Print

Please login or register.
1 Hour 1 Day 1 Week 1 Month Forever
Login with username, password and session length

[682]

Hello all,

             In my opinion, the biggest issue and obstacle faced in limb lengthening is the damage and poor adaptation of soft tissue to the newly formed bone. While the procedure, lengthening, pain etc. can be difficult and lengthy, once it is complete, the bone is functionally no different than that found in the rest of your leg and should, in theory pose no more problems. The same cannot be said for the soft tissue, ligaments, blood vessels, muscle etc. which appear to be stretched and adapt poorly causing numerous issues ranging from loss of athletic ability, fatigue to more serious and dangerous issues such as permanent damage through plastic deformation if lengthening goes beyond the upper limit of what the soft tissue is capable of.

I recently put the following 2 questions to Dr Birkholtz in his respective thread and I am awaiting his reply, until then I shall post them here in an attempt to create some discussion.

1) Soft tissue is one of the largest issues in regards to limb lengthening. Is there a medical consensus on why soft tissue doesn't adapt the same way it does during natural bone growth? We are all aware that after growth plates fuse no more growth can occur even under the same hormonal conditions but why does the same issue of growth of soft tissue occur where they technically have no 'end point' similar to plate fusion? Could one not accurately reproduce the hormonal conditions in soft tissue growth to mimic that found in natural growth? I believe I have read some studies that refer to issues with cell reproduction of soft tissue in regards to this.


2) A second question regarding soft tissue, after leg lengthening, does the body ever truly recover to the stretching even several years after combined with consistent physical therapy (if lengthened to reasonable standards rather than over lengthening leading to plastic deformation which I assume is permanent), creating new tissue as found in someone with legs of that natural length or does the body just adapt and become more flexible rather than truly recovering, with the soft tissue always being stretched to accommodate the new bone?

It raises other questions that just cannot be answered currently. Stem cell treatment sounds promising to address such issues but is currently in its infancy unfortunately, I hope that research in this field is furthered and can be applied to limb lengthening patients to ensure soft tissue adaptation and athletic ability isn't diminished.

Thoughts?

[TIBIKE200]

About your first question, remember that no one grows (usually) mm a day, every day non stop. Unlike natural growth which is slower. Also, the muscles dont stretch as much during natural growth also because it's not just one end of the bone that is becoming longer. Femoral muscles do get stretched during growth, but remember that the pelvis also grow in width and length so if someone let's say grows an inch, it's a combination of the femurs getting longer but also the pelvis getting longer and wider (and thus the proximal end of the quadriceps for example also go further away so in the end, the quadriceps doesn't get stretched by an inch but less).
   
  But the biggest factor is the much much slower growth rate combined with the flood of growth factors (HGH being only one of them)

[682]

You make some very valid points. The issue with speed is that no matter how slow we lengthen, it must be at a rate at which consolidation won't occur which will always be at a faster rate than ever found naturally. I wonder if theoretically, we could lengthen over a much longer amount of time would the effects not be such an issue, obviously, having a broken bone such a time span without consolidation practically would be impossible.

It makes me wonder if in an ideal world where finances, time, pain and complications weren't an issue (Oh how one can dream), would doing 2 or even 3 small surgeries in total with adequate consolidation and recovery between be a much more optimal process than simply one surgery and one phase of distraction.

I hadn't considered the effect of pelvic growth, thank you for bringing it to my attention.

You are of course correct in regards to the role hormones play in relation to growth and that human growth hormone is but one of many hormones which all play a part in growth. I think there is massive potential in hormone and stem cell therapy in the future to address many of the issues found.

[IwannaBeTaller]

1) Soft tissue is one of the largest issues in regards to limb lengthening. Is there a medical consensus on why soft tissue doesn't adapt the same way it does during natural bone growth? We are all aware that after growth plates fuse no more growth can occur even under the same hormonal conditions but why does the same issue of growth of soft tissue occur where they technically have no 'end point' similar to plate fusion? Could one not accurately reproduce the hormonal conditions in soft tissue growth to mimic that found in natural growth? I believe I have read some studies that refer to issues with cell reproduction of soft tissue in regards to this.

It's because of the speed. I once read that even if you lengthen at "only" 0.66 mm a day, this is still about 6 times faster than the speed of natural bone growth, which is why the soft tissue can't really adapt. But with LL, you can't lengthen at a slower rate because of pre-consolidation. So I wonder if we could, in theory, lengthen very slowly, allowing the soft tissue to adapt, and break the bone surgically every time it consolidates, and keep lengthening. Would this allow the soft tissue to adapt?

Then again, this doesn't explain why some people naturally grew extremely fast and had no soft tissue damage. This guy, Tony Robbins, with a pituitary gland tumor, apparently grew 10 inches over the course of 1 year. That's faster than even a LL surgery will allow. How does this guy not have extreme soft tissue damage? And then I heard many tall people say they have joint pains, but they are probably not as extreme as LL complications?

[682]

Iwannabetaller - Great minds think alike, I said a very similar thing in the post above yours including the theory of slow lengthening, the issue with unwanted consolidation and the theoretical re-breaking and lengthening and whether that would allow the soft tissue to adapt more efficiently compared to traditional lengthening.

The question about Tony Robbins raises a very interesting point, he grew an astronomical amount in a very short time period yet suffered no physical ailment (apart from the complications related to acromegaly/excessive growth hormone) that I know of. As I mentioned in my original post, if we were able to fully mimic hormonal levels during natural growth would the soft tissue react accordingly or is there another unknown issue/upper limit in which soft tissue reaches its own equivalent of epiphyseal plate closing after a certain amount of time that will no longer adapt to additional growth?

[Ozymandias]

Then again, this doesn't explain why some people naturally grew extremely fast and had no soft tissue damage. This guy, Tony Robbins, with a pituitary gland tumor, apparently grew 10 inches over the course of 1 year. That's faster than even a LL surgery will allow. How does this guy not have extreme soft tissue damage? And then I heard many tall people say they have joint pains, but they are probably not as extreme as LL complications?

If my math is right, 10 inches in 1 year is less than 0.7 mm/day, which seems a reasonable speed for tibial lengthening (and even slow for femurs). Plus, that guy probably had that lengthening kinda evenly distributed along his whole body (tibias, femurs, spine, neck...) so the stress on the soft tissue was much lower than in LL. And even more, I think he was a teenager when that growth happened, right? He was probably not done (naturally) growing yet.

[0184946]

The question about Tony Robbins raises a very interesting point, he grew an astronomical amount in a very short time period yet suffered no physical ailment (apart from the complications related to acromegaly/excessive growth hormone) that I know of. As I mentioned in my original post, if we were able to fully mimic hormonal levels during natural growth would the soft tissue react accordingly or is there another unknown issue/upper limit in which soft tissue reaches its own equivalent of epiphyseal plate closing after a certain amount of time that will no longer adapt to additional growth?

he didn;t even know he had acromegaly till he was 31 when he went for a casual check up. imagine that. being 6'7 growing from 5'1 to 5'11 in a year and not knowing anything is wrong. apparently his growing pains must've been bearable. and he has mentioned he is doing fine health wise. but i think his lucky he hasn't came across cancer risk from all those cells dividing at a alarming rate.

[TIBIKE200]

Remember also that Usually when we talk about leg lenghts, average inseam for jeans is usually 31-33. These lengths can accomodate both men who are 5'6 and also 6'. Many 6 footers have an inseam that is 32-34 which means that alot of them don't usually have freakishly long legs (like some here would think), but as Ozy said, it's a combination of many factors (pelvis, back, neck).

 

[IwannaBeTaller]

If my math is right, 10 inches in 1 year is less than 0.7 mm/day, which seems a reasonable speed for tibial lengthening (and even slow for femurs). Plus, that guy probably had that lengthening kinda evenly distributed along his whole body (tibias, femurs, spine, neck...) so the stress on the soft tissue was much lower than in LL. And even more, I think he was a teenager when that growth happened, right? He was probably not done (naturally) growing yet.

True, but since you grow more in summer than in winter, at one point in that year it must have been faster than .7 mm a day. But even then, it grew over the whole body as you've said.

[0184946]

but is the 0.7mm/day rate perfect ratio to prevent premature consolidation while at the same time having minimal lengthening pains?

[2please]

Are the soft tissue complications that are experienced typically local in that they normally only occur around the point at which the bone is broken? Or is soft tissue adaptation difficulty typically experienced up and down the entire limb extending from the epicenter (the location where the bone was broken)? Any anecdotal MRI's to suggest one or the other? I know it's already been mentioned by you guys but maybe there is indeed something to breaking the bone in two separate areas and increasing bone length to a lesser extent in two areas than entirely in one area in order to mitigate soft tissue adaptation complications. I'm also wondering if exogenous HGH injections or increasing endogenous HGH with peptide secretagogues (oral or injected) during recovery would help the soft tissue adapt quicker and ideally at the same rate as the bone is growing. Does anyone know if supranatural HGH supplementation is part of the LL recovery protocol or has it been suggested by any of the doctors?