Is one leg shorter than the other?

Interexaminer Reliability of Supine Leg Checks for Discriminating Leg-Length Inequality

H.Charles Woodfield, RPh, DC, B. et. Al. J Manipulative Physiol Ther 2011;34:239-246

Image credit Daniel Clark

Image credit Daniel Clark


These authors report the first EVER publication on the reliability of the Supine Leg Check (SLC) to appear in biomedical indexed literature. 

The SLC is a foundational clinical assessment in many upper cervical practices and this article provides some well researched supporting information.  Of note:

·         It is estimated that “approximately 90% of the population have anatomical difference in leg length, averaging 5.4mm(~3/16in)…whereas a difference of more than 20mm(~3/4in) is considered clinically significant in contributing to various musculoskeletal pathologies.”

·         According to NUCCA (an upper cervical chiropractic technique) protocol in new patients  ”a ¼ in discrepancy determines the need for further testing diagnostic testing, and in established patients a 1/8 in threshold is used.“

·         This article concluded that “two trained examiners demonstrated moderate agreement in determining the side and magnitude of length inequalities using a standard supine leg check procedure.” 

From an academic standpoint this article is ground breaking as the first indexed publication on SLC.  The authors did an exemplary job of noting inherent limitations, all the while keeping the protocol as clinically applicable as possible.  As reliability of a procedure is distinct from validity there is still much to report on, but these pioneering authors have opened the door with regards to one of the most commonly used screening procedures used in Upper Cervical Chiropractic.