Engineering and Technology
Kate Adomakowaah Kontor, N/A, MD
Komfo Anokye Teaching Hospital
Kumasi, Ashanti, Ghana
Leg length discrepancy (LLD) is a common occurrence in the general adult population and predisposes to low back pain (LBP). It causes LBP through a frontal plane lateral tilt of the pelvic girdle on the short leg side and a sagittal plane pelvic torsion or pelvic axial rotation in the transverse plane with respect to the vertical line axis. In establishing the effect of LLD in causing LBP, there is disagreement on the magnitude of LLD implicated in causing LBP. Functional leg length discrepancy’s direct and indirect tests determine this magnitude. However, these are performed differently by different clinicians, making the acquired magnitude unreliable. There is also disagreement on the use of a raise, a simple, inexpensive, conservative therapeutic option for LLD-induced LBP. This systematic literature review aimed to synthesize evidence on LLD and its relationship with LBP.
Design:
The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) recommendations were followed in conducting this systematic literature review. Search terms from which keywords were selected included “the Effect of leg length discrepancy on Low back pain”, “functional leg length discrepancy clinical assessment”. “use of a raise on shorter side in managing lower back pain”. Scopus, Medline (Ovid), Embase (Ovid) and Cinahl databases were searched from February 2014 to February 2025. Inclusion criteria were: date limit of February 2014 -February, 2025, English language only articles, adult (18 years and above) study participants, and full texts of peer-reviewed publications. This date limit was chosen to enable recent best findings and practices on these aforementioned subject areas to be assessed in the last 11 years. Quality assessment for evidence syntheses on included articles was performed using the Scottish Intercollegiate Guidelines Network (SIGN).
Results:
Only 5 articles on the effect of LLD on LBP, 1 on functional leg length discrepancy clinical assessment methods, and 4 on the use of a raise on the shorter side in managing lower back pain qualified to be included in this evidence synthesis. The evidence suggested LLD-induced LBP was exacerbated in individuals in prolong standing occupations, may cause disc herniation and in the older adult (≥65years) pain and disability from delayed diagnosis. Of the direct and indirect commonly used methods for assessing functional leg length discrepancy, the indirect method is deemed a functional test and more reliable because the requirement of the patient in a standing position allows both functional and static assessments. There is agreement regarding the use of a heel lift in managing LLD-induced LBP but not necessarily in the proportion needed for correction, the correction strategy, and the correction period to employ.
Conclusions:
Although the literature suggests that LLD predisposes to LBP, few studies mainly case reports have been undertaken in the past 11 years to elucidate this effect; therefore, there is not enough evidence to inform clinical guideline on the relationship between LLD and LBP. Furthermore, the LLD reviewed literature had no representation from low- and middle-income countries (LMICs), although LLD may not have a racial bias. The standing examination position is the key determinant of the reliability of functional leg length discrepancy’s functional test. In this regard, there is therefore the need for training curriculum and continuous professional development courses to feature hands-on practical training of medical professionals to boost their expertise. There is agreement regarding the use of a heel lift in managing LLD induced LBP but not necessarily in its proportion needed for correction, the correction strategy and the correction period to employ.
