It is not uncommon to hear “My left leg is just not as stable as my right” or “I lack control placing my right foot on runs” or “My balance is much better on one side.” I haven’t encountered people voicing this about their arms, but it could certainly manifest in the upper body as well. I won’t say it’s always, but it seems like in all cases when patients have complaints about a lack of stability in one leg (not a specific joint, but the entire limb), it’s a spine issue.
Again, if we think of the spine as the fuse box, it makes sense that an irritated spine could create these somewhat vague complaints in the limb. While “instability” is usually a good, appropriate descriptor, it’s also often a lack of control, responsiveness, and/or balance. What I’ve seen people call “dead leg syndrome” on blogs is most likely an example of this too.
Don’t make the mistake I made. Years ago I noticed a marked difference in the stability between my right and left lower extremities. Leaning against the wall in the hospital one day with my legs about a foot from the wall, I could balance fine on my left leg when it was placed under my left hip socket, but failed miserably to do so on my right side. I spent close to a year doing relatively fruitless single leg strengthening and balance/coordination exercises. It got better, but not by much. Some time after that (having given up on making progress and having gotten into MDT), I remedied the issue with directional preference movements of my low back. -- Laura
If you are not well-versed in ruling out the spine as the source of an extremity symptom, you are missing roughly half of the sources of patients’ problems. This issue can be mitigated if the patient has been referred from someone whom you trust has already effectively clinically cleared the spine. Often, however, people with knee pain go directly to a “knee doctor” or those with numb hands visit a “hand doctor” who, in my experience, only examine that specific body part.
A system, an algorithm, is needed to ensure success in any paradigm. In my practice, experience and pattern recognition factor in, but a structured process directs my evaluation and treatment. Most importantly, a patient’s spine is investigated before moving on to an extremity. I’ll say we need to ensure the problem is not coming from a faulty fuse box (since so often it is). How long I spend on this inquiry can be minutes, it can be days - it depends on the individual case.
There is certainly a role for these professionals, but our current utilization methods need revamping. Let’s use extremity specialists only when it’s clear-cut that that intervention would be most effective for helping patients. --Laura
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