A Very Common Complaint, Especially After Surgery And Injury, Is "One Leg Is Shorter Than The Other". Though Out Of The Many Times I've Heard This, Only Once Did Someone Actually Have A True Leg Length Discrepancy Or A "Shorter Leg". So What Is Happening That One Might Feel This Way? What Is Causing This Phenomenon That Makes Us Jump To Buy A Lift In Our Shoes Which Can Wreak Havoc On Our Hips And Spine, Change Our Gait Patterns And Overall Cause Musculo-Skeletal Dysfunction Later On In Life?  

I Think To Understand This, We Have To Understand The Role Of The Inflammatory Process (Which Can Include Pain And Swelling) After An Injury Or Surgery. Most Notably After A Hip Surgery (Due To Close Proximity And Muscular Attachments To The Pelvis), But Also After Knee And Ankle Surgeries, People Experience Post-Surgical Pain And Swelling. This Is The Bodies Response To Heal The Joint And Muscles. Pain And Swelling, In The Musculokeletal Scheme Of Things Are The Greatest Cause Of Muscular Inhibition. Knee Buckling And Not Being Able To Reach Up Into A Cupboard Are Just Two Examples Of Pain Shutting Your Muscles Down In A Sense. It Can Make Us Think We Are Weak When It Is Just A Temporary Muscular Shutdown, Waiting To Be Awakened After Pain And Swelling Subsides.

Now When We Have A Leg Injury Or Surgery, Not Only Are Our Muscles Inhibited, But Our Gait And Standing Pattern Changes. How Does That Happen? I Can Answer That Question With Another Question. Would You Feel Comfortable Standing On A Weak Leg? Probably Not. What Tends To Happen Is Actually A Subconscious Response By Your Body To Avoid The Painful Leg. This Causes A Chain Reaction To Put Most Of The Weight Onto The "Good Leg". Now Another Question. If You Weigh 180 Pounds And Each Leg Was Able To Handle 90 Of Those Said Pounds And Suddenly Only One Of Your Legs Now Has To Take 150 Of Those Lbs, Do You Think Your Body Will Adjust To Accommodate This New Balance Of Weight?

Now The "Domino Effect" Begins. With Most Of Your Weight On One Leg, Your Pelvic Complex Will Start To Shift Towards To The Leg That Is Handling Most Of Your Weight. If You Can't Picture This, Put Your Hands On Your Hips. Does One Side Stick Out More Than The Other?  This Weight Shift Of The Hips And Pelvis Is Not Just Horizontal, But Can Go Vertical As Well. It Can Migrate Upwards Towards The Ribs. Once The Domino Effect Ends, You Are Left With A Pelvis That Is Higher On One Side Than The Other. When The Pelvis Goes Up, It Pulls Everything Along With It, Effectively Making The Leg Seem Shorter. 

Now When Wearing A Shoe Lift To "Lengthen" The Leg, You Are Not Helping The Problem, But Actually Making Things More Complicated By Pushing The Already High Pelvis Even Higher! Imagine The Domino Effect That Now Starts In The Spine. When Your Pelvis Goes Up, It Takes Up Space. Space Designated For That Side Of The Spine. So When The Pelvis Goes Up One One Side, The Spine Gets Pushed Towards The Other Side. Now The Journey Towards Scoliosis Begins...

Don't Get It, Try This:

Stand In Front Of A Mirror, Preferably Shirtless To Get A Good Visual Of What You Are About To Check. Now Put Your Hands On The Very Top Of Your Pelvis (What Most People Might Call The Hips But Are Mistaken) Right Underneath The Bottom Of Your Ribs. Now Look In The Mirror At The Level Of One Hand Versus The Other. Is One Higher? If So, Shoe Lifts Could Be The Furthest Thing You Need Right Now.

Note: The Above Explanation Is Not The Only Reason You Can Have A Perceived Lower Leg. I Will Discuss The Phenomenon Of Hip Drop In Relationship To Leg Length In A Future Article.


Joshua Mazalian is a doctor of physical therapy and board certified as an orthopedic clinical specialist. He is the owner of JAM Sports and Spine Physical Therapy and Sports Performance. For any questions, you can email him at info@jamsportsandspine.com.


To know the treatment for a headache or migraine one needs to know the source first. There are many variations of a headache including neck, tension and migraine headache. I will leave out tension headaches and discuss in another article relating to TMJ. To figure out the type of headache we first must ask ourselves a few questions: where is it located? What is its behavior? What eases the symptoms? What makes it worse?

True migraines are of vascular nature. They are usually on one side of the head including the eye. They can get worse with light and noise. They are not eased with certain positions or pressures. Sometimes they can be triggered by adverse reactions to food, drink, or stress.

In comparison, headaches stemming from the neck are of a mechanical nature. Positioning and pressures can help. Anything that would relax the neck such as a hot shower might ease the headache. This type of headache is usually caused by irritation of a nerve in the neck called the Greater Occipital nerve. Pain or headache symptoms start in the back of the neck and over the head and and above the eye (they call this manifestation the "Rams Horn" presentation for obvious reasons). Treatment for this type of headache would differ than that of a true migraine in that you are not treating the vascular components, but of the compression of that nerve. In order to take pressure off that nerve you would need to relax the muscles (hence why a hot shower would help), realign the upper cervical vertebrae with stretching and hands on manual therapy including light massage and vertebral mobilization.

Try this: next time you get a migraine try one of three things to rule out a neck a headache 1) take a hot shower or put a heating pad on your neck 2) put pressure in the back of your neck right below your skull and hold that light pressure for 5 to 10 seconds 3) put both your hands underneath your skull and gently start to lift up. If none of these help, the neck might not be your problem.

Note: infrequently, headaches can represent more serious problems. Some risk factors for more serious underlying pathology includes if you've had a recent traumatic blow to the head, a history of cancer, AVM, history of drug abuse, history of high blood pressure as well as a long time smoker. Consult your physician if they are frequent, abnormal and severe in intensity.


Dr. Joshua Mazalin works as a Physical Therapist at ProexPerformance Group in Los Angeles.



Page 4 of 4