It’s common for individuals to be informed by a practitioner that they have a leg length discrepancy (LLD), which could be contributing to their low back pain. It’s been suggested that 90% of the population have a difference in leg length, does this mean almost all of us have low back pain from a LLD? 

Currently there is insufficient evidence to suggest that LLD is the sole cause of low back pain, however certain length differences can produce structural and functional changes seen in the low back, pelvis and surrounding tissues.

Checking for a LLD is a common assessment tool used by practitioners to confirm a potential difference, usually performed by pulling at the legs to see a potential difference; however, these tests are usually unreliable and a true assessment is measured through scans.

In cases where we want to get a more accurate measure of leg length discrepancy we will refer patients for an EOS scan. These are low radiation standing xrays which are performed at certain SKG Radiology Centres across Perth. They give an accurate assessment of leg lengths as well as other anatomical and postural measurements. It’s likely that a leg length difference of less than 2 cm has no significant clinical value, so how about people that have a discrepancy over 2 cm?


The human body is extremely adaptable and is able to passively change its structure to accommodate leg length discrepancy through ways such as changes in lumbar spine angulation, or muscle length. The prevalence of people with over 2 cm difference in leg length is around 1 out of 1000 people. This may result in the above biomechanical changes described, as well asa change in active muscle compensation.


In some cases the pelvis may anteriorly (frontward) rotate on the shortened leg, and posteriorly (backward) on the longer leg, creating an uneven rotation and levelling of the pelvis, but does this contribute to low back pain? Evidence suggests that pelvic rotatory or level changes don’t affect low back pain.


It is recommended to use a heel lift in differences of over 2cm, as well as visiting a podiatrist for a difference in over 2cm.

There are misconceptions that spinal, pelvic and hip adjustments are a plausible modality during treatment; however, adjustments do NOT change the structure of bones and the surrounding tissues, meaning the uneven pelvic positioning will not be corrected. 

As discussed, low back pain is likely caused from other intrinsic and extrinsic factors.

Here at Fortitude Chiropractic, our extensive history assessment and multi-modal approach will help determine these outcomes in order to help manage your low back pain, through various modalities including manual therapy, dry needling, rehabilitation and home-based exercises.

Book online here or call (08) 6184 8835 to make an appointment today!

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