Large leg, small leg...



Balance is a bit of a buzz word in physical health circles, it is an all encompassing title, but the reality is that our bodies do like to be balanced and when they are not, dysfunction occurs.


So let's take a look at a practical example in the lower body.


When I get a client with knee pain, apart from testing the knee joint itself, one of the first things I do is to measure the circumference of their upper and lower legs... Why? Because it tells me an awful lot about how the lower body is functioning and therefore why they might have knee pain. Knee pain may end up damaging the structures of the knee, but it rarely starts there. Usually it starts elsewhere and it is the resultant forces that culminate in the knee and cause the damage. So to get back to the root cause of the knee issue I have to understand how the lower body is working.


Here is an example. If you measure your client's left upper leg circumference and it is 2 cm larger than the right one and then you measure the circumference of their lower leg and it is also 2 cm larger on the left, then you can be pretty certain they are favouring that leg for some reason, as globally the left leg is larger. If their pain is on the larger side, it may be caused my overwork, the overloading that left leg is creating pain. If the pain is on the smaller side, the question to ask is why are they offloading? Is there damage within the joint that is causing this issue..... By measuring and getting an initial global overview, it gives you clues, 🧐things to go away and look at further, things that you may miss is you only look at the knee joint itself.


Let's now get more complicated and say that this time the left upper leg was 2cm smaller but the left lower leg was 2cm larger..... humm 🤔, what is going on there! What would cause the left lower leg to overwork like this? Well there are many options here but it may be sensible to start by looking at the firing patterns of the lower leg. If the calf muscles are overworking and hypertrophying, is this because the hamstrings are weak? Are they trying to assist the hamstrings? Is the foot weak and are they overworking to try to stabilise the ankle? Even more confusing.... are the gluteus muscles weak? Have the hamstring muscles tried to assist the gluteus muscles and now got too tired causing the calves to help? The gastrocnemius muscle is in a position to assist the hamstrings, it isn't a great use of this muscle but it can do it. So in this case it would be worth finding out which muscles are weak, which tight and which overworking...


In both examples, the knee pain may simply be dealt with by rebalancing, if the rebalancing makes the knee pain worse, then the time may have arrived for a scan to see what is happening inside that joint!!



If you are using this for CPD have a go at this task:


Your client with right sided knee pain arrives with an anteriorly positioned pelvis but only on the right side, the right upper leg is 1cm larger than the left upper leg, the right lower leg is also 1 cm larger and the arch of the foot is very weak on the right side. Make a list of the possible reasons this client has knee pain, then work through what you may be able to do in your gym or clinic to resolve this issue. Then write it all up in your CPD log. For our FREE CPD logbook, click here and subscribe to our newsletter.



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