When I graduated Chiropractic school, we were still under the impression that Vitamin D was really only useful for growing and maintaining strong bones. Since then, research has demonstrated links between low levels of Vitamin D with weak immune systems, pain and inflammation, and even mood and anxiety. Seasonal Affective Disorder (SAD) hits many people in the winter, and it is not likely a coincidence that during the winter months, we are more likely to be deficient in Vitamin D.

            Not only were we wrong about the vast number of things that Vitamin D does, we were also grossly wrong about the appropriate dosage. The National RDA was established at 400 IU, largely because this was the quantity required to prevent Rickets and Osteomalacia. Not having bone disease is much different than being healthy. The final verdict is probably not in, but it is not uncommon for people to take 5000 to 10,000 IU of Vitamin D3 on a regular basis if they want to be healthy, and 2000 IU is a common maintenance dose. In cases when a person has a blood test and is found to be clinically low in Vitamin D, it is fairly customary to briefly take dosages of 50,000 IU at a time.

            In a perfect world, we should be able to make most of our own Vitamin D in our livers with the assistance of ultraviolet light from the sun. However, this far North, we really are only subjected to the right wavelengths to do this between June and September. It is also alarming to find that many people who are tested end up being low regardless of the time of year, the amount of time they spend in the sun, or the amount of milk they drink, all of which were old school ways of predicting Vitamin D health.

            If you don’t have a baseline on your Vitamin D levels, it would be worth having the test done to determine what, if any, additional action steps may be needed. It’s not just your bones, but your immune system and mental health that may be at stake. 

-Dr. Russell Petersen, DC. Creekside Performance Center, 4000 Enterprise Dr., Sheboygan, Wisconsin.

Leg Length Discrepancy and Hip Arthritis

Uneven Leg Length and Degenerative Joint Disease of the Hips

When traditional Medical Doctors take X-rays, they are primarily concerned with finding broken bones, dislocations, or disease. Chiropractors look for those things too, but we also get valuable information about balance and alignment, some of which was validated by a recent study. Some people grow up with one leg slightly shorter than the other. Common sense would suggest that this would lead to less efficient joint movement and greater wear and tear in the body. 255 adult X-rays were analyzed to measure hip and low back Osteoarthritis in relationship to short leg. There was a significant correlation (though nearly twice as high in men as in women) between degenerated joints in people with short legs compared to those whose leg lengths were balanced. There was also a statistically significant relationship with low back spinal degeneration, though nowhere near as strong as that of hip degeneration.

What I find sad about this is that if leg length discrepancy is properly diagnosed, the main treatment is a rubber heel lift of a specific height placed in the bottom of the shoe on the short side. It provides a functional balance between the hips and we sell them in our office for a whopping seven dollars. Very few remedies in health care come that cheap. Of course, it is essential for the X-rays to be taken standing up in weight bearing, otherwise the relative leg length is meaningless. Using a tape measure to estimate leg length on physical exam has limited reliability, since soft tissue variations can create errors.

This new study only measured the correlation, or general relationship between short leg and hip/lumbar spine degeneration. Proving a cause/effect relationship would be much harder to do, but this study suggests it would be worth it to pursue, even if at the end of the day, a specific heel lift is likely to remain the best treatment.

*Murray KJ, Molyneux T, Le Grande MR, Mendez AC, Fuss FK, Azari MF. Association of Mild Leg Length Discrepancy and Degenerative Changes in the Hip Joint and Lumbar Spine. JMPT, June 2017, Vol 40, Issue 5, p320-329.

-Dr. Russell Petersen, DC. Creekside Performance Center, 4000 Enterprise Dr., Sheboygan, Wisconsin.