INTERNAL HEALTH: A Chiropractic Specialty
The Lower Extremities—Part III
by Howard F. Loomis, Jr., D.C., F.I.A.C.A.
This article is the conclusion of a series on the short leg syndrome. Previously, I have discussed the
importance of proper alignment of the
hip, knee, and ankle joints to each other.
This month, we move into the pelvis
and summarize the role of proper lower
extremity mechanics on walking and
maintaining proper spinal alignment.
Prone hip extension to verify pelvic
Ask the patient,while lying prone, to
bend one knee to 90 degrees and raise that
leg off the table as far as possible. Check
the height. Return the leg to the table
and straighten the knee. Now, have the
patient similarly raise the opposite leg,
and determine the side of RESTRICTED
hip extension. The following muscles are
involved with extending the hip with the
• Adductor Magnus (posterior part)
• Gluteus Maximus
• Semitendinosus and Semimembranosus
There is an interesting relationship
involving the quadriceps and the hamstring muscles. Despite being antagonists
to each other, both the hamstrings and
quadriceps contract when one is rising to
stand from a sitting or squatting position.
Their combined effort allows for efficient
• The hamstrings (L4 to S3) pull harder
on the hip than the rectus femoris, resulting in hip extension. Hip extension
also adds a passive stretch component
to the rectus femoris, which results in
a knee extension force.
• The rectus femoris (L2 to L4) pulls
greater on the knee than the hamstrings, resulting in knee extension.
This is a useful clinical sign for de-
termining acute problems in the lumbar
spine that also involve the quadriceps
muscle, which is innervated by the
femoral nerve (L2 to L4). Patients with
low back pain will rise from a seated
position by using their hands to “walk
up” their thighs.
I would like to close this account of
the short leg syndrome by pointing out
that the dura mater and the sympathetic
chain also originate from the sacro-coccygeal articulation. The implications
are profound and easily account for the
success of our profession in the past. I
believe an appreciation for the material
presented in these articles will take you
a long way toward professional success
in the 21st century.
Dr. Howard Loomis can be
reached by mail at 6421 Enterprise Lane, Madison, WI 53719
or by phone at 1-800-662-2630.
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