Ever feel like your body is off-balance one hip higher, your shoes wear unevenly, or odd aches pop up in your knees, hips, or back? If so, you might have a leg length discrepancy and yes, it matters more than you think. This issue can have a direct impact on movement, posture, and discomfort throughout your body.
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Why Does Leg Length Discrepancy Matter?
When one leg is longer or shorter than the other—even by a small margin—it can throw your whole body out of balance. This can create issues wherever your body is weakest: hips, knees, feet, spine, or even in your digestion or thinking (thanks to nervous system compensation). Research estimates that 90% of people have some difference, but most are mild. About 20% of adults have a difference above 9mm (about 3/4 inch), which is significant enough to need support.
True vs. Functional Leg Length Discrepancy
- True Discrepancy: One leg bone is physically shorter or longer, due to genetics, injuries, or surgeries (congenital, trauma, or after hip replacements).
- Functional (Apparent) Discrepancy: The legs are structurally equal, but soft tissue, joint misalignments (like in your SI joint), or muscle imbalances make one leg “act” shorter. This is far more common, and easily misdiagnosed.
How Do You Know Which Kind You Have?
- True: Only confirmed by measurements between bony landmarks (greater trochanter to lateral knee, or by X-ray).
- Functional: May appear shorter/longer with some measurements, but really reflect pelvis, SI joint, or muscle tightness.
What Causes Leg Length Discrepancy?
- Congenital structural differences (from birth)
- Traumas/fractures or damage to growth plates (especially in childhood)
- Hip or knee replacements, bone infections, tumors
- Muscle or ligament tightness (especially hip rotator cuff, SI joint imbalance)
How Much Is Too Much?
Small differences (<10mm or 1/2 inch) rarely cause problems. Above 10mm, you’ll likely feel symptoms—back/hip/knee pain, uneven wear on shoes, or even poor posture and gait changes. Significant differences may require lifts, physical therapy, or, rarely, surgery.
What Should You Do?
1. Test & Measure
· Compare both bone length (greater trochanter to ankle; not just ASIS-to-malleolus, due to joint effects).
· Assess for SI joint or pelvic involvement: Often, a rotated or flared pelvis mimics a true discrepancy. Address this with appropriate therapy, not just a heel lift.
2. Address Functional Discrepancies First
· Target soft tissue and muscle imbalances, especially pelvic muscles and deep rotators (obturators, gemelli, piriformis, quadratus femoris).
· Stretch AND strengthen—each muscle may need a different “counteraction” exercise. Check both sides to keep your pelvis balanced.
· Avoid using heel lifts for purely functional causes, as they can reinforce imbalance.
3. Stretching & Mobility Work
· Find which stretches are hardest for you—those are probably your critical areas.
· Don’t just focus on the “short” side—balance both.
4. Know When to Involve a Specialist
If you truly have a bone length difference >1/2 inch and symptoms persist, a skilled therapist or ortho can guide treatment, which may involve lifts, therapy, or rarely surgery.
Key Takeaway
Don’t assume all leg length differences need a “fix.” Find out whether yours is structural or functional, treat what you can, and always address muscle and joint imbalances alongside any other interventions. Your entire body from head to toe will thank you.
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