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The Hidden Sources of Chronic Pain


In the course of our 30+ year study of posture and its relationship to pain, we have come upon a truth that has been the solution for thousands of patients that suffer from pain – structural leg length asymmetries and hip asymmetries matter! Clinically referred to as Lower Limb Length Inequality (LLLI), this is an actual difference in the length of the bones of the legs, resulting in one leg being shorter than the other. And the hemi-pelvis is when one hip bone is smaller in size than the other. When LLLI is present, the body must use its incredible capacity for adaptation to find ways to compensate. In most cases, the pelvis tilts, rotates, torques, or flexes (possibly combining any of these) in order to deal with the short leg. A chain reaction of postural distortion follows, affecting the spine, shoulders, and cranium, as well as the hips, knees, and ankles. The dynamic support system of our body- our muscles- responds by contracting in some places and stretching in others – creating muscle imbalance. Uneven pressures and forces are distributed throughout the muscles,bones, and joints which then create pain, weakness, and damage to all of the structures involved. The principles of Integrative Neurosomatic Therapy (INT) show us that, if LLLI and/or a hemi-pelvis is/are present, it must be addressed in order to overcome pain patterns. Addressing LLLI and/or hemi-pelvis is one of the areas of manual therapy in which INT excels.

  • LLLI of as little as 5 millimeters (1/4 inch) can be the source of significant

  • About 60% of the population has a LLLI of 5 mm or more

  • The solution to LLLI is low-tech, easy to implement and relatively
    inexpensive – a lift inside or on the sole of the shoe, while providing

  • an inexpensive sit lift for the hip that may be smaller than the other.

  • Shoe lifts must extend the whole length of the foot - not just the heel

  • Once a lift is in place, Integrative Neurosomatic Therapy's corrective
    work creates lasting postural changes that will eliminate pain

  • Addressing LLLI and a hemi-pelvis can eliminate the need for long-term ongoing treatment
    to manage pain

The great debate surrounding LLLI and having a hemipelvis centers on a misunderstanding regarding its prevalence. Many healthcare practitioners believe that LLLI and having a hemipelvis is very rare and that legs and hips "appear" to be different lengths only when muscles of the hips and back pull them into an asymmetrical position. This is what is typically referred to as Functional Leg Length Inequality. Recent research shows that structural LLLI is very common but has only been researched in conjunction with hip and low back pain. Our clinical experience shows that the postural distortion perpetuated by LLLI has implications for pain in all areas of the body. It is almost always missed or disregarded by other healthcare practitioners. Thankfully, the St. John-Clark Pain Treatment Center therapists are highly trained in recognizing and addressing LLLI and are considered among the leading experts in this much-overlooked condition.

Christa Byler has been training and using St. John Neuromuscular treatments since 2012.

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