation improved from 34 degrees pre-care to 8 degrees post-care: Of note were
    improvements in shoulder protraction, unlevelling and list of head/neck, and unlevelling of hips,
    knees and ankles.’ Page 11 (Case 4)
    (This is what’s being achieved with your heel wedges.)

    4) http://www.orthobullets.com/pediatrics/4119/legg-calve-perthes-disease-coxa-plana causes leg length discrepancy and 33% have ADHD

    5) http://www.unboundmedicine.com/medl...tivity_disorder:_a_retrospective_case_series_
    Might be a good one to order from the library. Abstract hints that postural realignment is beneficial.

    If you/we were to go ahead with this, the first thing would be to do a comprehensive lit search, then grab some ADHD volunteers from GP lists, CAMHS professional or specialist paediatrician. There would be 2 arms to the study: 1) Determine frequency of leg length discrepancy in ADHD sample and 2) Measure efficacy of intervention (heel raise).
    I would love to have a go at this and find out about funding etc. What do you think?

    Since the email we have enquired about funding from but we have been told we need more evidence to suggest a link, which is obviously very difficult. Hence that's why I asked the question. I would be interested to hear your thoughts.

    Thanks again


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