Active Quiroprática, Chiropractic Clinic
serving Lagoa Carvoeiro Portimão Silves Porches Lagos Monchique, Algarve, Portugal
Dr. Krystov Bock

USA reg. Dr of Chiropractic / Chiropractor

(+351) 282 352 202 / 966 706 606

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Dr. Bock's Blog...

Back Pain after Joint Replacement
or, are your legs the same length?

(Chiropractic Corner column, The Portugal News, 11/28/15)

It is quite common to have a patient come into the clinic having back pain, and they cannot remember any recent injury at all. Their pain may have come on gradually over several months, or it seems to come and go with no apparent cause, even when there is no change in person's activity.

When asked about previous injuries or surgeries, I often find that the patient remembers having had joint replacement of either, or both, the hip(s) or knee(s), or possibly a severe fracture of the leg. The surgery or fracture has healed successfully, and over all they feel fine. But now they are having back pain. They may have had some treatment for the back pain, but their pain persists... they feel frustrated and don't know what to do.

One possibly cause of the back pain is that due to the surgery or healed fracture, the legs are now no longer the same length! With joint replacement surgery, as careful and diligent as the surgeon is, it can be a challenge to maintain the absolute original length of the leg. Unequal leg length causes the pelvis, lower back, muscles and ligaments to become tilted and twisted, resulting in lower back pain.

Algarve Chiropractor Dr Bock knee replacement lower back pain

(Knee replacement, unequal length)

This is one of the causes of "non-specific" lower back pain, and treatment only to the lower back seldom eliminates the pain. The Leg Length Discrepancy must also be corrected to remove long term intermittent pain. The back pain and correction of leg lengths can be treated... without surgery!

Previously, conventional medical wisdom was that up to 1.5 cm difference between leg lengths was considered "normal" and "adaptable" by the body. However, I personally see many of my patients struggle with only a few millimeters of difference. Following hip or knee surgery, there is an abrupt change in the lengths of the legs that the body struggles to adapt to and tolerate.

An easy way to understand this condition;  if your house's foundation has suddenly settled on one side due to heavy rain, quite often ceilings or walls will begin to crack due to the unequal pressures and twisting of the house. A good builder is able to find this foundation problem and fix it by returning the house to its original position. As an expert, he would use a variety of tools to identify the "shift" in position and return it to level working order.

In the human body, the best way to identify and accurately measure a leg difference is by having a single standing pelvis X-ray taken. I am then able to measure the tops of the leg bones, at the inside hip joint, and compare side by side, showing my patients the difference. We are also able to see the position of the pelvis and the lower lumbar spine, and how it is being affected by the leg lengths.

A standing X-ray is the most accurate measurement. (A tape measure on the outside of the body, gives only very rough measurement, and sometimes can give conflicting information since they are taken lying down.) What we really want to know is, when you are standing... what is the total long of your bones, and are they of equal length?

Algarve Chiropractor lower back pain hip surgery replacement

(Hip replacement, unequal length)

You get a lot of information from one standing X-ray (all of these issues are seen above):

1) The leg lengths can be compared to each other and measured accurately.

2) If there is a difference in leg length, there is most likely a twisting or rotation of the pelvis, as the body weight turns and settles onto the shorter leg.

3) Side-ways bending of the Lumbar spine is seen.

4) Often the Lumbar spine can be seen to twist and rotate.

5) Unequal pressure is put on the hip joints, possibly leading to hip joint irritation.

In layman's terms, even a slight difference in leg length puts uneven pressure on the pelvis and legs, causes twisting of the pelvis, and then, twisting and rotation of the spine. With the twisting and rotation, all of the joints, ligaments and muscles are put under strain and now have to work harder. No wonder the lower back is having physical stress and begins to feel pain. 

Uneven leg length is one of the causes of "non-specific" lower back pain.  Non-specific, because the cause of uneven leg lengths hasn't been looked for, identified and treated. It is important to determine which side is shorter, and to apply the proper amount of correction.

Dr. Bock, at Active Quiroprática, has been treated this problem for years with a combination of 1) Chiropractic therapy to relieve your lower back pain and 2) correction of the underlying cause -- the difference in leg length. Patients feel a significant improvement in their back pain and increased stability in the pelvis and lower back. As the pelvis and Lumbar spine return to their proper position, the constant lower back pain is relieved and patients usually feel much better walking, running, playing golf or tennis. As the lower back pain gets better, so does your sleep!

If you have had either a hip or knee replacement in the last year, please come into Active Quiroprática and have this condition identified, and treated before having problems. If your surgery was over a year ago and you are having unidentified low back pain, come in and get yourself back on the level!

Please call today for an appointment and we can help you get better fast!

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(+351) 282 352 202 / 966 706 606

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Active Quiroprática, Chiropractic Clinic
Dr. Krystov Bock
















































































Centrally Centro located Chiropractic Physiotherapy Quiropratica Quiropratico in Lagoa, Algarve, Portugal
Formerly associated with Lutz Quiropratica Quiropratico, 2013 and 2014