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Saturday, July 15, 2017

Use of Lifts for Scoliosis: Email Advice

     I was diagnosed with scoliosis (not a serious one, below 30 degrees) when I was 15. A specialist ( a super doctor who was also a university professor an expert in postural problems) said that wearing a heel lift could have been useful: the legs had the same length but my pelvis was a bit twisted and one side 15 mm higher than the other. 
Dr Blake's comment: I have done this before, but love to have the MD treating the scoliosis primarily tell me it is okay. There is structural short legs, functional short legs (which this would be), and a combination of the two. Since we only x-ray rarely to attempt to avoid any needless radiation, we are probably indirectly treating functional short legs. If the body collapses to one side, and then have to use all this effort to right itself with each step, it makes sense to treat, and it makes sense the body would say "Ahhh, thank you."

     He said it was good practice not to go for a thick heel lift (that a heel lift should be half or less than the real gap since that could have cause the thoracic curve to worsen.He asked me to come back after a few months with new x-rays (taken while I was wearing the 5 mm heel lift). The lumbar curve was reduced while the thoracic curve was either the same or just slightly worse. I had less pain and he said I should wear it till I was 18 at least and that afterwords it would be useless. I kept wearing it till I was 35 then I thought I would get rid of it.

     All good, till after 5 months I started to have lots of pain like sciatica in my lower back and down my hip, left knee.. the side where the crest of the pelvis was lower (where I used to have to heel lift). The pain worsened...also, I was doing pilates and other exercises I was taught as a young patient (exercises to help cope with scoliosis I was taught for a few months on a weekly based by an expert when I was 16).
I had never had such a terrible pain in my life, I could not stand or walk anymore for more than 20 minutes. I was fine when sitting or laying in bed. My doctor said that I should see a physiotherapist. I insisted that I wanted to see a more competent person (like a doctor who studied 15 years to become an expert about posture and scoliosis, but he insisted that a physiotherapist was good enough). 

    The physiotherapist told me (after a thorough assessment) that my scoliosis (actually my lumbar curve) was not there when I lay on the bed, but just when I stood up. That it was a sort of scoliosis cause but postural problems that that even if my legs had the same length I had to wear a heel lift (15 mm). He said a heel lift would be useful if my scoliosis was still there in all sort of positions but that in my case it would do the job. I started wearing a 6 mm heel lift since I did not trust him (20 years before the specialist said I should wear a smaller one; half the real gap). I felt better within the following 2 days and I had 2 great months: no pain!!! Now some pain is back but on the other side of the pelvis, the hip without the heel lift (the right side) it is not as bad as the pain I had on the left side, not at all, but it is annoying. Now I don't know what to do. If I take the heel lift off from the left shoe) I will go back having that unbearable pain...I am 40, I do lots of core exercises and have a very strong core, I do lots of exercises all the best ones for scoliosis... any advice?
Dr Blake's comment: Thank you for this wonderful discussion and should help so many patients with scoliosis and back or hip pain to think about lifts. I have extenisve writings on lifts for short legs which apply to your care. You were probably at the low end of the amount of lift all those years that could help you. So, when you took them out, your body could not adjust and the nerves got pinched. Muscular soreness from changes of position can give you level 3-4 pain, but pinched nerves are 9-10. That level of pain can not be tolerated. As you work on your core, continue to correct the imbalances produced by the S shaped spine. There is typically two very tight areas and 2 weak areas on opposite sides of the curves. A physiotherapist can typically spot and help you develop a program to stretch where you have to stretch and strengthen where you have to strengthen. 
     First, you can keep the 6 mm, but use 3 mm full length and 3 mm heel for a total of 6 mm. This will spread the force over a longer area. You want to physio to watch you walk and look for dominance. Limb dominance is defined as the side you put more weight on when you walk. You want to find the right amount of lift that corrects that asymmetry. What amount of lift will put equal forces up your spine. At least make that observation, only if it is stored away for now, because it is a repeatable observation. It makes a difference to where we go as an individual if that is 6, 9, 12, or 15 mm which at least half full length. A typical Spenco or Dr Scholl's insert gives you 3 mm, so it is typically easy to stack them for this purpose.
     Second, as you go up, or get symptoms temporarily on either side, you can also put an insert in the other shoe to drop the correction for a short time. I hope this at least gets you started. Rich

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Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.