Hi, I’ve recently read through other posts here about leg length discrepancies and it seems that you are slower to recommend shimming than Starting Strength does. Would you have any general protocols for someone with an LLD or is it case by case? I have heard with other sports like running that the literature doesn’t find orthotics to be helpful until the difference is at least 20-25mm or something. Would you recommend only shimming a shoe as a last case scenario only (e.g., if pain is present and fixing form isn’t helping)?
In my case, I’ve had hip pain since I began squatting. I pushed through pain, I made changes to my form, I dropped/added activities and exercises to see which ones aggravate it (mainly squatting). I suspected an LLD but I never got it checked out until recently because I was hoping to overcome it through fixing my form. My LLD is only 8mm (from x-ray) and I cannot squat with a level pelvis regardless of weight (which may or may not matter). I’ve tried dropping down to just the bar and building up slowly countless times hoping to develop the strength to keep my pelvis level. If I shim, my pelvis is level but I haven’t progressed it this way long enough to know if this will fix any problem. Should I just give shimming a shot? If I shim the squat should I shim my press and deadlift too (and deload to build up evenly)? I realize this may not be enough information to provide appropriate feedback. Let me know if you have any other questions.
Thanks for all the content you are putting together! I’ve learned a lot here.
Age: 32 Weight: 180lbs Height: 5’11’’
Training" 1.5-2 years on and off with main lifts but only two 3-4 month stretches working on SSLP. DL = 315x5, BP = 195x5, OHP = 120x5, SQ = sets between 155-215 depending on pain (all in lbs).
Thanks for staring the thread.
Overall, LLD is readily identifiable in asymptomatic people Similar to the discussion of imaging, if we have a high prevalence rate of a supposed issue in the asymptomatic population then it becomes increasing harder to call that issue a problem that necessitates fixing. Correlating pain to LLD is even more complicated and not well supported in the literature.
Who examined you for an LLD?
At age 32, you’ve likely had the 8mm difference throughout life (barring acute traumas) and therefore the question needs to be considered why now would this be correlated to symptoms now?
That makes sense to me, the pain could stem from any number of things. The only reason it might be correlated to my symptoms now is that my pain began when I started lifting.
I had regular hip pain lifting (on the short side) and I’ve had two bouts of what might have been sciatica (each lasting 3-6 weeks), I went to the doctor and he thought it might be sciatica but wasn’t sure. The first time I had numbness was after bumping the pins on the way down during the squat and tweaked my back. I don’t know if this continues to be related or not. It was over a year ago and I had hip pain before and after it. After the second time, the doc sent me to physio who told me to keep lifting. I asked if it could be a bulging disc they said maybe but it didn’t matter (I think BBM would agree here).
The physio helped me adjust exercises until I was pain free. The last session with them was last November. I’ve repeatedly reset my squat and tried progressing it but at some point the hip pain comes back. I went back to the doctor asking if it could be an LLD, he gave me a referral for an x-ray. After it was confirmed the doctor recommended seeing physio again and only if they recommend orthotics to consider it. I don’t want to go down that route. I am pain free for deadlifts, OHP, everything else I do except squats. I regularly take squats out of my programming so that I feel good for a few weeks and then I put them back in a low weights with a slow progression.
Shimming my squat feels good so far, I also shimmed my press once and it felt better than not shimming (but not much difference). Then I made the mistake of shimming my deadlift on a working set and that has caused pain for the last 4 days (I think TFL and glute med). Maybe too much change too fast.
Although avoidance may seem intuitively correct, it often perpetuates the situation. I’d also recommend not over analyzing this. Are you able to squat full range of motion with empty barbell? What part of the squat is bothering you?
I can squat full range of motion with an empty barbell. I’ve reset to a weight I can tolerate and progressed well up to around 170-215 around 20 times. Sometimes leaving my pelvis not level, sometimes trying to keep my pelvis as level as possible. At some point, usually when I feel it starts getting harder I get hip pain. Occassionally, its bad enough that I can’t even do the bar and I do body weight squats for a few days increasing range of motion until I can do the bar again.
i read and reread the squat chapter many times. I’ve had friends check my form and posted on the SS page for form checks. I’ve taught a couple friends to squat up to over 300lbs but can’t seem to do it myself:( (yet). Of course my form can still get better .Maybe it’s the problem, but I feel like I’ve tried quite a lot to fix it. I think it’s better now than it has ever been.
I should also say I have a really hard time getting my right knee out. Pushing my knees out equally hard results in my left knee tracking outside of my left foot and my right knee either just inside or just over my right foot. Pushing any harder forces my right foot to supinate (it’s already the longer one and this makes my pelvis more uneven). I can’t figure out if this is a problem at my ankle or hips or both. Maybe just part of the whole system being asymmetrical. The whole right side is tighter and I always feel more weight on my left. Without a shim, I can’t change this even if I’m squatting just the empty bar.
r_sund, given that your LLD measured 8mm, and in the absence of any reported causative trauma, per Michael’s inquiry, it sounds to me like you may be in the clear, as your LLD is within the normal range variance and clinical interventions would not normally be contemplated in this case. If you feel good with the shim, I would say that’s fine, but I would not place a great emphasis on your reported discomfort being attributed to your LLD, as you admittedly reported not much difference with/without the shim while pressing.
I agree with Michael that you may be overanalyzing this. Ask yourself, if you didn’t know about the LLD or shims, would you continue to train anyway? I ask this because it sounds like you are actively looking for a mechanical reason to explain your discomfort (i.e. LLD, bulging disc, sciatica, TFL, glute med), which is understandable, but remember that often times, in the absence of trauma, there is no identifiable cause for pain and discomfort and the best thing you can do is to continue to train to your tolerance rather than diligently looking for something to “fix” when nothing seems to be broken.
I would also encourage you to try and adopt a more “can do” attitude regarding cleaning up your technique. If you have identified that you are pushing your knee out so far that it is causing your foot to supinate, the obvious course of action is to stop doing that. I am certain that you are capable of figuring this out given your demonstrated analytical nature.
JHG, thanks for commenting. I suppose by posting I’m questioning what I previously understood. The SS recommendation is to shim, regardless. Up until a couple days ago when I searched this forum I thought that was the go-to protocol. My tone might sound doubtful but I’m just trying to process that shimming might not be right for me. I hope that is the case but my mind was previously made up and I had a narrative to describe what was going on.
If I go about addressing my pain through improving my form. I think my next step is sorting out my knees. Would recommend pushing my knees out equally from centre (requiring unequal force from the hips) or maintaining the assymetry by pushing out equally? Does that make sense?
Again, it sounds as though you are over-analyzing the situation. I’d recommend not looking for problems to fix but rather attempting to squat without hypervigilence to the symptoms you are experiencing. If you’d like technique advice - you can post in the BBM Facebook group. Pain is a multi-factorial experience and can’t be reduced to “this one thing”. Admittedly, I’m not a fan of shimming as the narrative usually supplied appears (in this context) to relate to a narrative that is not well supported as it relates to the experience of pain. How have you been managing since we last spoke?
Don’t you think that vigilance is a product of having a problem repeatedly? The first 5 times it happened, sure I thought, no big deal I’ll keep trying but eventually I start thinking I might be doing something wrong. I just posted to the Facebook group. I have moved past blaming the LLD thanks to BBM; I admit, when I found out, it was easy for me to say hey that must be the problem. I’ve been looking at other aspects of my form. For example, I can’t push my knees out equally side to side. Maybe that is worth working on. I ruptured a ligament in my right ankle ages ago and the joint doesn’t work the same as the left. It seems problematic to continue doing the same thing without trying to find out why I can’t progress the squat and making small changes, no?
I’ve tried a couple times this week to squat but I have pain with the empty bar and I stop at 135lbs. I think it’s just aggravated.
I should say, of course I’ve had pain at times from other lifts: a tweaked back deadlifting, elbow or shoulder pain benching. And sports and work injuries over the years, broken bones, torn ligaments, torn muscle, tendonitis. My experience until now is I back off and keep going and in time it’s fine. This problem has just been particularly stubborn for me.
Not necessarily a repeated “problem”, however hypervigilance to an area typically is a part of the persistent/recurrent pain process and may perpetuate the perceived “problem”. The process can be further perpetuated via catastrophizing (rumination over the perceived “problem”, magnification of the perceived “problem”, and learned helplessness – “I have no control over this”). Pain is complex and the longer pain persists the harder it becomes to correlate the perception to biology (like leg length discrepancy). Based on your last response, it sounds as though you found a squat technique that fits your needs and you are able to load comfortably – sounds like a big step in the right direction.
I’d like to add in here and describe my issues and what I observed. Overanalyzing might not lead to anything but the issue surely is ‘nuanced’ enough in that little changes might have a big impact.
So I have a similar situation in where I have a relatively minor but noticeable femoral LLD (left femur is longer).
My pelvis has been tilted pretty much my whole life but I didn’t have symptoms up until one deadlift maybe 1,5 years ago where everything started. Since then I had pain during squats and deadlifts from bothersome but doable to so painful that I couldn’t do the weights I was supposed to.
Before that deadlift and I knew about my LLD and tried to fix things because it bothered my form especially for squats. Like you I couldn’t keep one of my knees out and it would cave in all the time.
Tried shimming but didn’t really stick to it because I didn’t see too much improvement and at the same time actually had noticeable decrease in performance, especially in the DL and Press. I’ll admit it’s possible that I was just used to the LLD my whole life and my body adapted to it and needed some more time to get used to the shimming.
In the mean time I discovered that using a staggered stance I could suddenly keep my right knee out better and from the front at least every thing looked more symmetrical. I put my right foot (the shorter leg) slightly in front and more turned out than the left one and I’ll be damned if this didn’t improve my technique.
I started incorporating the staggered stance in the squat, deadlift as well as the press and it improved all my lifts (contrary to the shimming - ironically). All went fine for a while until, you guessed, it I suddenly had a weird “plop” in my left hip / SI joint area which caused some pain. The pain improved after the workout to a level where it didn’t bother me. During the next squat or deadlift training I could feel it again though - starting from the warmup sets. I powered through it and thought that it did get a little better during the work sets. It hurt the most when racking the bar and getting out again. But the thing is this pain never went away for maybe a year. Sometimes I could power through it with some discomfort after racking the bar and sometimes not being able to squat or deadlift at all.
I was so used to the modification I introduced earlier on with the staggered stance that I didn’t think that this might be the issue - especially since it improved my technique on the lifts. I thought I might overextend my back too much… or too little? Or maybe not do the Valsalva properly anymore? Or do something weird when lifting the bar out of the rack? But after (over?)analyzing things one painful day I realized it could be caused by my stance. It actually took me months to fully go back to the non-staggered stance, because lifting non-staggered felt so much worse in a technique kind of way that I couldn’t believe it could be because of it. So I went back and forth between staggered and non-staggered while things actually did improve… And got worse once I tried staggered again. It also got considerably better when I started to consistently just use a slightly less staggered version. This is probably where I realized it had to be the stagger and stopped using it completely, with the exception with slightly turning my feet out some more, especially the right one to allow that knee to push out as much as possible. My issue has improved massively since then with seldom having pain (last time after playing beach volley) and never affecting my lifts anymore.
So yes… I thought I was thinking things through. That putting the foot where I had issues with my knee caving in in front of the other would allow me to push it out better and solve my asymmetry. It did in some way but obviously it affected the load symmetry on my hip negatively as well.
That being said… yes I do think analyzing things properly here and trying out several thing might lead to improvements. I know from my experience that no matter how much you try to ignore it - the pain is really there. Some times less and sometimes more. Powering through it is probably what you need to do as well because you can’t just stop lifting. But there’s so many little things that could affect your lifting, technique as well as your pain. And not everything is obvious. Things are more nuanced than that.
Thanks, jwis. The last week or two I’ve been using a narrower stance with my feet only pointed out about 15 degrees and not focusing on pushing my knees out quite as hard as I was before and my squat is feeling really good. When I push out hard my left leg goes out further than my right and it’s hard not to supinate my right foot. I’m just trying to keep them over my feet which doesn’t take much effort with a narrower stance.
On another note, related or not. I went to an athletic therapist at a research centre again. They said the left side of my pelvis had anterior pelvic tilt and my right didn’t. They tried pulling it back in-line and told me I need to strength it in this position. Does this jive with current research or not? In any case, I felt the adjustment in the tension in my hip flexor and hamstring. As mentioned above, my pain worsened drastically about 1.5 years ago with a bad squat where I bumped the rack and tweaked my back. Is it possible that this is a result of an acute injury and now it’s an alignment problem? In any case, I’m trying Michael’s advice and not really worrying about what the source of the problem is. I’m trying to squat in a way that is comfortable. After 135lbs felt painful a couple weeks ago I’m now at 175lbs and it feels light and painfree.
I already had it booked since finding out about the LLD. I wanted to know what they would say. The more information I have the better decision I could make I figured. They also don’t recommend shimming. So, that reinforcement makes it a little easier I think.