Leg Length Discrepancy

Implications of Thoracic Stiffness and Prolonged Slumping and Slouching

Inguinal Hernia



Leg Length Discrepancy (LLD) and Pilates

“I've only just discovered that I've got one leg longer than the other.....”

It really is worth knowing that the vast majority of leg length discrepancies are apparent rather than actual: one leg appears longer through muscle tightness and joint misalignment rather than actual bone length variation. As few as 1:1000 LLDs is as a result of bone length discrepancy. This means the Pilates Method of Exercise and a good Pilates teacher have an important role to play in countering any musculoskeletal problems that may occur as a result of this asymmetry.

If you believe, or have been advised by your medical practitioner, that you have a leg length discrepancy, take the time to read through the following review summary – partly to be assured that there are many things that can be done to minimise any impact.

Take a look through the section on possible musculoskeletal disorders associated with LLD and be assured that Pilates Exercise can help to prevent onset or alleviate symptoms of many in the list.

Although the review summary is written for colleague Pilates teachers, I have minimised or softened the use of medical terms to aid lay-understanding.

I hope you find it useful!

Mark Thistlewood

Leg Length Discrepancy (LLD)

A Non-Medical Summary by Mark Thistlewood BCPA of a Review Article by Burke Gurney P.T., Ph.D (2001) published in Gait and Posture 15 (2002)

For the full review follow:

Gurney reviews a large number of recent studies of LLD:

Limb (or here, Leg) Length Discrepancy (LLD) also known as Anisomelia.

2 types of LLD:

SLLD Aetiology (cause):

FLLD Aetiology:

It appears the body can better compensate and adapt to LLD acquired in infancy or early life than when onset comes later on.

Possible Bio-Mechanical Alterations in the Body as a Result of LLD:

Measuring LLD:


Many measurement scales have been put forward. One suggests:


There is much controversy about surgical treatment – when to treat (LLD severity), age of patient (young cope better than old at adapting) etc.

Warning for LLD Runners:

Possible Musculoskeletal Disorders Associated with LLD:


LLD can lead to saggital pelvic obliquity (hip hike) causing a compensatory , non-progressive lumbar scoliosis.

Friberg reports possible:

Sacroiliac Malalignment:

4 of 5 studies reported that 13 – 22% of LPB patients had LLD.
Incidences of radiating leg pain in short leg were significantly reduced with a shoe lift.

Hip Pain (HP):

Brunet studied 1493 runners: HP 2 times more likely in LLD subjects

Stress Fractures:

Higher incidence for LLD subjects. 2 times more likely for LLD runners (LL stress fracture in 73% v 27% SL)

Other Pathology:


The range of studies draw no consistent conclusions – therefore, at present, any cause / effect relationships are not proven.

Better to treat on a case-by-case basis:

Implications of Thoracic Stiffness and Prolonged Slumping and Slouching

The thoracic spine or mid-back consists of 12 vertebrae with pairs of ribs attached. It is the spine's most stable area for good reason – to protect our vital organs – and therefore relatively immobile. However, limited movement in the thoracic spine can have significant bio-mechanical implications throughout the body.

Thoracic and Ribcage Structure and Movement.

The vertebrae of the thoracic spine are cleverly designed to limited extension (backward bending) with the spinous processes (the 'dinosaur' bones that we can sometimes see at the back of the spine) being very close together.

Movement in the thoracic spine can occur in all directions, but with the attachment of the ribs, is of small magnitude. Therefore each joint in the spinal column must contribute its bit!
We have:

Flexion and extension are more limited in the upper thoracic; rotation and lateral flexion (side bend) more limited in the lower thoracic.

Movement limitations increase with age as ligaments and joint capsules stiffen but an important aim of Pilates exercise is to maintain optimal levels of movement in all planes throughout our lives!

Prolonged Slumping and Slouching

This can cause an increased convexity of the thoracic spine (hyper-kyphosis) which can have the following bio-mechanical implications:

Pilate offers a wealth of  exercises that promote optimal movement throughout the spine. With patience and practice, a rounded mid-back can gradually improve and then you may well find - no more headaches, neck pain, shoulder limitations and discomfort!

Inguinal Hernia

(information supplied by:

What Is It?

When part of an organ protrudes through an abnormal opening or in an abnormal way, this is called a hernia. A groin (inguinal) hernia occurs when part of the intestine bulges through a weak spot in the abdominal wall at the inguinal canal. The inguinal canal is a passageway through the abdominal wall near the groin. Inguinal hernias are up to 10 times more common in men than in women. About one in four men develop a hernia at some point in life.
There are two types of inguinal hernias:

In adults, direct and indirect inguinal hernias look and feel about the same. They can occur on one or both sides of the groin. Your doctor may not know which type of hernia you have until surgery is performed. However, both types of hernias are treated in a similar manner.

A type of hernia called a femoral hernia can appear similar to an inguinal hernia. Femoral hernias are much more common in women than in men. They may cause a lump that appears just below the groin and extends into the upper portion of the thigh. In a femoral hernia, a portion of the intestine protrudes through the passage that is normally used by large blood vessels (the femoral artery and vein) when they pass between the abdomen and the leg. Femoral hernias are most common in older, overweight women.


At first, an inguinal hernia either may not cause any symptoms or may cause only a feeling of heaviness or pressure in the groin. Symptoms are most likely to appear after standing for long periods, or when you engage in activities that increase pressure inside the abdomen, such as heavy lifting, persistent coughing or straining while urinating or moving the bowels.
As the hernia grows, it eventually causes an abnormal bulge under the skin near the groin. This bulge may become increasingly more uncomfortable or tender to the touch. As the hernia increases in size, a portion of herniated intestine may become trapped and unable to slide back into the abdomen. If this happens, there is a danger that the trapped intestine may twist and die because its blood supply is cut off. This causes severe pain and requires immediate treatment.


Your doctor will review your symptoms and medical history. He or she will ask you when you first noticed the lump in your groin, whether it has become larger, and whether it hurts.

Doctors can diagnose most inguinal hernias by examining the area. Your doctor will look for an abnormal protrusion near your groin and will feel the area to check for a mass. Often, the protruding hernia can be pushed back temporarily into the abdomen with careful pressure. Your doctor may ask you to cough or strain, which may make the hernia easier to feel or see.

In some cases, your doctor may need to confirm the diagnosis with an ultrasound orcomputed tomography (CT) scan. In these procedures, painless sound waves or X-rays can distinguish a hernia from other causes of a mass in the groin area, such as an enlarged lymph node (swollen gland).

Expected Duration

An inguinal hernia will not heal on its own. It is likely to become larger and cause increased discomfort until it is repaired. Hernias that are not repaired can cause bowel obstruction or strangulation, which is when part of the intestine dies because its blood supply is cut off.


Indirect hernias in children cannot be prevented. To reduce the risk of inguinal hernia as an adult, you can:


Not all hernias need to be treated. However, most hernias that cause symptoms or that become larger should be repaired by a surgeon. While awaiting surgery, some people wear a device called a truss, which puts pressure on the hernia and keeps it under control. In people who are poor candidates for surgery because of poor health or advanced age, a truss may be used permanently.

There are two basic types of hernia repair: open surgery or laparoscopic surgery. Both usually are done on an outpatient basis and take about one hour to complete.

When To Call a Professional

Contact your doctor if you develop a lump, tenderness or a persistent feeling of heaviness in your groin area. In babies and young children, call your doctor promptly if you notice a lump in the child's groin or scrotum.


Hernia surgery is very safe and usually quite effective. Depending on the location and size of the hernia and what technique is used, up to 10% of hernias may develop again at some point in the future.
After open surgery, the person can usually resume normal activities within one to two weeks. For laparoscopic surgery, full recovery generally takes one week or less. After any hernia surgery, the person should avoid heavy lifting for six to eight weeks (or as long as the doctor directs) to allow muscle and tissues to heal completely.


Website created and hosted by Take Note Publishing Ltd.