Recurring single sided running injuries are not typically a coincidence. Part I discussed a common clinical presentation that’s often overlooked: leg length discrepancy. And although leg length is not the only reason for recurring injury, it’s a great place to start. Early identification of a leg length discrepancy can result in rapidly improving symptoms. It’s simple enough to check, too. Leg length issues are not overly common in the running community, but if missed conservative treatment will surely fail. Sure, you can rest an injury and see your symptoms (pain) improve, but you’ll likely be fronted with frustration when the pain abruptly returns as within a run or two.
With our foot fixed on the ground the pelvis and hip socket become a moveable piece in the chain. Typically your hip and pelvis maintain stability through the surrounding musculature, including the pelvic floor, abdominals, and hip muscles. It should make sense that a loss in surrounding strength in said muscles could cause instability at the pelvis. An unstable pelvis has the ability to come ajar (and often stay ajar). You might be thinking, “Well I’m sure I would realize if one leg was longer than the other,” right? Unfortunately not. Your neuromuscular system is tricky and subconsciously adjusts. This prior patient had no idea…
“You know your right (or left) leg is longer than the other, right?” I ask. “It is?” you respond. This happens nearly 99% of the time during evaluation. Finding a leg length discrepancy is only a third of battle. The second third is fixing the alignment and the final third belongs to maintaining alignment. Typically the first two are cake, while the final stage of maintaining alignment is often left unaddressed.
You may thinking, “if my pelvis can shift into the wrong position, it certainly can shift back, right?” Absolutely. Re-aligning the pelvis can be achieved by patient-generated or clinician-generated forces. Patient-generated forces, also known as Muscle Energy Techniques, utilize your own muscular contractions to pull your pelvis back into alignment, while clinician-generated forces are performed by a PT, chiro, or MD. Advancing to a patient-generated force is always ideal as you’ll be able to monitor your leg length and adjust as needed. Self-aligning are musts for completely managing and fixing pelvic malalignment. Skipping right to stabilization exercises are pointless if you’re stabilizing your pelvis in the wrong position.
Ah-hah, the tricky part. To maintain alignment you’ll need to regain strength through the spine, pelvis, and hips. For some, maintaining alignment is fairly easy while others fight a longer battle. Although I have no empirical evidence, clinical experience leads me to correlate a longer history of symptoms with increasing difficulty maintaining alignment. In fact, I’ve re-aligned patients in the past to only see them fall out of alignment by sitting up–a perfect example of instability. Without this final stage of stabilization you’re really missing the boat. The trick is to re-align, stabilize, and repeat.
It’s tough going at this alone, especially if you’re uncertain of the direction and magnitude of the pelvic shift. Knowing the right stabilization exercises is important, too. Instead of navigating a confusing landscape of anatomy and treatment, find a PT (physio for all our Canadian friends) who can help you identify your shift, correct it, and stabilize it. Your plan should include a program that trains you on self-correction (for home) and proper stabilization exercises to maintain alignment. Don’t make the mistake that I see all too often: correcting the the leg length but failing to stabilize it afterwards. You’ll find your self being becoming increasingly dependent on a clinician-generated force (adjustment).
Remember, leg length discrepancy aren’t the only cause for recurring single sided injuries, but it’s always a great place to start–particularly for those who are failing to see improvement from traditional treatment. If ruled out (by a clinician–not you) progress to evaluating strength deficity and form flaws that cause recurring breakdown and injury.