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JOURNAL CLUB: RELIABILITY OF LEG CHECKS - By Meagan Stachnik -
T
he Chiropractic community is considered a group of professionals educated in the musculoskeletal system, neurology, vitalism, and scientific evidence approaches. Diversity in Chiropractic technique, analysis and philosophy that exists within the profession offers opportunity for clientele to choose the correct approach for their bodies and take control of their care and treatment plan. Patients may not necessarily know the differences and similarities of the assessment techniques performed by chiropractors, but they are always familiar with certain things every chiropractor may perform in one way or another. They’ll say, “My chiro pops my hip”, “My chiro does this hip pull on me”, and “my chiro does this leg sweep”. The terminology is often difficult to interpret when a patient is requesting an adjustment after seeing a different chiropractor, however, one analysis most chiropractors are taught one form of analysis leg length inequality check (LLI). Known by many names such as Derefields or prone leg check, the LLI is one of the most noninvasive tests that can provide a considerable amount of valid functional and structural information regarding a patient. However, should chiropractors trust the reproducibility and validity the LLI? Nguyen and colleagues (1999) sought to answer this question, and herein is a summary of their results and interpretation to shed some light on the LLI technique.
Patient exclusion criteria included structural short leg, significant leg trauma, cancer or infection diagnosis, paralysis, prosthesis, fractures or current sprains, and replacement surgery to the knee or hip. Examiners had 15 years of clinical and instructor experience of the activator method. The examiners were unblinded throughout the process. Appropriate footwear coined ‘laced-up oxford shoes’ were key to their protocol to ensure adequate reliability for the test. Inadequate shoes were removed, and the examiner prompted the patient onto a Hi-Lo table. The testing examiners each took turns administering the LLI.
Nguyen et al. examined LLI with an activator method approach with a subject base of 34 patients.
6. Headward pressure applied with thumbs.
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Protocol performed by examiners: 1. Reference point of the leg length - welt of the heels of the shoes. 2. Palms of their hands cupped the lateral malleoli and brought legs together until heels touched and formed horizontal right angles. 3. Thumbs under heel of each shoe, index fingers on posterior aspect of lateral malleolus indicated a ‘finger gun’ position. 4. Examiners used their thumbs for removal of inversion or eversion and dorsiflexed feet. 5. Flared or externally rotation of the feet so toes abducted to a natural angle of 10-20 degrees.
7. Leg length then observed and documented.
