Short Legs, Twisted Hips, and ACLs: Preventing and Fixing Low Back Pain Permanently

Back pain sucks.  Once you’ve strained your back it never seems to go away.  You are stuck with a lifetime of pain and discomfort. Or so you thought.  A few simple hacks in your biomechanics may alleviate the direct cause of lower back pain.  I’m not a doctor or chiropractor, but I did study biomechanics at Truman State University and understand physics so don’t sue me.  I’m just trying to share what I’ve learned in my decade long battle with back pain.

I experienced my first back strain as a high school senior while playing soccer about 11 years ago as a result of a slide tackle.  Since then I’ve experienced severe strains that have resulted in pain, immobility, and even an ambulance ride after carrying boxes of coin at a bank.  At the time I thought it was just a freak injury and that it would go away.  Unfortunately, it’s been a chronic problem that was actually fairly simple to solve and had I seen a medical practitioner or chiropractor with an understanding of the full body’s biomechanics, I would likely have saved myself a lot of pain.

For those that want the solution here it is:

See a Chiropractor to see if you have Leg Length Disparity or Short Leg Syndrome.  The Chiropractor will determine remedial steps that will help to align all of the various limbs that may be causing harmful torquing forces on your various joints including those in your lower back, pelvis, knees, and ankles.  This will usually result in the use of relatively inexpensive orthotics or heel lifts ($10 or so) that will help you on your road to low back pain recovery.  An orthopedic surgeon or other medical doctor will probably recommend some type of back surgery.  This is a terrible option since they are paid A LOT of money to do back surgeries and are thus incentivized to perform surgery that may not correct the underlying problem.  If you do elect for back surgery, get opinions on what is the CAUSE of the the symptoms.  If the doctor does not have an explanation that makes sense in terms of mathematics and physics then run away… fast.

For the Explanation Why Read Further:

Prior to my first back strain I had torn the Anterior Cruciate Ligament in my left knee after landing on an attempted layup in a recreational basketball game.  A freak accident?  Maybe.  But knowing what I know now, I’m guessing the ACL tear was inevitable and it could have been prevented with some research, a chiropractor visit, and a heel lift.

Leg Length Disparity / Short Leg Syndrome

I’ve found out that I have Leg Length Disparity or Short Leg Syndrome.  This is a long way of saying my legs are of different lengths with my left leg being about 7mm longer than my right leg.  This small disparity in length can cause huge problems in how forces are transferred up the leg and through the joints, back, and neck.  Over a long period of time it can cause degeneration in important cartilage and “discs” that lubricates joints, bone spurs in places you don’t want, mis-alignment of the back and neck, improper gait, excessive heal striking, and extensive straining on muscles.   In the short term it can cause torque in joints that can make you more susceptible to sports injuries like muscle strains, ligament tears, and sprains.

Biomechanics of the Foot

The foot is an amazing example of form.  It is basically a spring comprised of 26 bones, 33 joints, and a multitude of nerves and muscles that transfers forces to produce locomotion.  In an ideal gait, the forefoot strikes the ground relatively evenly.  Nerve endings in the ball of the foot detect the force and sends signals throughout the nervous system that an impact has occurred and prepares the rest of the musculoskeletal  system for the impact.  An improper strike can cause the body to react differently by twisting the body, foot, or joints adversely.  Below is a picture of the soles of my soccer cleats that show how my long left leg caused excessive heal striking and excessive eversion in my left foot.  Notice the heel on the left sole is completely worn through and the size of wear near the ball of the foot and big toes are larger than the right foot indicating an improper foot strike with excessive load on the medial side of the foot.

Heel Striking and Eversion

Soles of my Soccer Shoes

The recent trend in barefoot running attempts to correct the problems in biomechanics caused by raised heels common in most athletic shoes.  The raised heels cause the heel to strike the ground first instead of the forefoot and prepares the body for a jarring impact since this is not a natural impact.  I’ve recently switched to some Adidas Adipure Trainers for normal running, training, and walking for this reason.  Although Switching to thin-soled zero-drop shoes improves gait, it does not fix the problems caused by a short leg which I’ll describe below.

The Body is a Series of Levers

The body has evolved and optimized over millions of years to move quickly and efficiently without injury, mostly in short bursts of intense activity (think chasing after prey or being chased by predators).  For those physics inclined people, you will find that our limbs are actually levers that transfer forces via the contraction of muscles.  If the levers are misaligned the torque caused by the levers can magnify small forces into large problems.  In my case the length of my left leg caused several problems:

  1. Vertical rotation of the pelvis to compensate for the short right leg.

    Spinal and pelvic rotation

    Example of rotation caused by Short Leg / Leg Length Disparity

  2. Improper curvature of the spine

    A misaligned spine caused by short leg

  3. Improper load of femur onto the knee joint which leads to:

    Uneven weight distribution

  4. Eversion of the foot and improper foot strike

All of these factors increased the probability of injury relating to knees, lower back pain, tight upper back and neck muscles, and likely an increased likelihood of ankle problems.

Factor 1 causes a number of problems mostly related to low back pain.  First it may cause bone spurs along the pelvis.  In my case they actually looked like devil horns which is a little scary!  Second it causes the hip to rotate both back and sideways which causes the front of the “discs” to compress.  Compression and degeneration of the discs that help to lubricate the joints between the back bones and sacrum lead to the constant dull pain and more importantly it impedes the transmission of important neuromuscular data between the lower extremities to the spinal cord and brain.

Factor 2 leads to the body constantly pulling in various directions to attempt to re-align the spine for optimal performance.  This leads to muscle fatigue and neck pain.

Factor 3 probably led me to my ACL tear.  If forces are not transferred perpendicular to the ground, the knee acts as a point of rotation and the femur acts as the lever.  Since the femur is the longest bone in the body, it magnifies the force and may cause ligaments to weaken over time and eventually snap.

Fix Me

So the fix in the end involves a few changes to my biomechanics:

  1. Heel lift – The heel lift raises my entire right leg to level out the pelvis and therefore re-align the spine and lower extremities including the knee and ankle

    A typical heel lift

  2. Pelvic Lift – This is a technique related to posture and not a product.  Years of improper gait has caused compression and degeneration of the discs.  I’d like the discs to regenerate and to do this I need to quit compressing them abnormally. Pelvic lift involves “pulling” the sacrum/cocyx (tail bone) up towards the belly.  To do this while walking and running is a little difficult but usually involves activating lower abdomen muscles and “sucking in”.  A chiropractor can do a gait analysis to determine what you can do to have a biomechanically correct gait.

19 thoughts on “Short Legs, Twisted Hips, and ACLs: Preventing and Fixing Low Back Pain Permanently

  1. Solid write up Jim, complete with simple explanations and solutions. It is true that ACL tears are most often secondary to improper gait, which is caused by pes planus (flattening of the foot), leg length disparity, or lumbar curve. Each of these cause internal rotation of the femur head, increased pressure across the medial knee, and increased likelihood of lateral ankle sprain due to improper foot mechanics.
    Hope you are doing well.

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  3. Good post. But, I disagree about it affecting you for the rest of your life. I’ve had the same issues but began seeing a chiropractor and it immediately began helping me.

    • Thanks for the comment. I agree that seeing a chiropractor is the best way to improve lower back pain, increase mobility, and fix the source of the problem. It does take a while to erase what in my case was 20+ years of poor biomechanics.

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  8. Nice article. I have been reading alot on the “short leg syndrome”. I had a stiff back pain back in Oct 2010 and after seeing 3 different orthopedic doctors, 2 epidural shots, a SI joint shot, 15 weeks of physical therapy, countless visits to my family physician, X-rays of Si joint and hips, and last but not least, the 20 prescriptions I tried to ease the pain. As a last resort, and at the disagreement of my family physician and physical therapist, I went to a chiropractor. within 30 minutes I was diagnosed with short leg syndrome (difference of 10mm) and was told to wear a heel lift. I am now on my 5th day with the lift and what a difference! I was in pain for almost 2 years and was ready to give up. The KEY was having the x-rays taken while standing up. i usually do not write on these sites but felt compelled to given my situation. My pain was unbearable at times and my job requires me to walk all day. So anyone reading this that has had back issues and never had this checked, please do so! It has given me my life back!

    • Awesome! I’m glad you were a rebel! I have not had a primary care physician since about 2007. Since then I’ve relied on my chiropractors for any health care needs including non-back adjustments. It’s amazing that such an easy fix, a heel lift, can fix a problem that eluded a physician, physical therapist, orthopedic doctors missed. Unfortunately, I don’t think they are trained to analyze the body like a chiropractor does. Good luck in your enlightened recovery and I’m glad you shared your success with me!

      Jim

  9. I have this and have terrible back and neck problems as a result. I am currently having excruciating pain in my side, about2 inches to the right of my spine(my left leg is the short one). I wear 2 extra inserts in my sneakers, but I believe in my case the damage is done. I’m on the road to getting back surgery, but I have terrible insurance and its a long process.

  10. the worst part is that I’m in so much pain, that it hurts to move around, and the more I sit around the more weight I’m gaining, resulting in the pain becoming even more intense(although I can’t imagine this specific pain in its location being more intense than it is already) .

    • Sorry to hear about your situation. Have you consulted with a chiropractor or MD to see what options you might have? It might still be correctable without surgery if there aren’t any fused vertebrae.

    • go to a good qualified doctor, ask to have a stand up xray of your hips. have them measure your hips to see if you have one hip smaller than the other. I have a rare situation of a short leg and small hip, both on the same side. After many doctors and almost surgery i found an MD who treats holistically. he figured out the problem and for the last 6 years I have been basically pain free. However, this summer I managed to jam my long leg up into the hip socket which caused so much pain that i could hardly move when lying down. I have been in a stability belt for 6 weeks and it has worked wonders. don’t give up – there are great doctors out there who want to treat the problem,not the symptoms.

  11. I have just discovered I have short leg syndrome, I developed back pain for the first time two weeks before Christmas, nothing i did worked. I put up with it for two weeks and then I went to my chiropractor who had cured me of tennis elbow four years ago, after one visit she sent me for x-rays and diagnosed the left leg was slightly shorter than the right. She has realigned me and I am using the heel lift and it has made such a difference. I have also suffered with migraines since I was about 13 and after just seeing your website I now know they can be as a result of short leg syndrome, wish I had known this 30 years ago, good luck to anyone else out there.

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