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[kats20]

Hi guys hope you're all doing well. I understand that the main problem with ll is the stretching of soft tissues. Can someone please explain to me the difference between natural growth during puberty vs ll? Why can we not stimulate growth of soft tissues during ll?gm

[Ostentician]

With natural growth your body adapts to the change rather quickly and becomes balanced. The muscles and bone grow in conjunction with each other and this results in a much more balanced, normal growth.

With LL, you are stretching your leg bones and not growing anywhere else. So your body has to adapt to the growth without having the benefit of having the rest of the body (muscles, veins and nerves) grow with it. This leads to some mobility and balance loss.

[kats20]

thanks  for your reply - what is it that makes the tissues grow during puberty though? Is it just because the natural growth of the bone during puberty is slower than ll so the tissues have time to grow? Does this mean that if you could do ll really slowly, the tissues would have time to grow rather than just stretching unnaturally fast?

[ghkid2019]

thanks  for your reply - what is it that makes the tissues grow during puberty though? Is it just because the natural growth of the bone during puberty is slower than ll so the tissues have time to grow? Does this mean that if you could do ll really slowly, the tissues would have time to grow rather than just stretching unnaturally fast?

Yes. You grow much faster during LL than during puberty. You grow an inch a month in LL opposed to like an inch every 3 months in puberty.

You also have high as fk growth hormone during puberty, so everything grows faster and better than just stretching

[kats20]

why is it not possible to lengthen slowly enough for the tissues to grow alongside the bone? Or at least, why is there not more focus on regeneration of the tissues during traditional ll? The surgery as it is just now just seems so...........primitive. Do you think these are the areas which will see developments in the future?

[Ostentician]

Leaving the nail for lengthening for longer than a few months would cause lots of infection. Besides, unless you have a protein deficiency or something your muscles should return to a relatively normal state after a while. On development, I'm not sure. We've advanced a lot from previous lengthening techniques (ie we have nails that lengthen from inside instead of the barbaric nail that used to be used) however I don't think this is a surgery that will ever be 100% risk, complication and after effect free. You are, after all, destroying your bones and molding them into your own image to make them the length you want.

[cyborg4life]

If you lengthen too slowly you could end up with a premature union of the bone which wouldn't be ideal for max length causing the surgeon to do another break etc. aka not fun. But times are changing. There are a lot of LL doctors doing research on improving recovery post LL etc. Also technology is moving faster than a lot of people may know so in my opinion I think there will be advancements that are more appealing than current LL methods.

[Aquahoma2]

Sorry, guys, a very stupid question follows. I am just a little bit confused by your discussion.

It's clear that when you stretch your broken bones, the bone tissue grows in between the parts of bone. But what really happens to all the other tissue, i.e. muscles, nerves, vessels, etc.? Do they grow too, or just remain in an unnatural stretched position forever? I supposed that they are stretched at first, and then grow essentially to the position that would be normal if you had had this bone length originally.

[ghkid2019]

Sorry, guys, a very stupid question follows. I am just a little bit confused by your discussion.

It's clear that when you stretch your broken bones, the bone tissue grows in between the parts of bone. But what really happens to all the other tissue, i.e. muscles, nerves, vessels, etc.? Do they grow too, or just remain in an unnatural stretched position forever? I supposed that they are stretched at first, and then grow essentially to the position that would be normal if you had had this bone length originally.

they grow also. they dont stay stretched forever

[kats20]

If doctors focused more on recovery of soft tissues obviously more people would do it. Even though it's a barbaric procedure I know I would do it in a heartbeat if recovery methods were more advanced and sophisticated.

I appreciate your thoughts and it is good to hear from people much more knowledgeable than myself that methods/technologies are developing.

[kats20]

Why do you not have a full recovery though if the stretched tissues eventually do catch up with the bone growth?

What I'm saying is yes, you definitely do not have a full recovery, but can someone please explain to me the physiological reasons behind it?

For a layperson catch up growth would seem to equal full recovery although this is obviously not the case so I'm trying to understand why..............

[Ostentician]

Your body simply isn't use to having a longer leg and it probably will never 100% adapt. Guys who have LL write about how their leg feels unruly and unbalanced after finishing LL, and how it's harder to maneuver it after due to the extra length and weight. I think this is alleviated if you only lengthen a safe amount (3-5 cm) but I still think it has some effect. Your changing your bodies core balance after all.

[kats20]

Which area do you think developments are most likely to be in -

a.finding a method of distracting the bone slowly enough for soft tissues to grow in unison ie. comparable to puberty, or

b.finding more sophisticated ways of helping soft tissues recover

[Polvorón]

Your body simply isn't use to having a longer leg and it probably will never 100% adapt. Guys who have LL write about how their leg feels unruly and unbalanced after finishing LL, and how it's harder to maneuver it after due to the extra length and weight. I think this is alleviated if you only lengthen a safe amount (3-5 cm) but I still think it has some effect. Your changing your bodies core balance after all.

But that would happen to puberty tall people too, not only people who did CLL.

[IwannaBeTaller]

But that would happen to puberty tall people too, not only people who did CLL.

It's true that people who are naturally tall also have issues with balancing and finding it harder to maneuver their bodies due to their longer legs and higher center of gravity. That's why having shorter legs can be an advantage for certain sports/certain positions in sports, although being tall also has many advantages (it's why shorter athletes like Messi learn to use their shorter legs as they gives him better agility and a lower center of gravity compared to many taller players).
It's also a possible reason, as I remember someone in the forum mentioning, why there are so many falls in NBA games which has a lot of tall players. The only difference between naturally tall people and those who did LL in that regard is that the naturally tall people had more time to adapt to their body since they reached their height in their teenage years.

[IwannaBeTaller]

Sorry, guys, a very stupid question follows. I am just a little bit confused by your discussion.

It's clear that when you stretch your broken bones, the bone tissue grows in between the parts of bone. But what really happens to all the other tissue, i.e. muscles, nerves, vessels, etc.? Do they grow too, or just remain in an unnatural stretched position forever? I supposed that they are stretched at first, and then grow essentially to the position that would be normal if you had had this bone length originally.

The body actually creates new tissue cells during limb lengthening, it's not only existing cells stretching. However, if I recall correctly, the process is still inferior to the natural growth of the body during adolescence. The tissue isn't able to adapt to the longer bone as well as if it had been natural growth. Someone in the forum posted an email from an LL doctor about that question and the doctor said that when natural growth is finished, there probably is an unknown genetic trigger that tells the body cells to stop growing naturally, and since we can't activate that trigger with distraction osteogenesis, the result will not be as good.

[kats20]

thanks Iwannabetaller, that seems to answer my question. Hopefully there will be more research into reprogramming the body back to a state of 'natural' growth during ll.

[Polvorón]

Soft tissues can grow, look at people with stretched earlobes, some people have really big holes, some enough to put a drink can inside. Also, sometimes people get their skin burned and lost, and that skin is recovered through distraction of surrounding skin.

My advice is to take X rays, and if the bone is not consolidating too fast, decrease the elongation rate, I have read here that this makes the process better.

[IwannaBeTaller]

Soft tissue can grow, but the growth process during LL is inferior to natural growth of soft tissue during childhood/puberty. That means the soft tissue will be stretched and won't perform as well as it had originally. I have found the statement from an LL doctor I talked about earlier, and I remembered correctly. It was from Dr. Birkholtz:

3) 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.

The main difference in soft tissue adaptation to growth during normal growth vs CLL growth, is the rate at which it occurs. It seems like one of the ways that soft tissue adapts to growth is because of a constant distraction force which triggers gene expression and provides soft tissue growth. In normal growth, this rate of elongation is quite slow and as a result the tissues grow at the optimal rate and can 'keep up'. In limb lengthening we have to speed up the process because the bone will consolidate prematurely if we stretch too slowly. If we could drop distraction rates down to 0.1-0.3mm per day, we will probably have soft tissues that will adapt better. In addition there is probably some form of genetic trigger that switches off after normal adolescent growth, similar to a growth plate closing. Lastly, the predominant protein in soft tissue is collagen. It does become less supple as time goes on, and this is a result of aging. This causes more resistance to stretching as well.

Although distraction histiogenesis does cause new tissue to form (ie grow properly), there is an element of elongation through stretching. One of the reasons why realistic lengthening goals should be borne in mind.

I think that with current technologies available, athletic potential is definitely affected regardless of lengthening amount. Whether it is noticeable in an individual would depend on factors like pre-op status, flexibility, genetics, lengthened amount, technique etc etc.

http://www.limblengtheningforum.com/index.php?topic=4227.msg65432#msg65432

Sorry to break it to you, but LL will be a compromise between becoming taller and losing some physical performance/integrity.

[kats20]

thanks that's really helpful and answers my question precisely. Hope there are developments in this area.

[llendpoint]

I think people look at athleticism after LL from the wrong angle.

Here is an example:
Person A is very fit and exceeding in sports.
Person B is average or below average in that regard.

If we put a number behind their skill, let's give person A 80 points, and person B 40 points.
80 points mean that person A has never fully utilized 100% of what he is capable in terms for exercises, but only 80%.
For person B it is 40%.

After LL, people assume that every person will never get back to their relative 100% level.
For person B, it means to go back to only 40 points (his previous 100% mark), and for person A it means to reach 80 points (his previous 100% mark)

But what if both, person A and B, decide to put in 90% effort training, which causes a normal person to get to a level of 90 points in terms of fitness, putting in effort like never before, effort that far exceeds their effort before LL.

Isn't is obvious that person B will reach a level much higher than ever before, and that person A will also get back to over 80 points?

If a person is fit just by working out 5 times a week 10 min each for over 15 years, that person can easily double this amount of training after LL.

Instead of getting back to 100%, that person will inevitably exceed his previous all time high level.

What some consider a decent fitness level after LL for person B, is for person A a level that he will never drop below.

You guys all think you are at 100%, but that 100% has always been a variable, not an absolute mark.

[Polvorón]

Soft tissue can grow, but the growth process during LL is inferior to natural growth of soft tissue during childhood/puberty. That means the soft tissue will be stretched and won't perform as well as it had originally. I have found the statement from an LL doctor I talked about earlier, and I remembered correctly. It was from Dr. Birkholtz:

http://www.limblengtheningforum.com/index.php?topic=4227.msg65432#msg65432

Sorry to break it to you, but LL will be a compromise between becoming taller and losing some physical performance/integrity.

Probably means that it was not studied if that switch exists.
Maybe the switch is the HGH, who is lower at a higher age.

If I can get the surgeries that I need, I will tell you how it goes.

[cyborg4life]

@LLprime2 you make a phenomenal point! This is how I look at it and how I believe most people should too.

It's no doubt that LL will alter the body tissues etc. and things won't be the same. But I knew for a fact that prior to my LL I wasn't as mentally strong and wasn't training anywhere near my fullest potential in fact I doubt anyone prior to LL really is. The "reason" a person has for getting LL done should serve as a big motivational driving factor for the future enhancements in their quality of life on the other side.

The sheer amount of effort required for a successful outcome in any type of orthopedic surgery strengthens one's work ethic and especially something as involved as LL. Also, assuming spirits are still high post-LL (as they should be if all goes well with recovery and they are religiously aggressive with a thorough physiotherapy routine), that person is going to be willing to train harder, and thus as a result, will reach a higher level of fitness/athletic performance.

This goes for most things in life, what doesn't kill you can certainly make you stronger. It just might take a more strategic approach of working hard in a smart direction.