When I got him in supine for treatment, I noticed again a leg length discrepency of about 1.5 inches and attributed it to the prolonged sitting in the car. I also summized that it is a major contributor to his left knee flexion and his shaking. I suspect that he is flexing his left knee to compensate for the difference in his leg's length since his pelvis is unable to drop on the right to compensate. I also observed and palpated a restriction in his left hamstring and sciatic nerve that prevented him from obtaining knee extension in sitting with out leaning back.
With treatment of the tissues around the pelvis and legs the leg length discrepancy resolved. I also treated the left hamstring/sciatic nerved via functional mobilization with stabilization to his pelvis and left lower extremity. His gait improved and his home program the same, stand every 15 minutes getting both knees straight and weight shift.
I also worked on depressing of the right lower extremity in sitting so that he would not need to bend his left knee in order to properly heel strike.
We also worked step ups on the stairs using 1 handrail and cane (to mimic his home environment) 5 times each.
Throughout the day, I assess the leg length in supine and it manged to be okay, in spite of his sitting most of the day.
