question

What is Short Leg Syndrome?

answer

A condition in which an anatomical or functional leg length discrepancy results in - sacral base unleveling - vertebral sidebending and rotation - innominate rotation

question

what is a functional Short leg?

answer

One leg appears shorter than the other due to somatic dysfunction in sacrum, pelvis, lumbar spine, cranium or anywhere

question

What is an Anatomic Short leg?

answer

It is an actual discrepancy in the lengths of the femurs or tibia

question

what can cause a Anatomic Short leg?

answer

- childhood trauma with fracture or growth plate injury (often) - polio, cerebral palsy, major illness, osteomyelitis, surgery (hip replacement) - basically any illness that affects the metabolic growth rate of bone

question

What is the typically presentation of a pt with Short Leg Syndrome?

answer

- back pain - SI joint pain (usually on the side of the longer leg) - Hip pain - Knee pain - Pelvic pain - Dysmenorrhea/menorrhagia - Chronic constipation

question

what might be in the history of a pt with Short Leg Syndrome?

answer

- more often chronic pain that has gradually worsened over time - occasionally discovered after an injury from which the pt never recovered - pt may tell you that the wear out their shoe at different rates or that their pants hang unevenly

question

what are the signs of short Leg Syndrome, that would be seen during a physical exam?

answer

- Standing exam (with feel level and pointed straight forward) - discrepancy in crest heights, ASIS, PSIS, ischial tuberosities - Difference in feet - pronation vs supination - One leg flexed at hip, more forward or externally rotated at hip - may have mild or even moderate-severe scoliosis dont forget to also examine: angle between the thigh and leg, and angle between the leg and foot

question

How does pronation of the foot affect leg length? What does pronation of the foot involve?

answer

Pronation *shortens* the leg pronation of the foot involves: *abduction, dorsiflexion, and eversion*

question

How does supination of the foot affect leg length? What does supination of the foot involve?

answer

Supination *lengthens* the leg supination of the foot involves: *adduction, plantar flexion, and inversion*

question

How can you tell the difference between a functional and anatomic short leg?

answer

Functional - resolves with OMT and postural correction - re-evaluation of findings and malleoli shows no further asymmetry Anatomic - regardless of whether dysfunction is resolved, leg remains short OR now appear shorter after removal of compensations

question

what are the two possible signs of Anatomic short leg syndrome when examining the pt in the supine position?

answer

One - leg lengths are *asymmetric* at malleoli - pelvis and sacrum ect. may or may not show somatic dysfunction but more likely to *appear balanced*, especially if the patient uses a lift Two - leg lengths are *symmetric* at malleoli - pelvis and sacrum extra may or may not show somatic dysfunction but more likely to *appear unbalanced*

question

Which leg is more likely to be short in Anatomic Short leg syndrome? What is the common presentation of Anatomical short leg syndrome?

answer

- *Right* is more common - Somatic dysfunctions resemble common compensatory pattern - L-spine SlRr - Left on left torsion - Right innominate anterior/ left posterior

question

what is the compensatory fascial pattern seen in anatomical short right leg syndrome?

answer

OA - left (r-to-l) → RTM diaphragm CT - right (l-to-r) → thoracic inlet diaphragm TL - left (r-to-l) → abdominal diaphragm LS - right (l-to-r) → pelvic diaphragm these are transitional regions - areas where anatomic structure changes create the potential for the greatest functional change

question

describe the biomechanics of somatic dysfunctions caused by short leg syndrome

answer

- when the sacral base is unlevel, the body compensates to try to keep the eyes level - early in the process the thoracic and lumbar side form a long *C-shaped curve* that is *concave on the long leg side* and *convex on the short leg side* - with more time compensatory mechanism redistribute an *S-shaped curve forms* with the *lumbar concavity away from the short leg* and the *thoracic concavity towards the short leg*

question

early in the biomechanical process what shapes does the thoracic and lumbar spine form?

answer

a C shaped curve

question

what side of the C shaped curve is concave and convex?

answer

Concave = on the long leg side Convex = on the short leg side

question

late in the biomechanical process what shape does the thoracic and lumbar spine form?

answer

S-shaped curve

question

what direction does the lumbar and thoracic concavity face in the S-shaped curved spine?

answer

Lumbar concavity away from the short leg Thoracic concavity towards the short leg

question

what are the consequences of Short leg syndrome

answer

Muscle imbalance - *hypertonic muscles in long leg - weak muscles in short leg* *Ligaments* (such as the iliolumbar ligament) will *calcify* in under prolonged stress *Bone will remodel* when under stress - within the compensatory curve, wedging of the vertebrae will occur Joint degeneration will occur with *arthritis* of the hip/SI on the *long leg side*

question

describe the referral pattern of pain from the iliolumbar ligament

answer

ipsilateral groin, and sometimes into the testicle or the labia and the upper medial thigh (gluteus medius, minimus area, and greater trochanter)

question

What is the medical management for Short leg syndrome

answer

- Treat with OMT 2-3 times to see how the patient response before adding a lift or doing x-rays - Postural x-rays (sacral base unleveling is the most important criterium) - Lift therapy - Exercise

question

How do you take measurement from a postural X-ray review

answer

1. make a reference line (RL) using a plumb line 2. make a line from the top of each femur to the RL 3. make a line from the top of each iliac crest to the RL

question

when/how to use a lift for short leg syndrome

answer

Acute: usually after trauma or joint replacement surgery - cna replace entire amount of sacral base unleveling Chronic - start with the lowest level of lip - gradual increase - usually only increase half (or a little more) of sacral base unleveling Lifts must be used at all times so that the body is not constantly trying to accommodate to changing leg lengths

question

when would short leg syndrome not require a lift?

answer

if unleveling of the sacral bases is less than 5 mm

question

what should you do if a lift greater that 12 mm is needed?

answer

must apply lift to outside of shoe to *avoid achilles contracture*

question

Swayback posture also called ____ is part of the clinical presentation of what?

answer

also called *increased lumbar lordosis* is part of the clinical presentation of *Lower Cross syndrome*

question

what is Levitor

answer

- it transfers pressure to cushioned pads, one over the superior portion of the pubic symphysis and the other on the posterior part of the sacral apex below the S2 middle transverse axis - it is designed to resist the counter-rotation of the sacrum and innominates that occur under the influence of the strain of gravity - *used for sagittal plane dysfunction, makes the sacrum move toward extension*

question

what exercises are useful for short leg syndrome?

answer

- Knee/chest stretches - Quadratus lumborum and psoas stretches - Hamstring stretches - Pelvic clock

question

how do knee/chest stretches help in the treatment of short leg syndrome?

answer

helps general SI mobility and can help the piriformis - if knee is bought up to the opposite shoulder it will stretch the piriformis

question

what are the pelvic clock exercises best used for?

answer

best for addressing *lumbar sagittal plane postural decompression*

question

what is the stork test?

answer

pt stands on one leg while your hands are on their iliac crests - observe if the pelvis remains even

question

How do you test/fit a lift?

answer

- Do a gentle side shift (try to push your patient gently off balance)→ if they have a short leg → more unstable - Then give the lift→ do a pelvic shift again (or a little bit of rotation) - Also do a standing flexion test and a stork test (pick up 1 leg and evaluate stability) - Once again, give a lift and check again - This tells you how stable and how good the lift is - If the lift is good→ pt will be stable and leveled out - Another way to know if the lift is working after they've had it for a while: when supine, you want the legs to be asymmetrical legs and a balanced pelvis because that means that they are no longer having to compensate -If the pelvis is off →the lift is not high enough

question

what is the definition of a Structural model?

answer

the goal of the structural model is *biomechanical adjustment and the mobilization of joints*. This model also seeks to *address problems in the myofascial connective tissues, as well as in the bony and soft tissues, to remove restrictive forces and enhance motion*. This is accomplished by the use of a wide range of osteopathic manipulative techniques such as high velocity-low amplitude, muscle energy, counterstrain, myofascial release, ligamentous articular techniques and functional techniques.

question

what is the definition of a Respiratory-circulatory model?

answer

the goal of the respiratory-circulatory model is to* improve all of the diaphragm restrictions in the body*. Diaphragms are considered to be "transverse restrictors" of motion, venous and lymphatic drainage and cerebrospinal fluid. The techniques used in this model are *osteopathy in the cranial field, ligamentous articular strain, myofascial release and lymphatic pump techniques*.

question

what is the definition of a Metabolic model?

answer

the goal of the metabolic model is to *enhance the self-regulatory and self-healing mechanisms*, to foster energy conservation by balancing the body's energy expenditure and exchange,and to enhance immune system function, endocrine function and organ function. The osteopathic considerations in this area are *not manipulative in nature except for the use of lymphatic pump techniques*. Nutritional counseling, diet and exercise advice are the most common approaches to balancing the body through this model.

question

what is the definition of a Neurogenic model?

answer

the goal of the neurologic model is to *attain autonomic balance and address neural reflex activity, remove facilitated segments, decrease afferent nerve signals and relieve pain*. The osteopathic manipulative techniques used to influence this area of patient health include *counterstrain and Chapman reflex points*

question

what is the definition of a Behavioral model?

answer

the goal of this model is to *improve the biological, psychological and social* components of the health spectrum. This includes *emotional balancing and compensatory mechanisms*. Reproductive processes and behavioral adaption are also included under this model.

question

what is structural/bioenergetic?

answer

free motion of the associated structures allows for greater physiologic function Key point: *improving structural relationships actually decreases the physiologic work (energy expenditure) of breathing* - small studies have shown increased compliance, increased tidal volume and distribution of gas throughout the lung example: you can eliminate some of the work required for the pt to breath by eliminating structural somatic dysfunctions which can prolong the time before the pt needs to go on a ventilator

question

Respiratory circulation

answer

- the *diaphragm acts as a the piston* in the thoraco-abdomino-pelvic cylinder - descent of the diaphragm creates a relative negative intrathoracic pressure, causing the inflow of air as well as fluids in the low pressure circulatory system, bringing venous and lymphatic fluid back to central circulation

question

what does shallow breathing lead to?

answer

leads to ineffective movement of fluid in this low pressure circulatory system - *venous and lymphatic stasis* results in increased metabolic waste remaining in the tissues - *"Cellular Constipation"*

question

what is the function of the Cisterna Chyli? how does the diaphragm affect the function of the cisterna chyli?

answer

it *collects the lymph from the lower abdomen, pelvis and lower extremities* and is located just below the diaphragm - the *motion of the diaphragm helps to draw lymph superiorly* into the thoracic duct which then traveses the thoracic inlet - the motion of the abdominal viscera also promotes this fluid movement into the thorax

question

what lymphatic treatments are available and what lymphatic treatment should you start with?

answer

- typically start with the *thoracic inlet* to open the door before you try to start pushing fluid through it - rib raising - diaphragm doming - pedal pump - upper thoracic lymphatic pump - pectoral traction

question

Neurological model

answer

- autonomic imbalance plays a role in almost every disease process - don't think of sympathetic and parasympathetic systems as a see-saw

question

what is function OMT treatment of the autonomic nervous system, such as rib raising?

answer

Treatment is not aimed at "turning the system up or down" but at *providing a stimulus that allows the body to regulate itself*

question

Sympathetic influence

answer

mucosal and parenchymal irritation stimulate visceral afferents - *T2-T7* bombarded with info, facilitated to discharge easily - Bronchodilation is good, but local vasoconstriction is not

question

what does long term sympathetic hypertonia lead to?

answer

leads to increase goblet cells that make thicker more tenacious mucus

question

where are the sympathetic chain ganglia located?

answer

on the heads of the ribs - SD in that region will have direct effect on sympathetic activity

question

what can affect the sympathetic input?

answer

the sympathetic chain ganglia are covered with fascia that blends with the *radiate ligaments* over the rib heads - this fascial restriction can alter the functional environment of the sympathetic chain

question

Parasympathetic influence

answer

this is normally the dominant state - creates a higher ratio of ciliated cells - produces a thinner mucous which is more easily cleared

question

Facilitation

answer

Adaptive homeostasis mechanisms can go out of control, especially when there is chronically increased sympathetic tone and viscerosomatic reflexes - once a *segment become facilitated, its threshold for stimulation is much lower*, so that normal stimuli can trigger a disproportional response, long after the original insult is gone

question

what is the goal of neurogenic treatment?

answer

- reduce parenchyma congestion - reduce mechanical impediments to respiratory motion - restore balance to the autonomic nervous system and reduce sympathetic hyperreactivity to the lung tissues

question

Restoration of Autonomic balance

answer

- thinking in terms of the neurologic model, consider addressing this first prior to instituting any other treatment techniques - without down-regulating sympathetics, providing more stimulation to facilitated area of the cord may further increase sympathetic ton - *Start with gentle inhibition to upper thorax*

question

Primary trigger point

answer

contain nociceptor activity in the center of a muscle or a group of muscles, and is mainly responsible for the development of the myofascial pain

question

Secondary trigger point

answer

develops in synergist muscle of the affected muscle. An imbalance tension in the primary muscle, due to shortening muscle fibers, and compensatroy overload of teh synergist muscles cause secondary Tp sides to develop. secondary Tps can also form at muscle attachment sites in highly sensitized connective tissue

question

Satellite trigger point

answer

forms within the pain referral zone of another muscle containing a primary Tp. According to davies and davies "long term chronic pain is often a compound effect from a chain of satellite trigger points, cascading from muscle to muscles". Satellite trigger points can sometimes resolve independently if the primary Tp site is deactivated

question

Latent trigger pooint

answer

a site where nociceptors have become activated but not sensitized enough to cause pain. However, these area are painful and produce a 'jump sign' when the tissue is compressed above the latent site

Postural imbalance and short leg syndrome – Flashcards

Unlock all answers in this set

Haven't found what you were looking for?

Search for samples, answers to your questions and flashcards