Limb Lengthening Forum
Limb Lengthening Surgery => Information About Limb Lengthening => Topic started by: sixfootandhalf on May 03, 2023, 05:13:22 PM
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ITB bands are notoriously difficult to "stretch" and anyone undergoing femur lengthening needs to consider a proper ITB release. Medical research firmly supports this, and will be presented here. If you are spending tens of thousands of dollars lengthening your Femur, move mountains to convince your surgeon to give you a proper ITB release. This is not medical advice, but purely informational/entertainment you should verify with your own doctor.
Read this: https://uesca.com/it-band-syndrome-myths-and-facts/
"Let’s first address stretching. The ITB is a very tough structure. In fact, in a 2010 study by Falvey et al., a strain gauge was used to test various stretches on the ITB and the result was that the ITB was unaffected.
Therefore, it is highly unlikely that stretching will have any effect on the ‘tightness’ of the ITB."
I highly recommend reading this: https://www.painscience.com/articles/iliotibial-band-syndrome-stretch.php
"Even if you do everything right, even if you perform the ideal stretch and manage to pull firmly on your IT band for a couple minutes — which is longer than most people ever bother — how much would you actually change the length of your IT band? How far would it move?
Roughly 2 millimeters — an overall change in length of less than half a percent.
You still won’t actually change its length, any more than you can make a leather belt longer by pulling on it. This is the most important thing IT band stretchers need to understand."
And also this: https://thedoctorsofpt.com/it-band-pain-myth-v-reality/#:~:text=Myth%202%3A%20The%20ITB%20can,to%20actually%20induce%20a%20stretch.
"Myth 2: The ITB can and should be stretched
Since the ITB is made up of fascia, which is different from a muscle, it’s nearly impossible to stretch it. It would take way more force than we’re capable of producing on our own, to actually induce a stretch. This is a good thing – since the roles of the ITB are to stabilize the side of the knee and provide energy storage and release during running, we don’t really want it to be stretchy anyway. "
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So what consequences can this have by doing LL?
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So what consequences can this have by doing LL?
This is why it band release is a must
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Any information on why one of my IT band (that was released) seems to be popping a lot recently? It started happening 4 nights ago when I turned to my side to sleep. I heard a huge crack throughout my femur (like popping a joint but 5x as intense). I thought my femurs cracked. Ostetomy are around my femur were a bit sore for the day. But fastforward now, every like 1 hour or so when im moving around and twist that leg a bit i hear a smaller pop which doesnt hurt. It's like cracking a knuckle, but im conviced it's my IT band. It's around where my ostetomy is thats cracking.
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since the roles of the ITB are to stabilize the side of the knee and provide energy storage and release during running, we don’t really want it to be stretchy anyway.
I assume when you release the ITB then you lose this stability of the knee and energy storage for when running? Just to try and understand the drawbacks of doing femur lengthening which as you argue well for would require ITB release.
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I assume when you release the ITB then you lose this stability of the knee and energy storage for when running? Just to try and understand the drawbacks of doing femur lengthening which as you argue well for would require ITB release.
"You assume" and you assume wrong. ITB will regrow back. In fact my doctor says some patients regrows back so fast he has to do another ITB release for them. Pretty much all US doctors requires an ITB release on femur lengthening over 5cm for a reason.
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"You assume" and you assume wrong. ITB will regrow back. In fact my doctor says some patients regrows back so fast he has to do another ITB release for them. Pretty much all US doctors requires an ITB release on femur lengthening over 5cm for a reason.
Very interesting thank you for the correction.
So the ITB release actually results in the ITB growing, and then being adapted to the new femur length? While if the ITB is not released it will just be stuck in very high tension state?
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yes ITB is the hardest one to stretch out. Thats why people who dont have it released walk with wide legs. It'll eventually stretch out, it's just harder and takes a lot longer. If you release it, it will grow back as your body is healing, just like how your bone done as well.
Dude just ask your surgeon, this is common knowledge at this point. Every US surgeon requires it if you're gonna do 5-8cm.
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I needed IT Band release twice on my right femur, IT Band release was performed during my initial Fitbone implantation , the first lengthening was "only" 5.5 cm before my Fitbone failed , then 3 years later (thanks COVID) I had a Precice 2.2 rod inserted (without ITB release) but after ~ 1.5 cm it was so tight it was like a guitar string and I could barely move my knee or take a medium size step (on crutches ofc), the ITB was released again, and I completed the total 2.4cm without great issue, but I must say my knee TFL is still quite achy and stiff , it takes ~ 30 body squats to get mobile in the mornings.
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If you don't push hard for the sort of ITB release done by Paley/Goitikas, you're going to have wide legs, severe stifness and you might not even hit your goal.
The entire experience is harrowing enough, but the suffering is going to multiply without a proper release done by current qualified surgeons.
The ITB grows back well according to every well known surgeon.
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I needed IT Band release twice on my right femur, IT Band release was performed during my initial Fitbone implantation , the first lengthening was "only" 5.5 cm before my Fitbone failed , then 3 years later (thanks COVID) I had a Precice 2.2 rod inserted (without ITB release) but after ~ 1.5 cm it was so tight it was like a guitar string and I could barely move my knee or take a medium size step (on crutches ofc), the ITB was released again, and I completed the total 2.4cm without great issue, but I must say my knee TFL is still quite achy and stiff , it takes ~ 30 body squats to get mobile in the mornings.
Hey, i hope you're doing well now.
Can you remember what sort of ITB release it was and who did it? Was it a proper Z cut etc?
What would you reply to those people who tried to tell you, oh , well maybe you didn't stretch enough.
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Agree 100%
When you say release, how can we define it, with some doctors offering a 'soft' release also.
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it band "unstretchable" because only 15% of its length is muscle
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ITB band proper release are critical.
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https://journals.sagepub.com/doi/full/10.1177/2635025421997139
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Tell it to Betz, who some people here considered as a very great doctor, who let his patients lengthen more than 10cm without doing itb release.
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Tell it to Betz, who some people here considered as a very great doctor, who let his patients lengthen more than 10cm without doing itb release.
Sure walk with 45 degree legs for 6 months after you consolidate lol. The release is to make the patient experience more practical, there's no health concern with not releasing it.
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They offer ITB release and imo.are one of the safest out therr
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My surgeon is a professor and was trained by one of the top CLL surgeons in Baltimore so I assume he knew what he was doing, He was typically cryptic/elusive when i asked about the release (I had asked him to perform it during the CLL but he didn't consider it necessary), he often became defensive when I asked such questions, i think he was used to adoration from the Sheeple not pointed questions.
I recall the final ITB release was tough, I spent 3-4 long days in hospital with puss/fluid draining from a tube in my knee before they removed the drain and let me go.
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I stretched during CLL, it was very painfull tbh, before CLL I had a +20cm sit and reach beyond my feet, now after only 8cm CLL I can barely reach the top of my feet, I stretch every morning, I am 56 yo so this may be a factor ofc.
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My surgeon is a professor and was trained by one of the top CLL surgeons in Baltimore so I assume he knew what he was doing, He was typically cryptic/elusive when i asked about the release (I had asked him to perform it during the CLL but he didn't consider it necessary), he often became defensive when I asked such questions, i think he was used to adoration from the Sheeple not pointed questions.
I recall the final ITB release was tough, I spent 3-4 long days in hospital with puss/fluid draining from a tube in my knee before they removed the drain and let me go.
8cm is quite a lot to lengthen imo , and age may have well been a factor, as well as the method you used.
But to lengthen 8cm without an ITB release is very hard to imagine, especially until the end.
It's unfortunate you had complications - who exactly did the ITB release, and what sort of ITB release was it i.e. Z cut, soft etc?
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I cant name the surgeon, it might bring legal consequences on me and I believe in moving forward, I believe it was a soft tissue release rather than Z Cut.
He is not a bad surgeon, the implants were very well placed with no rotation or deviation.
He did put too long a screw through my distal femur which caused me over a year of strong pain and reduced knee flexion after a year he arranged an MRI and later told me this is a life long injury that will not improve.
I quietly rejected his hypothesis and after some reading arranged my own oblique distal femur XRay ( not AP/Lateral as he had repeatedly given me) , I found a distal screw was projecting some 5 mm into my lateral TFL, I was upset he had missed this and arranged a local Ortho who under local aneasthetic removed it and i instantly gained another 10 degrees of flexion and the pain reduced markedly.
The TFL is still thick on the lateral I assume scar tissue has formed due to the repeated injury of the errant screw, so I still have some pain and reduced flexion (135 deg) but i can at least squat now.
When I last saw my surgeon he asked how my knee was, I told him it was better since i had the too long screw removed, he became quiet and changed the subject....
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You had a soft iTB release, as opposed to a proper Z cut? How did you know you were only getting a soft release, was it before or after?
How is your walk currently by the way?
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I left the nature of the release to the surgeon, I am almost certain he performed a soft tissue release
My walking is almost normal, my femoral Quads/hips are still tight and limit stride somewhat, I find if I walk at too fast a pace for too long (~ 1 klm) my Tibialis Frontalis gets very pumped and slows me down, maybe it is overcompensating for my femoral tightness ?
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My surgeon is a professor and was trained by one of the top CLL surgeons in Baltimore so I assume he knew what he was doing, He was typically cryptic/elusive when i asked about the release (I had asked him to perform it during the CLL but he didn't consider it necessary), he often became defensive when I asked such questions, i think he was used to adoration from the Sheeple not pointed questions.
I recall the final ITB release was tough, I spent 3-4 long days in hospital with puss/fluid draining from a tube in my knee before they removed the drain and let me go.
none of this matters. read the case reports they've published and formulate an opinion on the pearls of their technique after you've done that.
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Exactly. A proper ITB release may well be essential.
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From: http://www.limblengtheningforum.com/index.php?topic=66296.155
"RB from the forum basically had to go to Greece and have a proper ITB release / Z -cut with Goitikas:
"Hey guys,
Just discharged from the hospital after the ITB release. Doctor came to visit me before I left and said everything went well, he released both IT bands completely and also aligned my hips while I was in surgery as my left had become crooked due to the left ITB being tighter.
Pain has been very minimal, the only pain I have is at the incision site (4/10) when I bend my legs in bed or when I bend them to walk but no pain otherwise and doctor said incision pain will get improve over the next couple of days. But holy crap I am excited to tell you guys that my wide legs are completely gone and my legs are 100% in like a normal person when I have been walking with the crutches! My duck ass has also 100% disappeared when putting my legs together! I knew doing the release would help but I didn't think it would work instantly for both duck ass and wide legs. I will be mainly using crutches for the next 2 weeks or so as my legs are still weak and heavy from surgery but I am so glad I decided to undergo this procedure.
This really demonstrates that an ITB release should be done for all femur lengthening's. Some people may get lucky and not get hit with wide legs / duck ass but majority of people will have some form of issue that arise from tight IT bands such as a hip deformity on top of the wide legs and duck ass. I still recommend Betz in the current LL market as his nail is truly weight bearing and I'd still choose that over Precise, however be aware that not doing an ITB release can cause major issues and be ready to do it with another doctor willing to perform it unless you want to spend months and months rehabbing after lengthening with no guarantee that it will fix the issues caused by tight IT bands."
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So the IT Band heals again after the release, and as it heals it adapts to the new femur length, is this correct?
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It heals well.
Take a look at Sirstretchalot's thread
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Sometimes it heals too fast the patient has to get it re released, pretty rare though. But 100% get an ITB release if your goal is 5cm+ femur
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5-6cm doesn’t require an itb release
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"In 2010, Irish researcher Dr. Eanna Falvey and her colleagues measured the mechanical effect of a basic IT band stretch (like the standard one illustrated at right) plus a more sophisticated stretch, and found virtually no difference: the IT band was effectively unaffected. And that was including knee flexion, in a stretch carefully applied to corpses by anatomists!1213 In an even more aggressive experiment in 2017, the IT band was completely excised, washed, frozen, thawed, and machine-stretched … and it still stretched only a few millimetres"
https://www.painscience.com/articles/iliotibial-band-syndrome-stretch.php#:~:text=The%20iliotibial%20band%20itself%20is,tendon%20in%20the%20human%20body.
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5-6cm doesn’t require an itb release
Neither does 8, it just makes your life easier. If you dont have an ITB release, you're not gonna feel good at 6 cm lol
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5-6cm doesn’t require an itb release
Lol, you're so wrong.
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Neither does 8, it just makes your life easier. If you dont have an ITB release, you're not gonna feel good at 6 cm lol
wrong, did about 6cm on femurs, feel great, didnt need it. Neither did any of the other numerous patients from my surgeon, who did 6cm on femurs, need an itb-release. Its usually just the people who go overboard with lengthening and do 8+cm who complain about wide legs and other complications, that can only be remedied with addiontal itb-surgery.
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Lol, you're so wrong.
hes actually correct
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I love how people assume you don't need something because they didn't need it.
Like ITB is required in pretty much all US doctors that go 6+cm target. It wasn't always like that, it's just that they realized a lot of patients had trouble with duck ass and wide legs they decided to require it for those target ranges. Why do you not go tell Dr Paley he's wrong instead of us lol.
Just to clarify. It isn't required, just make's your lengthening life easier because ITB is a very stubborn facia to stretch.
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Just look at the diaries of the LL patients, their wide legs and severe stifness began around 3cm and was much worse by 5=6
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wrong, did about 6cm on femurs, feel great, didnt need it. Neither did any of the other numerous patients from my surgeon, who did 6cm on femurs, need an itb-release. Its usually just the people who go overboard with lengthening and do 8+cm who complain about wide legs and other complications, that can only be remedied with addiontal itb-surgery.
You didnt get itb release when doing the surgery? I thought all surgeons perform it prophylactically
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hes actually correct
He literally is not, like, how ignorant can you be.
I did 6cm and would not be anywhere close to walking if I didn't have ITB release upon fixator removal, they were so tight it was ridiculous.
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when did the tightness start?
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Not everyone needs it just because you did.
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Not everyone needs it just because you did.
Except the fact that it's no longer an option and US surgeons requires it if your target it 8cm. But I agree with the fact that you can finish lengthening without it, and a few years ago, US doctors did NOT require it. But they've learned and realize there's more pros to doing an ITB release than not to do it so they've started requiring it.
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Both Dr Becker and Dr Goitikas are world class surgeons, and amazing professionals.
Dr Goitikas has not criticised or given any bad remarks about Dr Becker, and i regard Dr Becker as one of the world class leg lengthening surgeons, and an amazing human being.
We don't always see eye to eye with our own family, and small disagreements are perfectly healthy and normal.
Dr Becker currently offers a 'soft' ITB release, which is a pokign method in the ITB band.
Dr Goitikas offers a minor ITB incision on the band itself. There is a more agressive form of this called a Z plasty but he does not do this normally - only in rare cases. He uses the less invasive but 'proper' ITB release.
I have had a consultation with Goitikas, who told me that almost every surgeon now offers an ITB release, and the 'soft' ITB release done by the Betz/Becker institute will do little if anything at all for leg lengthening.
The soft poking method is not enough.
Goitikas, and Paley too in their works, remarked they ALWAYS perform prophylactic iTB release if anyone is lengthening femurs past 5cm. They say that the ITB band heals extremely well, and you can find diaries of so many patients who had LL in Germany, but flew to Goitikas for the ITB release, and their walk actually improved.
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Betz had mentioned you just need to stretch, even if it's 8,9,10cm. Hard work, and rigorous physiptheraphy and stretching may be all you need.
Goitikas and Paley have said the opposite , the ITB band can not be stretched like this, a release is almost absolutely essential to resolve extreme tightness, wide legs, duck ass, and return to normality.
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A 'soft poke' release is not sufficient, as per Dr Goitikas. This 'soft' ITB release does little if anything for leg lengthening.
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In 2007 when I got LL, one of the docs routinely did achilles releases for tibia patients going beyond 5 cm. :o
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Jesus fking christ ITB releases live rent free in your head. Every single post you make is about this.
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Jesus fking christ ITB releases live rent free in your head. Every single post you make is about this.
Lol finally somebody said it
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Goal is 9cm femur
Becker says I don't need a release