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Several primary studies have shown that an anatomical short leg predicts anterior rotation of the ipsilateral ilium, whereas anatomical long leg predicts posterior rotation of the ilium on the long leg side. At the same time, in chiropractic and other manual therapy professions, it is widely believed that the leg check finding of a short leg is ass...
Context in source publication
Context 1
... 1 shows the putative short leg mechanism, but also the dislocation of the front of the pelvis that would result. Moreover, it was demonstrated as long ago as 1936 2 and brought to bear on contemporary chiroprac- tic technique by Hildebrandt 3 that torsion occurs around a horizontal axis through the symphysis, rather than through the sacroiliac or hip joints, as others have surmised (Fig 2). ...
Citations
... 29 Considerations such as these suggest that discrimination of functional from anatomic short legs may have an impact on clinical outcomes. 32 Practitioners who focus on the upper cervical spine are also entrenched in functional leg checking. 33,34 The assumption for this group is that it may be a surrogate measure of the state of atlas alignment, given that upper cervical radiographs cannot be obtained during every office visit. ...
... Three participants (7.0%) reported prior histories of lower extremity injuries and surgeries. The sample was 37% female, and their mean age was 25.5 years (range: [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42]. ...
Objective:
The primary objective of the current study was to determine the reliability between methods of supine and prone leg length inequality (LLI) assessment. The secondary objective was to determine if the degree of examiner confidence affected the degree of intermethod agreement.
Methods:
Two experienced doctors of chiropractic assessed 43 participants for LLI, one using a prone and the other a supine method. They stated whether they were confident or not confident in their findings.
Results:
Kappa values for intermethod agreement were 0.16 for the full data set; 0.00 for the n = 20 subgroup with both examiners confident; 0.24 for the n = 18 subgroup with 1 examiner confident; and 0.55 for the n = 5 subgroup with neither examiner confident. Supine and prone measures exhibited slight agreement for the full data set, but no agreement when both examiners were confident. The moderate agreement with both examiners not confident may be an artifact of small sample size.
Conclusions:
This study found that supine and prone assessments for leg length inequality were not in agreement. Positioning the patient in the prone position may increase, decrease, reverse, or offset the observed LLI that is seen in the supine position.
... There is evidence that an anatomic short leg results in pelvic torsion with an anteriorly rotated innominate bone on the short leg side and a posteriorly rotated innominate bone on the long leg side (7). At the same time, it is widely believed in the manual therapy professions that a functional short leg predicts ipsilateral posterior innominate rotation and contralateral anterior rotation (8)(9)(10). Thus, depending on whether an observed short leg is anatomic or functional in nature, a clinician may deploy opposite vectors of correction during sacroiliac manipulation (8). ...
... At the same time, it is widely believed in the manual therapy professions that a functional short leg predicts ipsilateral posterior innominate rotation and contralateral anterior rotation (8)(9)(10). Thus, depending on whether an observed short leg is anatomic or functional in nature, a clinician may deploy opposite vectors of correction during sacroiliac manipulation (8). Apart from guiding the choice of the optimal vectors to be used, diagnosing aLLI may support treating the patient with heel lifts to reduce the risk of lower extremity, sacroiliac, and spinal complaints (11). ...
Introduction: Most forms of leg checking are for functional short leg, believed related to a treatable clinical entity, such as pelvic subluxation. However, a short leg may be anatomic in nature, which could lead to different treatment procedures. A variant termed compressive leg checking is thought to identify an anatomic short leg. The primary objective of the present study was to study the intra-and interexaminer reliability of compressive leg checking. The secondary objective was to assess the inter-method agreement of compressive leg checking and the sit-stand test, another test for anatomic leg length inequality.
... 4,5 Evidence-based practice suggests skillfully incorporating research evidence, patient values, and practitioner experience when determining which clinical evaluation tools to use and how to appropriately weigh the clinical information gleaned from them when rendering clinical decisions. 6 However, the reliability and validity of many evaluation tools leading to clinical decision-making for spinal manipulation (SM) have not been robustly established, [7][8][9][10][11][12][13][14][15][16][17] leaving evidence-based practitioners to depend more on clinical experience, patient values, and other aspects of the clinical presentation. Despite limited reliability and the lack of research studying the validity of some analysis procedures, patients with a range of mus-culoskeletal conditions often improve following SM performed by doctors of chiropractic using a variety of analysis tools and technique methods. ...
Introduction:
The reliability and validity of many evaluation tools leading to clinical decision-making for spinal manipulation are varied. We surveyed senior students and DC employees at one chiropractic college regarding 1) which analysis tools should be used and 2) factors that influence their choices.
Methods:
The survey queried which tools should be used on a routine patient encounter. Clinical evaluation tools included palpation, skin temperature analysis, leg length analysis, and radiographs.
Results:
Surveys were collected from 58 doctors of chiropractic (DCs) and 74 students. Respondents from both groups reported to most commonly use static palpation, followed by motion palpation and leg length analysis. DC respondents ranked evidence and personal experience high for rationale; student respondents frequently chose patient preference.
Conclusion:
DC and student respondents reported use of clinical evaluation tools consistently. However, some variations in rationale were noted. It is important for educators to provide a balanced presentation of the strengths and limitations of clinical analysis procedures to support the development of well-justified evidence-based clinical decision-making skills.
... Degenerative changes in cervical spine. Facet arthropathy of C1-C2, C4-C5, C6-C7 Special Tests [13][14][15][16][17][18][19] Cervical Compression/distraction in neutral cervical spine was positive. Altered neurodynamics of median nerve was suggested by upper limb tension test (ULTT-1). ...
The following case describes a 32 year-old female with a 1½ year history of chronic cervicogenic headache (CGH) with vertigo and chronic neck pain. After years of unsuccessful management with medication and conventional physical therapies; a therapeutic trial of multidisciplinary osteopathy spinal manipulations (MOSM) was carried out. MOSM included manipulations, soft tissue therapies, deep neck flexor (DNF) activation via pressure biofeedback, stretching exercises, postural reeducation and ergonomic corrections. After a treatment period of seven weeks the patient reported satisfactory improvement in headache, vertigo and neck pain. At the most recent follow-up, the pain had not returned to pre-treatment intractable levels along with marked improvement in cervical ROM. This case study demonstrates the importance of diagnosing and treating multiple sources of pain and the positive role of MOSM management can have in the management of patients with such clinical condition.
... For example, he warned clinicians to consider the possibility of anatomical leg-length inequality prior to attempting interpretation of Derifield legcheck findings, which runs parallel to my own papers that make that same point. 3,4 Thompson observed that during the cervical component of the Derifield leg check, the leg usually shortens on the side toward which the head is turned, a fact I was able to verify with a table optimized for leg checking-a table that allowed the legs to move semi-independently of each other during provocative leg checks. 5 He also noted the existence of tension on the short-leg side of a Derifield positive syndrome, consistent with my own hypothesis of anterior thigh stiffness in such cases. ...
... My reasons for thinking this rule has not stood the test of time have been developed elsewhere. 1,2 Briefly, that rule may be reasonable if the short leg in question is a functional short leg. However, if the short leg is an anatomical short leg, abundant evidence exists that more likely than not, the short leg will be associated with an AS ilium. ...
Aim: The effects of chiropractic manipulation, muscle energy technique and home exercise program on pain, depression and functional level were compared in patients diagnosed with sacroiliac joint dysfunction (SIJD) in this study. Materials and Methods: Forty-five volunteer patients aged 20-65 years who were diagnosed with SIJD participated in this study. The patients were tested through chiropractic and orthopedic examination methods, and aspects of dysfunction were detected. Patients were randomized into 3 groups: Chiropractic Manipulation Group (CM), Muscle Energy Technique Group (MET), Control Group. All groups were assigned a home exercise program. All treatment groups were evaluated with numerical pain scale (NPS), Oswestry low back pain disability questionnaire (OLBPDQ), Beck depression inventory (BDI) and algometer before and after treatment. Descriptive statistics were used in data analysis, Kruskal-Wallis tests in intergroup comparisons, Mann-Whitney U tests in pairwise comparisons, and Friedman, post-hoc Wilcoxon Rank tests were used for intragroup comparisons. The statistical significance value was set at p
A few spinal manipulation techniques use paraspinal surface thermography as an examination tool that informs clinical-decision making; however, inter-examiner reliability of this interpretation has not been reported. The purpose of this study was to report inter-examiner reliability for classifying cervical paraspinal thermographic findings.
Seventeen doctors of chiropractic self-reporting a minimum of 2 years of experience using thermography classified thermographic scans into categories (full pattern, partial +, partial, partial -, and adaptation). Kappa statistics (k) were calculated to determine inter-examiner reliability.
Overall inter-examiner reliability was fair (k=0.43). There was good agreement for identifying full pattern (k=0.73) and fair agreement for adaptation (k=0.55). Poor agreement was noted in partial categories (k=0.05-0.22).
Inter-examiner reliability demonstrated fair to good agreement for identifying comparable (full pattern) and disparate (adaptation) thermographic findings; agreement was poor for those with moderate similarity (partial). Further research is needed to determine whether thermographic findings should be used in clinical decision-making for spinal manipulation.
