True leg length discrepancies are rare in my experience. Or, if it’s there, it’s so minor it’s not worth worrying about.
It’s such a simple, quick test, it’s worth doing sometimes though.
When to do this test
Typically a new person will tell me they have one leg longer than the other, or I’ll decide to assess them based on how they move. Maybe they seem to always be leaning to a side when walking, or whenever they squat / sit down they lean one direction. Whatever it may be.
The process
First, you eyeball things with the person in standing. I’ll tell them to “Put your feet together, put each of your index fingers on that pointy part of your hip bone. Like where you would get a hip pointer.”
Then I’ll have them take their shoes off and do the same thing. This allows you to see if there’s any differences between shoes on or off, which could indicate how much they stand on one leg or wear down one shoe.
The big thing to understand at this point is we haven’t truly assessed leg length yet. Because the person is in standing, there could be a host of other factors pulling on those hips, all giving the illusion of a leg discrepancy.
Therefore, at this point some therapists will widen the legs. By doing this you’re assuring each leg is at a certain distance, which should reduce any muscular factors and give you a better indication of what’s going on structurally. So, sometimes you’ll see a discrepancy with the feet together but not with the feet widened, which indicates there is something going on muscularly and not a true leg length issue.
I don’t like this too much though. I feel like there’s still too much room for error, and honestly sometimes people really don’t get how to align their fingers right to begin with. As best I can, I like to get the assessment (and in general, assessmentS) out of the person’s hand and into mine.
So I put the person on the ground, keep their feet on the floor, but bend their knees up. By taking gravity out of the equation we can really hone in on what’s going on structurally rather than muscularly.
Make sure the person’s feet are even with one another. Don’t let one foot be in front of the other.
Not this,
but this.
From here I’ll put a clipboard on their knees. If the clipboard is straight, there’s no leg length issue. If it’s tilted, there is.
You can then get more nuanced by assessing where the discrepancy is coming from, the tibia or the femur? You do this by looking at the legs from the side. We know one knee is higher than the other, but is the knee being pushed forward or backwards? Forward = femur discrepancy; backward = tibia. You may see something akin to:
I never go this far though. I only go as far as “Is there a true difference?” I’m not sure there’s any change to make in practical recommendations once it’s been discerned there is a difference i.e. it doesn’t matter where the difference is coming from; it only matters if it’s there.
Justin Archer (@ThePostureGuy)
December 6, 2013
I agree, most leg length discrepencies are functional, not structural. But these are all good tests! If I could add one more thing, it’s that the majority of the time if someone says they feel as if (or they’ve been told) they have one leg longer than the other, and they have either some kind of asymmetry in their shoulders or kyphotic upper back (or both), along with an elevated hip/lateral pelvic tilt, I’ll have them interlock their hands behind their head and pull their elbows back. Instantly they feel like their body and balance has evened out. And the cool thing is that you (or a friend or family member of theirs) can see/feel the change correct itself by watching/feeling the iliac crests.
This is one of my favorite ways of demonstrating to people how the body works together as a unit. And it’s always fun to see the “lightbulb” go off in people’s head when they realize how their shoulder/upper back position correlates with their back, hip, knee, ankle, and/or foot pain.
reddyb
December 7, 2013
Hey Justin,
Thanks for the input. I do something of this nature sometimes too. The only difference is I tend to put people against a wall as I’ve found as soon as you try to elevate a really stiff person’s arms they swing their lower back into extension. This can be hard for people to grasp intuitively. However, put them against a wall and they can immediately feel when their lower back loses contact (swings forward).
Justin Archer (@ThePostureGuy)
December 8, 2013
And sometime simply standing someone up against a wall will promote enough thoracic extension to make the same change. It’s funny how sometimes the simplest things make the biggest changes (or at least enough). But I agree people will often compensate for a lack of thoracic extension and shoulder flexion with hip and lumbar extension. Good thing there are things like walls and floors to be used as giant rulers! 😉
marcyg321
January 7, 2014
Hi Brian,
I’ve been getting chiropractic adjustments occasionally for a few years now to my low back/sacrum area. I’m told that one side of my sacrum sits higher than the other side when I’m prone which seems to explain my chronically tight hamstrings – especially on one side. I decided to try your clipboard test to see if I’m uneven and sure enough my right knee sits about a half an inch higher than my left. Immediately after my last adjustment I did the clipboard test again and it evened out. Am I right in thinking this is a mechanical issue and not muscular in my case? Unfortunately, my body doesn’t seem to hold the adjustment for long. I can tell when I need an adjustment because of the hamstrings feeling tighter than usual on one side. Would it be best for me to only stretch my hamstrings when I’m “even” (right after adjustments?)
Thanks,
Marcy
reddyb
January 14, 2014
Hey Marcy,
If you’re having inconsistencies in your results of the clipboard test, you’re probably doing the test inconsistently. Your feet might not be fully aligned, you might be biasing things unknowingly, uneven floor, shoes are on, etc.
It sounds like more often than not, your right knee is a bit higher, indicating that leg is probably a little bit longer. Meaning you have a structural “issue” rather than a muscular one. If so, then getting adjusted is unlikely to provide value. (For what it’s worth, I don’t think it gives value anyways.)
A half inch is no big deal. Plenty of people have leg length discrepancies and are fine. Hence me putting issue in quotations.
If your hamstrings are truly stiff, I’d work on that often. Like 6 days a week. So much more than only when getting adjusted. If you haven’t read this, it’s a comprehensive look at how I go about stretching the hamstrings: http://b-reddy.org/2013/07/29/better-exercises-to-stretch-the-hamstrings/
After reading that you may find the solution is you’ve been going after loosening your hamstrings in the wrong manner, which is what I often come across.
marcy
January 24, 2014
Hi Brian,
The reason I do believe that the my sacrum is “off” and that the chiropractic adjustment is effective is because my hamstrings feel better immediately afterwards. When I do the clipboard method I try to be consistent and mark a line on the floor.
I’ve discovered something new while doing my regular yoga routine. For a while now, when doing supine knees to chest, I seem to have a block at the right hip joint.. I can’t bring the right knee in toward the chest as far as the left. What I discovered is that if, while I’m lying supine with knees bent and one ankle crossed over the opposite knee (both feet off the floor) as if doing a piriformis stretch, then press with my hand on my right anterior proximal thigh – as if pushing it away from me. I am then suddenly and easily able to reach fully with both knees to the chest with no pain or blocking feeling. Is this an indication that I might have femoral acetabular impingement? and the remedy? (for me?) Would love to know your thoughts.
Thanks,
Marcy
reddyb
January 26, 2014
More of an indication the head of the femur could be gliding too far anteriorly when you flex your hip. (Femoral anterior glide.) This can give the symptoms of femoral acetabular impingement, but I don’t like the FAI terminology as it doesn’t give you a course for correction. Femoral anterior glide does. The femur glides too far anteriorly => Make it stop doing that. (I have a bunch written on the site about this. Feel free to check out the “Hip Pain” category.)
The other thing to consider here is a structural abnormality at the hip, such as retroversion. More here if interested: http://b-reddy.org/2013/05/09/talking-about-hip-retroversion/
marcy
January 28, 2014
Thanks Brian.. Although I don’t understand FAI very well, I agree with you that it’s more likely the femoral anterior glide. I definitely have an anteriorly tilted hip. I have read most of your articles if not all of them but its been a while so I’ll definitely go back and re-read the one’s you suggested here. Regarding retroversion. I made a video of myself over the summer doing the prone hip internal/ external rotation and measured 32 degrees external rotation and 50 degrees internal rotation so I’m assuming retroversion isn’t the case with me since I seem more likely to be anteverted?
I’ve been regularly doing the rocking back and forth into child’s pose as well as the toddler squats – at first with my hands holding on to posts above my head and now I just do them without holding on to anything. Since then I’ve noticed my ankle flexibility (dorsiflexion) is much improved which explains why I can now stand in a complete deep toddler squat without falling over backward whereas before I fell right over. I’m now working on becoming even more upright in that position. And not only that but the other major improvement is with the knees to chest stretch. It seems to feel better (less of a blocking feeling in the right hip) right after doing the rocking back and forth and deep squats as if there is a better “fit”. I have no idea of course what’s going on in there, but it does feel as if my range of motion increases in the hip joint, (I also don’t have to laterally swing my right thigh out to the side while pulling it in toward my chest.) I can pull it straight in after those stretches. This makes me think my “block” isn’t a permanent structural issue after all.
When I do that rocking back exercise into child’s pose.. Tell me if you think this is okay.. When my hips are all the way in the down position and my arms are stretched forward, I grab the side edges of the yoga mat and pull it away from me so I can angle my right hip back deeply toward (touching) my right heel. While doing this I feel that blocking type of pain but then it seems to lessen and I relax into it. Do you think it’s okay that I’m doing this or could I be doing some sort of damage by pushing it in a way it doesn’t really want to go naturally? Hope this made sense.
I’m still dealing with the right hamstrings being very tight and I’m thinking all of the above is related but I guess that’s another post for another day.
Thanks so much for all your expertise and insight! 🙂
Marcy
reddyb
January 29, 2014
Hey Marcy,
The prone numbers you gave would suggest more anteversion, yes.
The Rocking and Toddler Squat can give relief because they help to posteriorly glide the femur. As you mentioned, if you find improvement after something like that, it’s hard to say you have a structural block. Sounds like more of a stiffness issue.
Regarding the Rocking variation: You want to be careful about tilting your hips in a direction. To do this, one often ends up rotating the lumbar spine, which is a big no no. (You want to make sure as you do the motion you don’t rotate either.) If your butt is on your heels, that’s as much ROM as one could hope for. If it’s not touching, you want to be careful about how you make it touch, bringing me to…
You also want to make sure you’re not getting the motion from your lower back in terms of flexion. That is, you don’t want to be really rounding the lumbar spine as you rock back, giving yourself the illusion you’re getting full hip flexion.
The video I’ve posted of the Backward Rocking was geared more for someone with a shoulder history. For someone with a hip history, the cue would be to “NOT let the lower back round.”
marcyg321
February 2, 2014
Hi Brian,
Normally when I do the rock back exercise – on the very first rep I notice that my left hip sits nicely on my heels but the right side seems popped up slightly higher. As I continue with the reps (angling back to the right and holding it a few seconds), this starts to even out little by little. I don’t think I’m doing any tilting or twisting of my low back as I descend. I try to focus more on taking the whole trunk back as opposed to forcing one side down if that makes sense. I tried your idea of keeping my low back arched during the descent and it felt really good. I was keeping it neutral (at least that’s better than purposely rounding it.) I plan to continue with this since it seems to be helping. I guess my initial concern when writing to you was the thought of a possible FAI which I think I can rule out. Now onto the hamstrings.. gonna re-read your article on that and give it a try. Thanks!
reddyb
February 3, 2014
Hey Marcy,
It sounds like when you’re angling to the right you’re actually making it so you’re going straight back. Where, if you don’t have this focus, you twist. So, what feels asymmetrical actually ends up being symmetrical.
You don’t want to keep the back arched, you want to keep it straight and make sure it doesn’t round. Be careful not to overcompensate by going too far the opposite direction.
marcyg321
February 3, 2014
Never thought of that! I will work on keeping my back in a neutral position with that. Thanks for all your expertise. 🙂
Kris Freeman
September 29, 2014
Hi, I am a Smart Bowen Therapist, a Dorn Spinal Therapy Practitioner and soon to be Applied Myoskeletal Therapist, and the problem of Functional Leg Length Discrepancy can be corrected in just a few moves. In fact, someone who wears a heel lift or orthotics can remove them once treated correctly and given the appropriate neuromuscular re-education exercises will stabilise the issue and pain will be gone. In Marcy’s case it could well be that the hamstring causes her FLLD and once treated an appropriate NRE for her hamstrings would re-educate that muscle to stay in place.
reddyb
October 1, 2014
Hey Kris,
Care to elaborate on these exercises?
Ratul
December 13, 2014
please reply,many times I neglected the fact that my right leg knee is a little bit lower than my left knee(whenever I sleep like the position in your 6th pic with clipboard not straight). I dont feel any walking problem but it scares me,whether this unevenness will increase or not due to some reason or will remain constant(like my right leg will become more shorter slowly).I dont know what is the cause,I dont even know whether this was present from my birth or not.Is there anything to worry about please tell me all the causes an whether it will increase or not.Please reply me in my email.
reddyb
December 15, 2014
If you notice the discrepancy like in the clipboard photo, then it’s probably something you were born with, which isn’t something to worry about. (You aren’t going to change it anyways.)
arjunmalik123
October 2, 2016
hey there,
– I was experiencing pain near my right hip, surfed the net, found your blog , did the clipboard test
-left leg is higher
– what to do now
– i want to mention that your site was most relevant regarding the symptoms and detailed too. Please help me with the treatment too.
Thanks in advance….
reddyb
October 4, 2016
If it’s structural, then there’s nothing to do. If you want help as to what to do for the hip next, check this out: https://b-reddy.org/2013/06/20/the-remote-client-process/
roy
February 18, 2017
i hope you will answer this- i tried the test with the clipbord and it was 100% straight, i also took a picture off me from the side and both legs look equal and theres no shine further out then the other. when i mesure my legs from the throcanter to the malleolu they look on the same lengh but when i mesure the legs from the asis to the malleolu theres a diffrence of about 2 cm.
when i stand one hip is higher then the other.
is it possible that when im in a supine position one hip is higher and because of that the clipboard is straight and the diffrence is actually true?
by the way when im in a supine position and my legs are fully extended the malleolu are matching and i cant notice a diffrence.
how do i suppused to know if i have a true disperancy or functional one? is the clippboard test is 100% ” correct”? and if it is a functional disperancy what shold i do with that because one hip is clearly higer when standing.
reddyb
February 20, 2017
Hey Roy,
It’s very unlikely when supine one hip is higher than the other. It’s possible, but not likely. Gravity tends to even that one out, where the hips will lay even.
Measuring from the trochanter is extremely hard to do. It’s not easy to know exactly where they begin. (Especially if the person is overweight.) Going with the pelvis is a better bet.
And if the pelvis is not even when standing, but you’re even in the clipboard test, then you likely have a functional issue going on. There is info on this here- https://b-reddy.org/2012/12/27/thoughts-on-correcting-a-lateral-pelvic-tilt/
roy
February 21, 2017
thank you very much.
reddyb
February 22, 2017
You’re welcome!