I have to be honest, choosing the word ‘epidemic’ seemed overwhelmingly serious for me to use but after reading the definition I knew it was the exact word that was appropriate when describing this situation. The word epidemic itself gets your attention. By definition in the Merriam-Webster dictionary the word epidemic means affecting or tending to affect a disproportionately large number of individuals within a population.

I think a comprehensive study should be conducted just based on what I have witnessed in my own practice. The surgeries that are being performed on either a foot, ankle, knee, or hip over time is eventually leaving the client with just a few millimeters difference in their leg length and creating multiple muscular imbalances and chronic pain. As massage therapists we are the people who can take the time to do necessary evaluations to recognize this little documented growing epidemic and help make a difference to the quality of client’s lives.

Maybe you have recognized it and maybe you haven’t. The clients are presenting with typical low back pain, piriformis issues, SI dysfunction, hip bursitis, etc. Their health history states that there was no direct injury or traumatic event. But what they do have in common is some form of surgery and a new joint replacement. The cases I am going to share with you (there are plenty more) are just riddled with direct correlation to their past surgeries and that famous chain reaction of muscular strains. 

The Stats

First let’s take a look at some statistics that influence the population with joint surgeries or replacements. According to Mayo Clinic there are one million hip and knee replacements done each year. As people age, they increasingly choose Podiatric Physicians for foot care. Medicare data verifies that Podiatric Physicians are the physicians of choice for 80 percent of hammer toe surgeries, 67 percent of metatarsal surgery, 77 percent of bunionectomies, and 47 percent of rear foot surgeries. Medical Economics magazine reported that 56 percent of all older patients have seen a Podiatric Physician. These numbers are staggering and climbing. 

According to the Boston Globe, baby boomers, determined to keep moving no matter what with the wear and tear of arthritis are fueling a surge in joint replacements. They are taking advantage of improved artificial joints and surgical methods. Aging Americans are getting so many new hips, knees, shoulders, and ankles that orthopedic surgeons are having trouble meeting the demand.

Root of the Cause

But none of these physicians are taking the time to look at the real cause of the issue. They are prescribing physical therapy before the surgery to rehabilitate an already diseased joint rather than looking above and below the joint being replaced for a correlation of cause and effect. Even with the new joint in place you still have the same structural issues you had before the surgery with a compounded problem of a more stable joint than we were born with, plus the trauma of surgery, which leaves the muscular and facial system to do one heck of a balancing act.

Chain Reaction Number One

Client complains of some foot pain, podiatrist decides to do surgery on the first metatarsal because the -ray shows some arthritis. Two years later she begins complaining of same side knee pain. She sees an orthopedic surgeon who specializes in knees, he sees some arthritis in the knee and he now recommends a knee replacement. Two years after the knee replacement which was on the right side, she begins experiences hip weakness and piriformis syndrome on the left.

The assessment revealed she now appears to have a significant limb-length inequality; her right foot is over pronating which is causing her pelvis to rotate. This client’s muscular system will have to fight for the rest of her years adjusting to the surgeries. She stated “I wish I would have never had the foot surgery.” I did suggest a lift for her leg length difference which is helping. Interesting fact, the orthopedic surgeon did an MRI, of course that was lying down and found that all of the bones were in alignment. He said you are fine, in pain, but aligned. What he didn’t consider is how her body has to adjust muscularly to take an upright position and hold the pelvis and spine erect. Gravity changes everything.  

Chain Reaction Number Two

Good friend, soccer coach, 52, had some medial knee pain. Went to see orthopedic surgeon, he took an x-ray, saw some arthritis. After surgery he admitted once in there she didn’t have that much arthritis, but he chose a partial knee replacement anyway. Fast forward four years, she presents in my office with piriformis pain. She had been seeing a chiropractor the past six months with no resolve.

I did a functional movement screen and looked at her leg length on the table revealing an incredible difference. The unbelievable leg length difference was probably caused by her great work out ethic. The chiropractor had taken an x-ray and noticed she had a leg length difference but didn’t give her a lift, until I prompted her to ask him. Sadly he had just forgotten to recommend one. We worked on all of the muscles that had been effected by the imbalance, got her out of pain, and she now happily wears her lift and has no more no piriformis pain.

Chain Reaction Number Three

Long standing client, 80 years old, develops some foot pain. She sees a podiatrist; he sees arthritis and does surgery with pins. A year later she is terrible, so she seeks an orthopedist help, he does surgery to remove the pins and to pin it differently. She spent another six months in a boot and non-weight bearing. Once she started to resume normal activities her hip started to hurt. So she began doing physical therapy to try to resolve the hip pain. After six months she called to see me for treatment. After the assessment I found a leg inequality. This was being caused by the poor foot position which was supinating and very rigid. The doctor had noticed the difference and prescribed a foot lift. Unfortunately, no one had explained in detail the importance of wearing it. So over time when she started going out for her walks she developed piriformis syndrome on the same side hip. I explain-ed the importance of wearing the lift all the time and treated the muscular imbalances. I am happy to report her piriformis syndrome has resolved.

Chain Reaction Number Four

Great guy, hard worker, now 81. He was an avid tennis player at one time. Right knee replacement, right hip replacement, left hip replacement, right shoulder replacement and finally low back surgery. He was fitted for a lift after his first hip surgery, but was never re-evaluated after his second hip surgery. I tried to convince him this leg length was causing the back pain and he should have a new lift. He stated “I wish I had done the lift.”

My Conclusion

If your client has any form of a joint replacement you will want to begin by looking for a leg length difference. Assess each time they come in for treatment because the imbalances can change depending on what they are doing. Take a picture and show the client they do have an inequality. Follow up by referring a prescribed lift that can possibly be adjusted when necessary. Remember millions of people have a potential now for this leg length difference!