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Chiropractic Research Review

Assessing the Validity of Compressive Leg Checking

Leg-length assessments are often used by chiropractors to verify the presence of subluxations and to determine treatment strategies. Evidence suggests that anatomic leg-length inequality (LLI) may cause chronic low back pain, which can be reduced by correcting the LLI with an appropriate heel lift.

Various studies have examined the ability of LLI measurements to be repeated (reliability) both between and among examiners. However, very few studies have explored the validity or truthfulness of these assessments.

This study addressed the question of whether a particular type of leg-length assessment (compressive leg checking) is an accurate procedure. The accuracy of compressive leg checking was assessed in two ways: by looking at how well the examiner fared against a known amount of artificial LLI, and how well the examiner could identify a change in artificial LLI.

Investigators recruited three subjects (two male, one female), between the ages of 28 and 37 and of average height and weight, for a prone leg-checking study. To artificially increase the length of a subject's leg, a research assistant randomly inserted a number of 1/16-inch thick shims into one of two surgical boots affixed to the end of an examining table. A blinded examiner then performed a leg check and assessed the location of each patients foot by observing a medially directed pointer and a metric ruler mounted between the legs of the prone subject.

Up to six shims could be inserted into either boot, and the trial called for two series of observations on each patient, for a total of 26 possible observations per subject. To maximize the independence of individual measurements, the examiner "reset" patients to their baseline condition between measurements, taking great care to make sure each subject's pelvis was centered on the table and then tugging on the subject's feet to undo any possible effect of the previous measurement on his or her legs.

The authors took great care to discuss the clinical relevance and potential errors of their study. After completing their analysis, they noted, "It seems safe to conclude that compressive leg checking is highly accurate, capable of detecting artificial changes in leg length +/- 1.87 mm. What this means clinically is that the difference between pre-leg checks and post-leg checks should exceed 3.74 mm if we are to be highly confident that a real change has occurred."

Cooperstein R, Morschhauser E, Lisi A, Nick TG. Validity of compressive leg checking in measuring artificial leg-length inequality. Journal of Manipulative and Physiological Therapeutics Nov/Dec 2003;26(9):557-66.
www.mosby.com/jmpt

Chiropractic Research Review

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