To Shim or Not to Shim

Around 2004, I had been doing triathlons for about 2 years and was aiming for my first marathon, the NYC marathon, in the fall of 2004. It was during this training period that I went to my physical therapist at the time who took an X-ray of my spine and saw that it was curved, due to the fact that my right leg was shorter than my left which jacked my spine due to my hip being not level. Because of this imbalance, all sorts of weird problems kept coming up in my knees, IT band, calves – you name it, it was hurtin’!
The fix was to get some hard orthotics, made from carbon fiber no less, and to shim up my right heel by about 1/8″. He told me that this was very common and that this should fix a lot of things. After using these hard orthotics for a little while, they cured not only my pronation related problems but also removed a lot of other nagging problems. I was ecstatic! While I wasn’t totally problem free, I was at least on the path to making it to the NYC marathon in one piece.
Then I discovered ART. And more significantly, I started using ART for performance enhancement, not just curing and managing my problem areas. In my case, this involved freeing up my hip areas where it meets the top of the leg. When my PT worked on these areas, he discovered so much constriction and adhesions that had developed over decades of being non-athletic and sedentary. He aggressively and regularly worked my psoas and glute muscles, and of course continued working on my quads, IT band, and hamstrings. The net effect was that all of sudden when I was struggling to run 2:00 400s on the track, this dropped instantly by 15 seconds after only 2 weeks!
This is significant, but not quite the focus of this post – the other effect was that after working on the whole leg, and using anatomy train and kinetic chain concepts in his ART treatment, he would place both legs together to assess the difference in leg lengths and….now they were both the same length!
Whoa. All this time, I was thinking that perhaps I was just born with a slightly shorter right leg and now that was clearly not the case. What was going on?
In the course of many discussions with my PTs over time, I had discovered that this is often a common phenomenon with many athletes. As a matter of fact, I encountered this often in magazine articles when they talk about cyclists, who after going to get an expensive bike fit, will be recommended a heel lift on one leg to help balance out power output. In subsequent discussions, I also learned that some people ARE actually born with a severe leg length differences, sometimes over 1/2″! I can’t imagine what that would feel like when walking, but then we just adjust our bodies to do so and we don’t feel any problems until something bad happens and we come into PT to get assessed and realize that we’re not symmetrical.
However, given my own experience with this on my own body, I know it’s curable. And in talking with my PT about it, he thinks it’s curable in over 90% of the cases. Wow. Something as simple as a leg length difference, which would be caused by all sorts and types of muscle imbalances, leading to injury due to the imbalance and uneven stresses on your body parts. And totally curable, but without the need for a crutch such as a heel lift or shim.
Why is the heel lift/shim a crutch? Because it doesn’t address the actual problem but only puts a bandaid on it. Think about what could cause your leg to be shorter than the other. In my case, it was a lot of bunched up, super tight muscles up by the hip area that were so tight and inflexible that they yanked my entire leg upward into the hip joint, causing a shortness of about 1/8″. So now I put a shim under my foot and at least I’m not running unbalanced, but my muscles are still constricted up there. Over time, this can cause all sorts of problems in the muscles, affect your speed, and potentially cause wearing down of the hip joint because additional pressure is being put in the ball and socket there. Isn’t this bad?
It is unfortunate that so many people are not aware of a cure for leg length problems and prescribe such things as heel lifts and shims. I am also surprised that those who do know unfortunately are not very likely to seek treatment and go through what it takes to remove this problem. Instead, they would rather just put a shim under their heel and go on with their lives because it’s easier, and certainly less expensive and less troublesome than going to a competent PT who can eliminate this problem over time.
Personally, I would rather not put a bandaid on a problem and make time to completely remove the problem which I know will extend my ability to race injury free for many years to come.

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2 responses

  1. Jamie Avatar

    I absolutely agree . . . to a point.
    First off, while in your situation the shim was a band-aid, that’s not going to be true for everyone. Your problem is functional, a by-product of muscular and fascial imbalance. There are others who have a structural issue–that is, their bodies are actually put together in a particular way. It’s the difference between flat feet and fallen arches– to have flat feet is a structural issue; no amount of training and corrective therapy is going to alter the skeletal construction of your feet. Fallen arches (chronic overpronation), on the other hand, can usually be remedied with work on the plantar fascia and strengthening of the muscles underneath the fascia.
    The ideal situation for a functional problem is to re-align the muscles and fascia for optimal performance. That’s what you’re doing with ART. My concern with that, however, is that when an athlete gets into a race situation–especially an ultra-endurance event like an Ironman, ultra marathon, or (for some athletes) even just a marathon–the muscles are going to become so fatigued that they slip into their bad patterns again. Of course, that might not be necessarily detrimental, depending on the length of the endeavor and the overall health of the athlete.
    I personally would prefer to gradually remove everything that aids proper biomechanics, which really just means that you don’t have to concentrate on form; I think that makes your body lazy. That’s why I advocate barefoot running. That said, I do race with running shoes, and I do have shims in my bike shoes to correct an unusual twist in my right ankle.

  2. DShen Avatar

    Yes you’re absolutely correct. I should have been more clear about that in the post because I did mention 90% of the cases but didn’t elaborate on that further.
    There will always be structural issues that cannot be solved without shims or other types of aids. So in those cases there is no choice but to shim.
    However, in talking around with people, reading articles about those who are shimming, and also in conversations with my 2 PTs, there are so many out there who don’t have true structural issues and in those case it is my belief that shims and the like are only band aids and that the basic issue has not really been addressed, which could then lead to a true cure for the condition.
    I think it is a shame that many people won’t put in the time to see whether their issue is truly structural or functional or not, and rather just go do the easy fix and not put in the effort to achieve a true, long lasting fix. And that requires time to go into a PT who knows what they’re doing, as well as correcting the imbalances in their bodies that you talk about, and most likely changing the way they’ve been doing things technique wise. Not many people are willing to do that.

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