# 5-7mm leg length discrepancy. Advice for road cyclist?



## acid_rider (Nov 23, 2004)

hello everyone

I went to chiro with X-rays (lower back pain and right leg pain) and he said I have small but measured ~5-7 mm leg length discrepancy - the injured right leg is the shorter one. I am a left hander if it makes any difference. 

He does not know anything about road cycling but otherwise he said it was normal and no action is required as 5-7mm is very common.

Any advice for a road cyclist? Do nothing? Stick a second shoe insole into my right Ultegra shoe? Anything else?

thanks and happy and safe 2006 to all


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## jorgy (Oct 21, 2005)

Speedplay makes shims for its pedals. Might be worth looking into.

http://www.speedplay.com/index.cfm?fuseaction=home.xshim


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## acid_rider (Nov 23, 2004)

*what about shimano ultegra?*



jorgy said:


> Speedplay makes shims for its pedals. Might be worth looking into.
> 
> http://www.speedplay.com/index.cfm?fuseaction=home.xshim


thanks for your reply. I have shimano R151 carbon-sole shoes and shimano ultegra pedals. Any solutions for that combo?

I just put another insole into my right shoe (shorter leg by 5mm) and tried it on. It seems to fit ok based on 5 min home wear test. The extra insole is 2-3mm thick so it wont compensate for 5mm discrepancy but even half should show something. I could always remove the insole from the (longer) left leg shoe (i.e. 2-3mm gone) to make it 100% even? Can I ride without insole at all in a carbon R151 shoe? Or can I buy ultra-thin ~1mm insole perhaps? 

thanks


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## jeff262 (Dec 19, 2005)

*I second the shim suggestion*

Years ago I rode with a guy that had nearly a 2" difference in leg length caused by a motorcycle accident! He had a custom aluminum piece made to go between the bottom of his shoe and his cleat. He rode great. I think that is the area best suited to make up the difference.


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## Bianchi Ti (Jun 11, 2002)

I have a two cm discrepancy and ride just fine with it. 5-10mm is common. If you absolutely feel that you need to take care of it, you need to find out whether it is because of a diffence in the femur or tibia. Femur discrepancies can partially be taken care of by cleat position while tibia differnces respond to shims. It should not make that much difference if your position is otherwise correct. If your having pain in your back that radiates to your leg it sounds like a herniated disk not a leg length discrepancy.


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## geneseo (Nov 2, 2005)

*another option*

I have a leg length discrepancy as well. Started out using the shims, but found it annoying to constantly set up every pair of shoes with the shims. Especially with the mt bike where the shims on spd pedals are pretty much useless. So I tried to just putting an extra insole from an old pair of shoes in the shorter leg. Worked out much better for me. It feels balanced enough, a lot easier to setup, and much easier to switch around between bikes / different setups. may not work for you, but worth a try. and much cheaper.


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## Dave Hickey (Jan 27, 2002)

acid_rider said:


> hello everyone
> 
> I went to chiro with X-rays (lower back pain and right leg pain) and he said I have small but measured ~5-7 mm leg length discrepancy - the injured right leg is the shorter one. I am a left hander if it makes any difference.
> 
> ...


If it really bothers you, try a different crank arm. Run 170mm and 175mm arms. Depending on what type of cranks you run, eBay always has single crank arms


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## bsdc (Feb 15, 2002)

I learned that you do nothing for leg length inequalities under 10mm. Recent research suggests otherwise.

Arch Phys Med Rehabil. 2005 Nov;86(11):2075-80. Related Articles, Links 

Conservative correction of leg-length discrepancies of 10mm or less for the relief of chronic low back pain.

Defrin R, Ben Benyamin S, Aldubi RD, Pick CG.

Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

OBJECTIVE: To study whether conservative correction in a leg-length discrepancy (LLD) of 10mm or less in patients with chronic low back pain (CLBP) can relieve pain. DESIGN: Randomized, controlled intervention study, with a mean follow-up duration of 10 weeks. SETTING: Physical therapy clinic of the national health services. PARTICIPANTS: Thirty-three patients with CLBP were screened for an LLD of 10mm or less, which was measured with ultrasound. Patients were randomly divided into intervention and control groups. INTERVENTION: In 22 patients, LLD was corrected by applying individually fitted shoe inserts. In 11 patients, LLD was not corrected. MAIN OUTCOME MEASURES: Chronic pain intensity (visual analog scale) and disability score (Roland-Morris Disability Questionnaire). RESULTS: Shoe inserts significantly reduced both pain intensity (P<.001) and disability (P<.05). A moderate positive correlation was found between LLD and the degree of pain relief after wearing shoe inserts (r=.47). CONCLUSIONS: Shoe inserts appear to reduce CLBP and functional disability in patients with LLDs of 10mm or less. Shoe inserts are simple, noninvasive, and inexpensive therapeutic means that can be added to the treatment of CLBP.

I recommend some type of correction between your forefoot and the pedal. Either something in the shoe or a shim added to the cleat.


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## Kerry Irons (Feb 25, 2002)

*General rule*

Whether to correct for leg length discrepancy appears to be pretty individual, but the general rule I've heard over the years is that if you do correct, shim about 1/2 of the difference. Obviously this is not universal, and someone with a 50 mm difference (2") is a lot different than you, with 5-7 mm. However, anything from just washers under the cleats, an extra insole, or Big Meat shims (IIRC) could work.


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## acid_rider (Nov 23, 2004)

*all your replies are greatly appreciated!*

I wish to thank everyone who replied and wish you happy and safe 2006! 

I will start off with one extra 2-3mm shoe insole as a first test and see how it goes.

Good riding, all.


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## bsdc (Feb 15, 2002)

kpcw said:


> While I am a big fan of chiros...
> 
> I would not run with this diagnosis and furthermore...wait till this pain goes away and your hips/pelvis level off. Some muscle tissue is/might be in spasm...your pelvis tilts, this causes the leg to be a few mm shorter....and you remember the song...the hip bone connected to knee bone, the knee bone cone foot bone etc.
> 
> ...


What you are saying might make sense, but the measurement was taken by standing x-ray, not eye-balled on the table. Standing x-rays eliminate functional leg length inequalities (LLI) and help reveal structural inequalities. Both the chiropractor Acid Rider is working with and myself learned that a 5-7mm LLI should not be corrected with lifts. I presented recent research that contradicted the information we learned in school. That's how medicine works. We do research and apply it to our practices as the information comes availible.

No one mentioned any treatment plan, but since you brought it up ... 2x a week for 6 weeks sounds like a reasonable treatment plan to me. It takes time for musculoskeletal structures to adapt to the changes being made. If he were to be referred for physical therapy he would be treated 3x a week for 4-8 weeks. If we were trying to align his teeth, the orthodontist would set him up with brackets and wires that would be on 24/7 and it would still take 2-3 years. How is it that 12 visits to a chiropractor is a "notorious scam?" 

I've responded to your posts about chiropractic care a number of times. It's always the same. "I've got an awesome chiropractor but most others are crooks." I'm sorry you've had bad experiences with some. I'm glad you've found one you like. Chiropractic is like every other profession. We've got all kinds of people in our profession. Some are good, some are bad. Some are good, but we just don't like their approach.

You're the type of patient that likes the "chiropractic asprin" on an as needed basis. You finally found a chiropractor that will do what you say. He'll see you when you want and won't suggest anything beyond what you ask for. I do the same thing with a lot of patients. There's nothing wrong with that. What I have a problem with is your non-professional medical advice regarding my profession. More importantly, I'm tired of having to waste my time rebutting your stupid advice.


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## physasst (Oct 1, 2005)

*Agreed*



bsdc said:


> What you are saying might make sense, but the measurement was taken by standing x-ray, not eye-balled on the table. Standing x-rays eliminate functional leg length inequalities (LLI) and help reveal structural inequalities. Both the chiropractor Acid Rider is working with and myself learned that a 5-7mm LLI should not be corrected with lifts. I presented recent research that contradicted the information we learned in school. That's how medicine works. We do research and apply it to our practices as the information comes availible.
> 
> No one mentioned any treatment plan, but since you brought it up ... 2x a week for 6 weeks sounds like a reasonable treatment plan to me. It takes time for musculoskeletal structures to adapt to the changes being made. If he were to be referred for physical therapy he would be treated 3x a week for 4-8 weeks. If we were trying to align his teeth, the orthodontist would set him up with brackets and wires that would be on 24/7 and it would still take 2-3 years. How is it that 12 visits to a chiropractor is a "notorious scam?"
> 
> ...


As an orthopedic guy, you DO NOT correct LLD under 10mm, many people within the population suffer from slight LLD's, and almost all of them will get by fine WITHOUT adjustments. My reply to the OP would be to NOT use any lifts and continue with the plan as laid out. BSDC is completely right on the money regarding time to allow the bodies adjustment. This is similar to many patients I've seen, who simply do not want to give their bodies time to work through many disorders.


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## bsdc (Feb 15, 2002)

physasst said:


> As an orthopedic guy, you DO NOT correct LLD under 10mm, many people within the population suffer from slight LLD's, and almost all of them will get by fine WITHOUT adjustments. My reply to the OP would be to NOT use any lifts and continue with the plan as laid out. BSDC is completely right on the money regarding time to allow the bodies adjustment. This is similar to many patients I've seen, who simply do not want to give their bodies time to work through many disorders.


As a chiropractic guy, I also learned that you do not correct an LLI under 10 mm. I don't know where this magic number came from. Honestly, I think it's just a nice round number some doctors decided to pick. Recent research suggests that lifts may be appropriate for LLI less than 10mm. Here's reference again:
--------------------------------------------------------------------------------------------------------------------------------
Arch Phys Med Rehabil. 2005 Nov;86(11):2075-80. Related Articles, Links 

Conservative correction of leg-length discrepancies of 10mm or less for the relief of chronic low back pain.

Defrin R, Ben Benyamin S, Aldubi RD, Pick CG.

Department of Physical Therapy, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

OBJECTIVE: To study whether conservative correction in a leg-length discrepancy (LLD) of 10mm or less in patients with chronic low back pain (CLBP) can relieve pain. DESIGN: Randomized, controlled intervention study, with a mean follow-up duration of 10 weeks. SETTING: Physical therapy clinic of the national health services. PARTICIPANTS: Thirty-three patients with CLBP were screened for an LLD of 10mm or less, which was measured with ultrasound. Patients were randomly divided into intervention and control groups. INTERVENTION: In 22 patients, LLD was corrected by applying individually fitted shoe inserts. In 11 patients, LLD was not corrected. MAIN OUTCOME MEASURES: Chronic pain intensity (visual analog scale) and disability score (Roland-Morris Disability Questionnaire). RESULTS: Shoe inserts significantly reduced both pain intensity (P<.001) and disability (P<.05). A moderate positive correlation was found between LLD and the degree of pain relief after wearing shoe inserts (r=.47). CONCLUSIONS: Shoe inserts appear to reduce CLBP and functional disability in patients with LLDs of 10mm or less. Shoe inserts are simple, noninvasive, and inexpensive therapeutic means that can be added to the treatment of CLBP.
--------------------------------------------------------------------------------------------------------------------------------
I believe you have to take in account a lot of different issues when deciding when to use a lift or not. This research has simply led me to be more open to correcting some people with LLI less than 10mm.


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## bsdc (Feb 15, 2002)

Wow! You have managed to demonstrate a rather good example of a straw man argument. For those that don't know, "a straw man argument is committed when a person simply ignores a person's actual position and substitutes a distorted, exaggerated or misrepresented version of that position. This sort of "reasoning" is fallacious because attacking a distorted version of a position simply does not constitute an attack on the position itself." 

I don't have the time or desire to respond to each statement you made. If you'd like to discuss any particular issue, I'd be happy to do that.


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## The Moontrane (Nov 28, 2005)

I was getting hot spots and saddle sores only on one side for years. This past summer I was measured to have a 3mm functional leg-length discrepancy due to forefoot varus. Shimming under my cleat threw me further off kilter saddle-wise, so I picked up a Specialized Body Geometry wedge that fits under the insole of my Sidi. It's a 1.5mm wedge, so I obviously haven't corrected the difference fully and probably won't because everything's OK now.

Since you have a structurally length discrepancy you probably would benefit from shims since you actually are having some pain-on the bike I assume.

You should be fitted by a professional for this.

Hope this helps,

Des


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## fleck (Mar 25, 2005)

physasst said:


> As an orthopedic guy, you DO NOT correct LLD under 10mm, many people within the population suffer from slight LLD's, and almost all of them will get by fine WITHOUT adjustments. My reply to the OP would be to NOT use any lifts and continue with the plan as laid out. BSDC is completely right on the money regarding time to allow the bodies adjustment. This is similar to many patients I've seen, who simply do not want to give their bodies time to work through many disorders.


I don't know what the right answer is. But if you're riding 8k miles per year your doc might think that 5mm is worth correcting...

any discrepency will cause your hips to sway and your muscles react building asymetricaly. This can alter the position of your spine. I'm know doc but that can't be good...


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