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Thread: Chiropractor vs. Orthopaedist

  1. #1
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    Chiropractor vs. Orthopaedist

    The second orthopaedist we saw measured my 16-year-old daughter's lumbar curve at 26 degrees and said it's functional because right leg is 1/4" shorter than left. (First ortho had measured the curve at 20 degrees--using the same X-ray--but did not measure the legs and called the scoliosis idipoathic). Second doctor recommends using a lift in her right shoe and did a new x-ray with the lift in and that gave a 6 degree adjustment (obviously only when the lift is in place). Yesterday a chiropractor we consulted for pain said not to use the lift because that can cause the muscles to try to correct in the wrong way. Now we don't know who to believe. Does anyone here have their child use a lift? Or use a lift themselves?

  2. #2
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    If there is indeed a true leg length difference (actual bones are measured at different lengths, rather than the legs being off because of uneven hips) then a shoe lift will DEFINITELY help. It will help even the body balance - hips, spine, legs, etc. This will improve the discomfort she's feeling because the body is in better balance.

    If the leg length difference is due to the hips being uneven, raising a leg a bit higher than the other, the source is likely the scoliosis. Improving the scoliosis (bracing?) may help. I honestly don't think a shoe lift is a bad thing. Ever. If it improves her body balance (scoli reduces) and improves her discomfort by balancing her body, how is that a bad thing? I can't visualize how the muscles are going to be a problem... Hmm...

    Good luck.
    Carmell
    mom to Kara, idiopathic scoliosis, Blake 19, GERD and Braydon 14, VACTERL, GERD, DGE, VEPTR #137, thoracic insufficiency, rib anomalies, congenital scoliosis, missing coccyx, fatty filum/TC, anal stenosis, horseshoe kidney, dbl ureter in left kidney, ureterocele, kidney reflux, neurogenic bladder, bilateral hip dysplasia, right leg/foot dyplasia, tibial torsion, clubfoot with 8 toes, pes cavus, single umblilical artery, etc. http://carmellb-ivil.tripod.com/myfamily/

  3. #3
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    Thank you Carmel. I hope this isn't a stupid question, how would they measure the bones? On an X-ray? Or is there an accurate way to do it joint to joint?

  4. #4
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    Hi...

    My understanding is that it's very difficult to know if there's a leg length discrepancy. Here's a paper that discusses the issue:

    http://www.podiatrytoday.com/article/2698

    I'd ask the chiropractor if s/he has any studies to pack up the assertion that a lift "can cause the muscles to try to correct in the wrong way." I've never heard that before. And, it seems to me that if the lift reduces the curve, that's a good thing.

    Good luck!

    Regards,
    Linda

  5. #5
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    Linda,

    Thanks for the reply and the very interesting article. The section about lifts was especially interesting. We haven't tried to have any shoes modified, yet. To start out my daughter is just putting them in her shoe--and there has been a little shifting. She's skeptical about it so we'll just have to see whether, over a period of time, it helps with the pain.

    Thanks, again.

  6. #6
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    To lift or not to lift? We battled the leg length/hip tilt and shoe lift while in the brace. Orthotist offered the stick in the shoe lift... she did not like it. After the brace, after surgery (only corrected one curve)...we still have this problem. She has a 3/4 lift (needs a bit more) now built into her shoe (much nicer than the in shoe type). She wears it because she lists to one side, limps when she walks and it increases her pain not to wear it. We are scheduled to see a new surgeon next week and I will be all over him with questions regarding this. Is it the hip, the leg or that bottom curve! If you'd like, I will let you know what he thinks. Also - we had a boot/saddle shop make her shoe. I bought the style she wanted, we took them in and he modifies them..cuts off the bottom, inserts the same color lift material and glues the bottom back on. Way nice for the style seeking young ladies. Having a pair of flip flops done now!

  7. #7
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    Functional scoliosis (i.e. nonstructural scoliosis) involves a temporary change of spinal curvature. This is caused by an underlying condition such as a difference in leg length, muscle spasms, or inflammatory conditions, (e.g. appendicitis), which may produce muscle spasm. Functional scoliosis is treated by correcting the underlying problem. The spine itself needs no treatment because it is not curved or rotated. It's termed as "postural".

    Structural scoliosis is when the mechanics of the curve are such that rotation of the vertebrae occurs in combination with lateral curvature, and this usually produces a protruberance of one side of the rib cage, seen best when a person bends forward.

    Therefore, in structural scoliosis, I would think the only reason one leg is longer is because one hip is higher (due to the curve and rotation). I would think a lift would only help with functional scoliosis if the spine is actually straight, but the leg lengths do actually differ. Hope that helps!

  8. #8
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    Thanks for the replies.

    Rodsmom, yes, please let me know what you learn from the surgeon on the next visit. I've located a place that can alter any of my daughter's shoes (I haven't asked about flip flops, but she loves them so I will). She's a little resistant to the idea because it's not clear yet whether this will help.

    MissEmmyF, your explanation is very clear and interesting and helpful. I'm finding that the information I get from the doctors is often contratictory. For instance I asked the orthopaedist about a muscle in DD's back that feels thickenen. He kind of pooh-poohed it. But the physical therapist talked about muscle spasm and felt it was important.

  9. #9
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    Quote Originally Posted by MissEmmyF View Post
    Functional scoliosis (i.e. nonstructural scoliosis) involves a temporary change of spinal curvature. This is caused by an underlying condition such as a difference in leg length, muscle spasms, or inflammatory conditions, (e.g. appendicitis), which may produce muscle spasm. Functional scoliosis is treated by correcting the underlying problem. The spine itself needs no treatment because it is not curved or rotated. It's termed as "postural".

    Structural scoliosis is when the mechanics of the curve are such that rotation of the vertebrae occurs in combination with lateral curvature, and this usually produces a protruberance of one side of the rib cage, seen best when a person bends forward.

    Therefore, in structural scoliosis, I would think the only reason one leg is longer is because one hip is higher (due to the curve and rotation). I would think a lift would only help with functional scoliosis if the spine is actually straight, but the leg lengths do actually differ. Hope that helps!
    Although most of the time there's a leg length discrepancy with scoliosis, it's actually due to pelvic tilt, it is possible to have both scoliosis and an actual leg length discrepancy.

  10. #10
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    Aterry-
    My daughter posts here too if your daughter has questions and/or wants to vent. We are picking up the flip flops today and could send a pic if you would like. Like I said, my daughter resisted the inserted one while in brace and now...she insists on wearing her lifted shoe. Physical therapist said it wasn't from her legs but from the pelvic tilting...primary care doctor offered leg xrays but we already have enough xrays taken. I would rather request the surgeon to get the xray combining it with something he needs done.

  11. #11
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    Lift experience

    Hi - I accessed physical therapy services for back and hip pain. My PT suggested a lift. I tried it and it seemed to help. I know another woman (we're both in our 40s) who swears by her lift. I've since had more pain and my PT recommended a CT Scanogram to determine if I do have a leg length discrepency. It showed that I do NOT. My pain comes and goes. I'll continue to explore options. My PT is Cindy Marti at Spinal Dynamics of Wisconsin. They do lots of work wtih lifts and identifying/measuring leg length discrepency. THey also have a highly specialized scoliosis program using the Schroth method. More at www.sdwpt.com

  12. #12
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    Hello bscoli,

    So, once it was determined that you do not have a leg-length discrepancy you stopped using the lift? I wonder why it seemed to help when there is no discrepancy? The technique for measuring sounds interesting, I'll check out the link.

  13. #13
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    Rodsmom,

    I think it's great that your daughter posts. I don't think my daughter is ready for that, yet. She's not in denial, really, but is a bit tender about the whole subject. Which isn't surprising, I'm totally confused so she must be even more so. A pic of the flip flops would be great since I'm planning to take her to a store about the lifts some time this week. Did you go to a specialist for the lifts?

    Thanks.

  14. #14
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    Back from the doctor

    Aterry ~ We went to the new surgeon yesterday. A bit surprised ~ he said that he would not have done her surgery any differently. He did not like the tenderness in the surgical area. He said that he wants her to try physical therapy. This is an issue for us because we do not live in an area that has many options. They have a great physical therapy unit there at his office but we live 2+ hours away. They were great...got us into the physical therapist yesterday while we were there. The physical therapist was very good explaining the muscle issues with us and then wrote her a personal plan. Gave her a walk through on the exercises. He told her to call him when those get too easy and he will give her more. We will come back to see him monthly or so as we progress since we live so far away. The biggest problem is my daughters low back pain...surgeon told us that it was from her leg length discrepancy. Now, we have been told previously by another physical therapist that she had a pelvis tilt and rotation but that the legs were the same length (physically measured them on her body). I asked the new surgeon how he could tell they were off and not from the scoliosis. He said something about the sacram and then showed me the top part of her hips and measured it to be 2.21 cm higher than the other hip bone. To be honest, I did not clearly understand him. He gave me the phone number for another doctor that deals with leg length problems. He also told me that the spine wouldn't look as bad if that film had been done with a lift in the shoe. (I thought of you when he said this). On the way home I spent some time thinking about the physician asst who did the work up for surgeon. He measured the last film we had of her. All the curves, etc. Came in and out of the room several times. (I assume that the surgeon was telling him to check something else.) He then brought a string in with screws wrapped at the bottom for weight and checked the alignment of the head and the sacram in both the back view and the side view. I was watching him the entire time. Later it dawned on me that this was most likely when the surgeon determined that the gimp in her walk and the tilt of the pelvis on the x-ray were not caused by the lumbar curve that still remains. I am very curious about the other surgeon we are to see May 6th to discuss her legs/pelvis. If you want, I will let you know what his opinion is.

    We did not get a professional to measure for the lift. I watched the physical therapist who said she had no leg length problems measure her for an insertable lift using magazines in the office. My husband and I used solid books on a solid floor to come up with the current lift watching her jean pockets and belt line, etc knowing full well that we would probably not be quite accurate but it would be better than without. We were off around an 1/8" from what the surgeon said yesterday and I am about positive that he would not want us to take that number as extremely accurate. I think that he would say the next surgeon we see would be the one to get an accurate number from.

    Our emotions go for roller coaster rides around here. Sometimes she gets mad and won't talk about it for awhile...frustrating. But I keep trying to remember that she is just a teen trying to cope with teen emotions and then we add all of this adult stuff to her to deal with...

    I hope this helps. Every day is a learning experience for us. Feel free to pm me if you wish.

    http://i640.photobucket.com/albums/u...ictures001.jpg

    http://i640.photobucket.com/albums/u...ictures004.jpg

    http://i640.photobucket.com/albums/u...ictures002.jpg

  15. #15
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    Thanks for the update. Please let us know what happens after the visit to explore the leg-length issue. It sounds like the physical therapist your daughter saw did a very thorough job. I'll be curious to learn whether the exercises help with pain. My daughter has been pretty good about doing her exercises but her pain hasn't abated at all. She has to sleep with a heating pad most nights. My husband really wants us to see the chiropractor--that's the one who pooh-poohs the ideal of leg length so I'm hesitant. If we go I'll take the two sets of X-rays because in the second set she's standing on a 1/4" shim and you can see an improvement. Part of what I find frustrating is that none of the doctors she sees treat the whole body. Even the 2nd orthopaedist, who we liked, didn't check the muscles in her back. Even though we told him about the pain and that the muscles seems "lumpy". He said that with her degree of curve there shouldn't be any pain but to come back if 6-weeks of physical therapy doesn't eliminate the pain. The physical therapist has been addressing the muscles (she said they are spasming) but she doesn't seem interested in checking her gait (although she did confirm the leg-length discrepancy). When we went to the special store for the lifts they didn't check the gait until I told them, too. And now going to the chiropractor I feel it will just be another person who will only look at one aspect. I'll try pm'ing, if I can figure out how. I'm bad at technology.

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