Leg Length Inequality

[Guest guest]

I can't speak to the science on this issue, but I have seen many

apparent leg length discrepancies successfully treated through the use

of therapeutic, strength-oriented yoga. This yoga is based on Iyengar

practice - it emphasizes balance, stability, and strength

progressions (not stretching). It incorporates many standing poses,

and often involves the use of straps and props to make exercises

possible for people with pronounced weaknesses or limted range of

motion. My teacher claims that true leg length discrepancies that

can't be corrected by transforming postural and movement patterns are

very rare. I would definitely consider carefully before becoming

dependent upon a shoe lift, which could actually normalize the

condition and make it more intractible.

Wilbanks

Madison, WI

> Leg length inequality (LLI) is a hot area here at the moment. I was

wondering if

> anyone had any thoughts or knew of research in the following 2

areas.

>

> Can LLI be measured without an X-ray and what is the validity and

> reliability like of such measures?

>

> Is there a link between LLI and conditions such as back, hip or knee

pain?

>

> Thanks,

>

> Silverman

> Wellington, New Zealand

[Guest guest]

Dr. Siff & board,

Good post on leg length. I did not mean to imply in my post that leg

length inequality, in itself, needs to be treated. I have seen

relatively large apparent length discrepancies associated with chronic

musculoskeletal pain, along with other signs like collapsed arches,

bowed legs, or a predisposition to keep one hip externally rotated.

When these people persist at yoga, these visible signs of misalignment

tend to improve as symptoms decrease and athletic capacity increases.

I have a friend who was convinced by a doctor that LLI was his problem

and began to use lifts years ago, and has become completely dependent

upon them, in all his shoes. If he removes them, he experiences a

fairly rapid onset of chronic knee, hip, and back pain. He is

unwilling to put effort into attempting to liberate himself from the

crutch, so I'm sure he will use them for the rest of his life.

Wilbanks

Madison, WI

>

> <Leg length inequality (LLI) is a hot area here at the moment. I

was

> wondering if anyone had any thoughts or knew of research in the

following 2

> areas.

>

> Can LLI be measured without an X-ray and what is the validity and

> reliability like of such measures?

>

> Is there a link between LLI and conditions such as back, hip or knee

pain?>

>

> *** This hot area first assumed eminence in the therapeutic world

several

> decades ago when leg length differences began to be blamed for a

wide number

> of ailments, especially running injuries. This led to little wads

of

> telephone book yellow pages being inserted into shoes to correct

these

> assumed imbalances and ultimately created the whole orthotic

industry. While

> orthotics comprising expensive shoe inserts can be of definite value

in cases

> of genuine pathology, as in post-polio or accident victims with

severe lower

> extremity injury, their value for managing slight structural

asymmetries is

> far from being proven or scientifically accepted.

>

> Structural asymmetries in all animals and humans are very common, so

common,

> in fact that symmetry may be regarded as the exception rather than

the rule.

> Consequently, some degree of asymmetry is perfectly normal,

efficient and

> harmless for a given individual. Asymmetry per se should not be

regarded as

> a sign of pathology or reduced functionality; it is only when

structural

> asymmetry produces marked functional asymmetry which demonstrably

reduces

> postural and movement efficiency and safety that it should be

regarded as

> something to be concerned about.

>

> Thus, if there happens to be a small, but X-radiographically

measured

> discrepancy in leg length, but it is not provably causally related

to some

> pathology of movement, health or comfort, then it should be ignored.

Some

> apparent asymmetries may have nothing to do with skeletal

differences but far

> more with soft tissue changes, length differences, neural patterns

or muscle

> spasm. And these generally tend to resolve themselves with

relaxation,

> movement, massage, trigger point release, sports training,

stretching and

> other quite normal activities that the individual can execute

without any

> need for outside intervention.

>

> The only accurate way to measure structural asymmetries is with some

form of

> X-ray and, even then, asymmetries measured during a lying or

standing

> position may not manifest themselves in other static postures.

Then, the

> degree and significance of these apparent asymmetries may be totally

> different and indeed, even desirable, during many dynamic actions.

After

> all, if the bones of any limbs display some asymmetries, it is

likely that

> they also exhibit muscle and other soft tissue asymmetries (e.g. of

length,

> site of bony attachment, mechanical structure, etc), so that some

asymmetry

> of local or general function may be necessary to compensate for any

> structural asymmetries.

>

> Take, for example, the way in which most of us stand, sit or lie -

we shift

> regularly from one position to another to ensure that any

asymmetries do not

> lead to neural, muscular or skeletal irritation or damage. If one

does not

> change from one asymmetric position to another, as is the case in

hospital or

> paralysis, then limb and life-threatening pressure sores/decubitus

ulcers can

> result. In other words, the vast majority of bodily asymmetries

are

> automatically handled by involuntary movements or changes in rhythm

(yet

> another process associated with nonlinear dynamics which some of us

discuss

> from time to time) - even during sleep.

>

> This is why many so-called " ergonomically " designed chairs and other

devices

> can constitute a case of overkill or redundancy. One never sits in

exactly

> the same " ergonomically correct " manner for prolonged periods - we

cross and

> uncross our legs, lean forwards, lean backwards, turn left, turn

right, and

> so forth, so that all of that expensive lumbar and other support

remains

> unused and useless most of the time. Thus, if you wish to behave

more

> effectively in life, don't rely on any executive chairs, built-up

shoes, etc;

> just make sure that you move regularly and use asymmetries of

function and

> position to reduce the possibility of local stress being imposed for

too long.

>

> It is one thing to identify structural or limb length asymmetry; it

is quite

> another thing to prove that it is definitely responsible for

pathology or

> impaired performance in the healthy person. No research has

categorically

> proved that these fairly common leg length differences (or any other

> relatively minor postural idiosyncracies) are the cause of pain,

disability

> or pathology in the back, limbs or any other part of the body (I

think that

> our colleague, Barrett Dorko, may even have some essays on this

topic on his

> website - Barrett?). If there does happen to be an apparent

connection

> between physical asymmetry, pain and dysfunction, it usually is

associated

> more with the imposition of excessively large or sustained loads in

a state

> of asymmetry than with any asymmetry of itself.

>

> In the vast majority of cases this leg length dogma is not borne out

by

> research and, like so many other guruesque belief systems, is more

> commercially valid than therapeutically sound.

>

> Dr Mel C Siff

> Denver, USA

> Supertraining/

[Guest guest]

I have a personal and admittedly anecdotal story to share. As a good

Canadian boy, I have played hockey all my life. I have tried to take good

care of myself even though I have a spondylithesis that is reasonably

advanced. Hockey was always a pain in my back, in fact, skating of any

kind was very difficult.

Six years ago, someone mentioned leg length and I had it investigated to be

sure it was " real " and not muscle shortening, etc.

It turned out to be over 2cm. I had a lift placed between the blade of my

skate and the boot to make up some, but not all, of the difference. I can

honestly say that I have not had one episode of back pain while on skates

since. I can also say that crossing over to the right (short leg over long

leg) is hugely improved.

I don't know that this is a solution for everyone and I can go with or

without the lift in shoes with no nasty consequences.

FWIW,

Greg Hart

Calgary, Alberta

[Guest guest]

Hi

To determine accurate leg length difference, you must not only

align the SI’s AND pelvis rotation

And then you can visually compare the length at the heels or

ankles.

We have seen several unequal innominates when measuring the

vertical height( One was 20 mm )

Bob

W. Pfeiffer, DC, DABCO

P. O. Box 606

Pendleton Or 97801

541-276-2550

From:

[mailto: ] On Behalf Of

Lindekugel

Sent: Tuesday, January 13, 2009 9:39 AM

DC Listserve

Subject: Leg length inequality

Hi folks,

Would love to hear you views on a classic chiropractic problem - leg length

inequalities. Currently, the types of evaluation I use are standing crest

hight, X-rays, prone LLI check, quad tension test, prone motion palp of

lumbo-pelivc region, side view ASIS/PSIS palp, and ANT/POST ASIS/PSIS

palpation, standing forward bend, childs pose to get a feel for functional or

anatomical leg length discrepancies.

In school they taught us that the best (though inadequate) test is a

" scanogram " . In this test, I think they take an AP full length

radiograph from toes to lower lumbar. Then cut up the image into three

sections and measure to see where the anatomical leg length discrepancy might

exist. I called Epic and thoought I was talking another language when I

requested one.

So my questions are:

1. What are the methods you docs use?

2. Is it within a named system?

3. Is there other imaging besides AP pelvis?

4. Do you use the typical 0.5mm as a threshold for correction?

4. How certain do you feel aboiut the results?

5. How do you correct anatomical LLI in yoiur office (ie, half/full

correction, full foot/ heel lift)?

Best,

Lindekugel, DC

Concordia Chiropractic and Movement Center

5425 NE 33rd Ave.

Portland OR, 97211

503-287-2273

[Guest guest]

Hi

To determine accurate leg length difference, you must not only

align the SI’s AND pelvis rotation

And then you can visually compare the length at the heels or

ankles.

We have seen several unequal innominates when measuring the

vertical height( One was 20 mm )

Bob

W. Pfeiffer, DC, DABCO

P. O. Box 606

Pendleton Or 97801

541-276-2550

From:

[mailto: ] On Behalf Of

Lindekugel

Sent: Tuesday, January 13, 2009 9:39 AM

DC Listserve

Subject: Leg length inequality

Hi folks,

Would love to hear you views on a classic chiropractic problem - leg length

inequalities. Currently, the types of evaluation I use are standing crest

hight, X-rays, prone LLI check, quad tension test, prone motion palp of

lumbo-pelivc region, side view ASIS/PSIS palp, and ANT/POST ASIS/PSIS

palpation, standing forward bend, childs pose to get a feel for functional or

anatomical leg length discrepancies.

In school they taught us that the best (though inadequate) test is a

" scanogram " . In this test, I think they take an AP full length

radiograph from toes to lower lumbar. Then cut up the image into three

sections and measure to see where the anatomical leg length discrepancy might

exist. I called Epic and thoought I was talking another language when I

requested one.

So my questions are:

1. What are the methods you docs use?

2. Is it within a named system?

3. Is there other imaging besides AP pelvis?

4. Do you use the typical 0.5mm as a threshold for correction?

4. How certain do you feel aboiut the results?

5. How do you correct anatomical LLI in yoiur office (ie, half/full

correction, full foot/ heel lift)?

Best,

Lindekugel, DC

Concordia Chiropractic and Movement Center

5425 NE 33rd Ave.

Portland OR, 97211

503-287-2273

[Guest guest]

-

Thank you for posting this inquiry. I have a patient who has a 1/2 " lift orthotic shoe and after adjusting his SI his PSIS, Iliac Crest and heels are even (with shoes off). Seems to me like the shoes are CAUSING a misalignment. I can visually observe him stepping up and over the lifted shoe after his adjustment! Unfortunately, he doesn't have a normal pair of shoes that don't bother his feet, so they want me to analyze his LLI and make a note for his orthotic folks at the VA.

So, how best to get the true LLI? I was trained in Gonstead xray measurements at Life West and it seemed like a reliable system. I could be wrong. The short of it (paraphrased from Textbook of Clinical Chiropractic: A Specific Biomechanical Approach Plaugher et. al. and Wilkins 1993 pp.125-127) was to measure the femur head height differences to the nearest .5mm(apparent LLI), then measure the distance from iliac crest to ischial tuberosity, bilaterally. This is all done on AP full spine view, but for LLI purposes, I would only expose the pelvis, with proper shielding. The side with the greater measurement between top and bottom of the inominate is considered the posteroinferior Ilium. Now measure the lateral deviation of the center of the pubic symph from a vertical line marked at S2 or S3. The side of deviation is considered the internally rotated ilium. This is where it gets interesting:

For every 5mm of AS or In misalignment, the ipsilateral femur head height measurement will be raised 2mm. For every 5mm of PI or Ex misalignment, the ipsilateral femur head height measurement is lowered 2mm. The end result is considered the Actual LLI.

One could get more accurate within this system, but I think these measurements would get you very close to your desired values.

Any comments, correctons or more accepted methods? Please reply to group for discussion's sake.

Dr. Ian Jarman D.C.Family Wellness ChiropractorCafe of Life @ Florence, Oregon(541)997-5100www.cafeoflife.com " Live as if your life depends on it " -Werner Erhard

[Guest guest]

WHat I had learned as the only reliable method is doing a scanogram. Any radiology center can do them, or at least I know EPIC and Tuality Hospital will do them. If you don't want to do that, do a Ferguson's view with your central ray at the femur head height to reduce projection error, and go off that.

Don White, RN, DC

A Good Credit Score is 700 or Above. See yours in just 2 easy steps!

[Guest guest]

WHat I had learned as the only reliable method is doing a scanogram. Any radiology center can do them, or at least I know EPIC and Tuality Hospital will do them. If you don't want to do that, do a Ferguson's view with your central ray at the femur head height to reduce projection error, and go off that.

Don White, RN, DC

A Good Credit Score is 700 or Above. See yours in just 2 easy steps!

[Guest guest]

Siegfried, D.C.Dedicated To Your Health301 NE Dunn PlaceMcMinnville, Or. 97128503-472-6550 :office503-472-1039 :faxgrsdc@...www.siegfriedchiropractic.comFrom: grsdc@...To: andrewcha Subject: FW: Leg Length InequalityDate: Fri, 23 Jul 2010 15:52:10 -0700

Hello List mates,Great comments Dr.Cha. Enclosed is some pertinent info.I am always interested in this issue as I have a right club foot and anywhere from 15-25 mm LLI on the left side, depending on the x-ray view; am still playing baseball--pitching--in the Portland City Leagues, and am always working to reduce the effects of both my club foot and LLI. These on top of several major sports injuries in college, etc. Am currently 59. Would not be able to compete at the current level without chiropractic adjustments, etc. Siegfried, D.C.Dedicated To Your Health301 NE Dunn PlaceMcMinnville, Or. 97128503-472-6550 :office503-472-1039 :faxgrsdc@...www.siegfriedchiropractic.comFrom: grsdc@...To: drdeed@...Subject: RE: Leg Length InequalityDate: Tue, 4 May 2010 21:09:50 -0700

Thank you Dr. Deed. This is good. Siegfried, D.C.Dedicated To Your Health301 NE Dunn PlaceMcMinnville, Or. 97128503-472-6550 :office503-472-1039 :faxgrsdc@...Date: Tue, 4 May 2010 17:39:31 -0400From: drdeed@...To: webmaster@...; grsdc@...Subject: Re: Fwd: Leg Length Inequality

Dr.

I'm not exactly sure what you are wanting from me but here are some resources for you on the topic of LLI:

1. CBP Lumbar Rehab Book Chapter 4. This is has a great review of the literature with analysis and intervention. You can purchase this book online at www.idealspine.biz or by calling 1-800-346-5146 and ordering from my Receptionist Annie.

2. I just completed a short article with current studies in the CBP Trade Journal the AJCC. This is available online at:

http://chiropracticbiophysics.blogspot.com/

3. On our patient resource and CBP doctor referral site we also have a nice article on LLI for the consumer at:

http://cbppatient.com/health-conditions/

4. We recommend the full foot lifts from Sole Supports and you can see these online at:

http://www.idealspine.biz/p-180-foot-lifts-by-sole-supports.aspx

I hope this is what you were looking for.

Dr. Deed

>

> > From: Siegfried <grsdc@...>

> > Date: May 3, 2010 12:32:50 PM EDT

> > <webmaster@...>

> > Subject: Leg Length Inequality

> >

>

> > Hello Deed,

> >

> > Can you refer/send me the most current info on this issue? Hello To

> > Don. We went to school together at WSCC.

> >

> > Thank you,

> >

> > Siegfried, D.C.

> > Dedicated To Your Health

> > 301 NE Dunn Place

> > McMinnville, Or. 97128

> > 503-472-6550 :office

> > 503-472-1039 :fax

> > grsdc@...

> >

> >

> >

> > The New Busy is not the old busy. Search, chat and e-mail from your

> > inbox. Get started.

Deed E. on, DC

President- CBP Seminars

Vice President- CBP NonProfit, Inc.

Chair PCCRP Radiographic Guidelines

ICA NV State Assembly Representative

Director- Ruby Mtn. Chiropractic Center, Inc.

www.idealspine.com & www.ChiropracticBioPhysics.com The New Busy is not the old busy. Search, chat and e-mail from your inbox. Get started. The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy. The New Busy think 9 to 5 is a cute idea. Combine multiple calendars with Hotmail. Get busy.

[Guest guest]

All right, that’s it!

I’m taking down the Vern Saboe poster in my room (Blue leotard with big red “S” on his chest) and putting up Sears and Siegfried posters.

We need heroes. Maybe I can get them posing together like Arnold and Sly Stallone.

Hey! I can hope can’t I?

E. Abrahamson, D.C.

Chiropractic physician

Lake Oswego Chiropractic Clinic

315 Second Street

Lake Oswego, OR 97034

503-635-6246

Website: http://www.lakeoswegochiro.com

From: Siegfried <grsdc@...>

Date: Fri, 23 Jul 2010 16:16:20 -0700

< >

Subject: FW: Leg Length Inequality

Siegfried, D.C.

Dedicated To Your Health

301 NE Dunn Place

McMinnville, Or. 97128

503-472-6550 :office

503-472-1039 :fax

grsdc@...

www.siegfriedchiropractic.com

From: grsdc@...

andrewcha

Subject: FW: Leg Length Inequality

Date: Fri, 23 Jul 2010 15:52:10 -0700

Hello List mates,

Great comments Dr.Cha. Enclosed is some pertinent info.

I am always interested in this issue as I have a right club foot and anywhere from 15-25 mm LLI on the left side, depending on the x-ray view; am still playing baseball--pitching--in the Portland City Leagues, and am always working to reduce the effects of both my club foot and LLI. These on top of several major sports injuries in college, etc. Am currently 59. Would not be able to compete at the current level without chiropractic adjustments, etc.

Siegfried, D.C.

Dedicated To Your Health

301 NE Dunn Place

McMinnville, Or. 97128

503-472-6550 :office

503-472-1039 :fax

grsdc@...

www.siegfriedchiropractic.com

From: grsdc@...

drdeed@...

Subject: RE: Leg Length Inequality

Date: Tue, 4 May 2010 21:09:50 -0700

Thank you Dr. Deed. This is good.

Siegfried, D.C.

Dedicated To Your Health

301 NE Dunn Place

McMinnville, Or. 97128

503-472-6550 :office

503-472-1039 :fax

grsdc@...

Date: Tue, 4 May 2010 17:39:31 -0400

From: drdeed@...

webmaster@...; grsdc@...

Subject: Re: Fwd: Leg Length Inequality

Dr.

I'm not exactly sure what you are wanting from me but here are some resources for you on the topic of LLI:

1. CBP Lumbar Rehab Book Chapter 4. This is has a great review of the literature with analysis and intervention. You can purchase this book online at www.idealspine.biz or by calling 1-800-346-5146 and ordering from my Receptionist Annie.

2. I just completed a short article with current studies in the CBP Trade Journal the AJCC. This is available online at:

http://chiropracticbiophysics.blogspot.com/

3. On our patient resource and CBP doctor referral site we also have a nice article on LLI for the consumer at:

http://cbppatient.com/health-conditions/

4. We recommend the full foot lifts from Sole Supports and you can see these online at:

http://www.idealspine.biz/p-180-foot-lifts-by-sole-supports.aspx

I hope this is what you were looking for.

Dr. Deed

>

> > From: Siegfried <grsdc@...>

> > Date: May 3, 2010 12:32:50 PM EDT

> > <webmaster@...>

> > Subject: Leg Length Inequality

> >

>

> > Hello Deed,

> >

> > Can you refer/send me the most current info on this issue? Hello To

> > Don. We went to school together at WSCC.

> >

> > Thank you,

> >

> > Siegfried, D.C.

> > Dedicated To Your Health

> > 301 NE Dunn Place

> > McMinnville, Or. 97128

> > 503-472-6550 :office

> > 503-472-1039 :fax

> > grsdc@...

> >

> >

> >

> > The New Busy is not the old busy. Search, chat and e-mail from your

> > inbox. Get started.

Deed E. on, DC

President- CBP Seminars

Vice President- CBP NonProfit, Inc.

Chair PCCRP Radiographic Guidelines

ICA NV State Assembly Representative

Director- Ruby Mtn. Chiropractic Center, Inc.

www.idealspine.com & www.ChiropracticBioPhysics.com

The New Busy is not the old busy. Search, chat and e-mail from your inbox. Get started. <http://www.windowslive.com/campaign/thenewbusy?ocid=PID28326::T:WLMTAGL:ON:WL:en-US:WM_HMP:042010_3>

The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy. <http://www.windowslive.com/campaign/thenewbusy?tile=multiaccount & ocid=PID28326::T:WLMTAGL:ON:WL:en-US:WM_HMP:042010_4>

The New Busy think 9 to 5 is a cute idea. Combine multiple calendars with Hotmail. Get busy. <http://www.windowslive.com/campaign/thenewbusy?tile=multicalendar & ocid=PID28326::T:WLMTAGL:ON:WL:en-US:WM_HMP:042010_5>

[Guest guest]

Ok how many mm are you using in a lift I assume? Why do you think it is 15-25 mm big range. ElliottSent via BlackBerry by AT&TFrom: Siegfried <grsdc@...>Sender: Date: Fri, 23 Jul 2010 16:16:20 -0700< >Subject: FW: Leg Length Inequality Siegfried, D.C.Dedicated To Your Health301 NE Dunn PlaceMcMinnville, Or. 97128503-472-6550 :office503-472-1039 :faxgrsdchotmailwww.siegfriedchiropractic.comFrom: grsdchotmailTo: andrewcha Subject: FW: Leg Length InequalityDate: Fri, 23 Jul 2010 15:52:10 -0700Hello List mates,Great comments Dr.Cha. Enclosed is some pertinent info.I am always interested in this issue as I have a right club foot and anywhere from 15-25 mm LLI on the left side, depending on the x-ray view; am still playing baseball--pitching--in the Portland City Leagues, and am always working to reduce the effects of both my club foot and LLI. These on top of several major sports injuries in college, etc. Am currently 59. Would not be able to compete at the current level without chiropractic adjustments, etc. Siegfried, D.C.Dedicated To Your Health301 NE Dunn PlaceMcMinnville, Or. 97128503-472-6550 :office503-472-1039 :faxgrsdchotmailwww.siegfriedchiropractic.comFrom: grsdchotmailTo: drdeedidealspineSubject: RE: Leg Length InequalityDate: Tue, 4 May 2010 21:09:50 -0700Thank you Dr. Deed. This is good. Siegfried, D.C.Dedicated To Your Health301 NE Dunn PlaceMcMinnville, Or. 97128503-472-6550 :office503-472-1039 :faxgrsdchotmailDate: Tue, 4 May 2010 17:39:31 -0400From: drdeedidealspineTo: webmasteridealspine; grsdchotmailSubject: Re: Fwd: Leg Length InequalityDr. I'm not exactly sure what you are wanting from me but here are some resources for you on the topic of LLI: 1. CBP Lumbar Rehab Book Chapter 4. This is has a great review of the literature with analysis and intervention. You can purchase this book online at www.idealspine.biz or by calling 1-800-346-5146 and ordering from my Receptionist Annie. 2. I just completed a short article with current studies in the CBP Trade Journal the AJCC. This is available online at:http://chiropracticbiophysics.blogspot.com/ 3. On our patient resource and CBP doctor referral site we also have a nice article on LLI for the consumer at:http://cbppatient.com/health-conditions/ 4. We recommend the full foot lifts from Sole Supports and you can see these online at:http://www.idealspine.biz/p-180-foot-lifts-by-sole-supports.aspx I hope this is what you were looking for. Dr. Deed>> > From: Siegfried <grsdchotmail>> > Date: May 3, 2010 12:32:50 PM EDT> > <webmasteridealspine>> > Subject: Leg Length Inequality> >>> > Hello Deed,> >> > Can you refer/send me the most current info on this issue? Hello To > > Don. We went to school together at WSCC.> >> > Thank you,> >> > Siegfried, D.C.> > Dedicated To Your Health> > 301 NE Dunn Place> > McMinnville, Or. 97128> > 503-472-6550 :office> > 503-472-1039 :fax> > grsdchotmail> >> >> >> > The New Busy is not the old busy. Search, chat and e-mail from your > > inbox. Get started. Deed E. on, DCPresident- CBP SeminarsVice President- CBP NonProfit, Inc.Chair PCCRP Radiographic GuidelinesICA NV State Assembly RepresentativeDirector- Ruby Mtn. Chiropractic Center, Inc.www.idealspine.com & www.ChiropracticBioPhysics.com The New Busy is not the old busy. Search, chat and e-mail from your inbox. Get started. The New Busy is not the too busy. Combine all your e-mail accounts with Hotmail. Get busy. The New Busy think 9 to 5 is a cute idea. Combine multiple calendars with Hotmail. Get busy.