Posture, leg-length discrepancies, musculoskeletal pain, and organ function


Poor posture not only leads to musculoskeletal pain, but can also impair organ function.

I discussed in another post how our function determines our posture (habitually sit in a slouched position and our posture hardens into having rounded shoulders and a forward head), and today I want to discuss the other direction – how our posture determines our function (how well our body works.)

I’ve just returned from a fabulous Integrative Neurosomatic Therapy course presented through Paul St. John’s clinic in Clearwater Florida, where this point was driven home. Poor posture does not only cause musculoskeletal pain, but can also impair organ function. Think about it. If one stands with one’s ribcage tilted to one side, the organs that sit on that side (like a kidney) are going to be squashed, which could very well impair its function. If one stands or sits with a collapsed chest and rounded upper back (the posture common to those suffering from depression) the diaphragm can’t descend properly with each breath, which may impact the lungs, and prevent proper oxygenation of the blood. Not only that, but the entire digestive tract would be squeezed making it harder to digest and assimilate one’s food. Also, with the chest tipped forward like that, the major blood vessels (aorta and vena cava) as well as the esophagus, (the tube the food goes down to get to the gut) may wind up slightly kinked as they go through the hole in the diaphragm designed for those vessels, potentially irritating the vagus nerve, which is near by. So maybe your acid reflux is not an acid problem but a postural problem! A flat cervical spine (neck) may be the root cause of a thyroid issue, because the area in the front of the neck may not be getting adequate blood.

If there is a functional or anatomical leg-length discrepancy that results in the pelvis being tilted in standing (one hip higher than the other), there will be a corresponding tilt in the opposite direction somewhere higher up in the spine to ensure that the head is sitting straight, and that the eyes are level. This is why frequently those will low back problems also have neck problems, and why leg-length discrepancies are often a primary cause of scoliosis. The areas that are tilted are vulnerable to wear-and-tear and injury, such as disk bulges, SI joint problems, hip degradation and pain (usually on the longer leg).

According to Friberg who studied army recruits and verified his findings on Xray, up to 60% of us have an anatomical leg-length discrepancy of 5mm or more. I had previously believed that most leg-length discrepancies were functional – a muscle imbalance problem in the pelvis – but if one takes the pelvis out of the equation by just examining the legs in standing, the numbers with anatomical leg-length differences are extraordinarily high. Many of us have a small hemi-pelvis – one side of the pelvis is smaller than the other, meaning that while sitting the pelvis is tilted. A high hip/pelvis in either sitting or standing may also result in squished organs on that same side. Anatomical leg length differences and smaller hemi-pelvises are very common structural issues that can cause all kinds of pain and possibly disease processes, they are easy to fix through shoe lifts (not heel lifts!) and butt lifts, and are generally not looked for at all by most health practitioners. Not everyone with a leg-length discrepancy is in pain, (those that are using appropriate stabilization strategies will be more able to dissipate the forces away from the joints), but a tilted pelvis will affect wear at the joints (hip, SI, spine, even possibly knee and foot) over time, increasing the potential for pain at some point. Children should be checked because if caught early enough before the epiphyseal plates in the bones close, a shorter leg can actually catch up with proper shoe-lift treatment.

So, who is your structural integrator? We all need a functional medicine doctor, a dentist, and I would argue, we need someone to help us with our structure. Integrated Neurosomatic Therapists are trained to look for leg-length discrepancies and smaller hemi-pelvises, and can help restore good structure through massage therapy techniques, by releasing tight muscles that are holding bones in a poor position. KMI Practitioners and Rolfers are also structural integrators and can help us realign our posture through massage. Corrective Exercise Specialists such as CHEK Practitioners can also help you improve your posture by suggesting particular exercises that will strengthen weak muscles, thereby bringing your body back into alignment. Yoga, with its emphasis on good postural alignment, can also be very helpful.

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Neurosomatic Educators

Clark, Randall & Jones, Tracy Posturology 101 Manual Neurosomatic Educators LLC, Clearwater Florida, 2005.

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Knutson GA. Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part I, anatomic leg-length inequality: prevalence, magnitude, effects and clinical significance Chiropr Osteopat. 2005 Jul 20;13:11.

Knutson GA Anatomic and functional leg-length inequality: A review and recommendation for clinical decision-making. Part II, the functional or unloaded leg-length asymmetry
Chiropr Osteopat. 2005 Jul 20;13:12.

Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 1983 Sep;8(6):643-51.

Friberg O. Leg length inequality and low back pain. Lancet. 1984 Nov 3;2(8410):1039.

McCaw ST, Bates BT. Biomechanical implications of mild leg length inequality. Br J Sports Med. 1991 Mar;25(1):10-3.

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Gurney B. Leg length discrepancy. Gait Posture. 2002 Apr;15(2):195-206.

Beaudoin L et al. Acute systematic and variable postural adaptations induced by an orthopaedic shoe lift in control subjects. Eur Spine J. 1999;8(1):40-5.

Copyright 2008 Vreni Gurd

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  1. KMI said,

    August 4, 2008 @ 2:55 pm

    Great Article.

    I’m a massage therapist currently half way through studying KMI structural Integration and have experienced amazing results from it in conjunction with visceral work. you can eat well, exercise be emotionally open and so forth, but sometimes its not enough. Sometimes structures of the body get so out of place that the only way to get you back is to physically pull it back.

  2. Ale_italy said,

    February 19, 2011 @ 9:28 am

    Do you really believe yoga is helpful?yoga asanas requires your body to assume very symmetrical position,and forcing an asymmetrical skeleton into a symmetrical pose may generate more unbalance…what do you think?

  3. Justus Kaminöfen said,

    May 29, 2012 @ 4:15 pm

    Excellent read, I just passed this onto a colleague who was doing a little research on that. And he just bought me lunch as I found it for him smile So let me rephrase that: Thank you for lunch! “Love is made in heaven and consummated on earth.” by John Lyly.

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