Stretched & Exercises Guide to Grow Taller After Leg Lengthening Surgery

Written by Joshua Leaf | Updated on August 19, 2021

A person stretching their calves on a slant boardLeg lengthening surgery is a very serious undertaking and requires a bold commitment to daily exercises and stretches that must be completed. No questions asked.

Your recovery success or failure primarily comes down to 2 things:

  1. Your surgeon’s experience
  2. Your dedication to daily physical therapy

Once you’ve chosen a top surgeon, number 1 is taken care of. That means your recovery boils down to how much effort you put into daily physical therapy.

During limb lengthening, it’s actually not the bone that’s hard to grow and stretch apart–it’s the soft tissues like your muscles and tendons that create the painful resistance during distraction.

For this reason, it’s absolutely critical to constantly perform exercises and stretches multiple times a day during the recovery process.

Should I Stretch & Exercise Before Surgery?

Some doctors say it’s not crucial to stretch before surgery so long as you’re already fairly flexible. However, some of the best doctors say stretching before surgery may “minimize pain and discomfort during the lengthening”. 1

There’s no official recommendation for exercises, but leg lengthening veterans suggest avoiding strength exercises such as squats 3-6 months before surgery. The theory behind this is you want to avoid building mass before surgery so your soft tissues “stretch” easier. 

Yet, you want to keep some endurance and strength because your muscles will atrophy or fade away after surgery. To keep fit and avoid building mass, it’s suggested to run, cycle, or swim instead.

Limb Lengthening Exercises Overview

Performing exercises is absolutely critical throughout both the distraction and the consolidation phase. The reason is simple: muscular atrophy (loss of muscle) is a nasty, vile creature. 2

The more you perform exercises, the more you will be able to fight off the atrophy of key muscles like your abductors and glutes, which help maintain proper movement patterns.

Correct movement is corrective. Period.

On the other hand, the recovery period is the best time to loosen up your tight muscles that are being stretched. If you stretch frequently and early on you’re less likely to form scar tissue. 

This means that in order to rehabilitate yourself following a soft-tissue injury, AKA your legs’ soft tissues being stretched apart several times a day, you need to get your body moving in the ways it was designed to.

Without a focus on strengthening exercises and stretches, recovery is more painful, longer, and ultimately less successful.

Walking: The Most Underrated Exercise During Distraction

Some patients hold dearly to the “breakthrough” that walking may possibly be the number one exercise you can do while distracting to make sure your post-distraction recovery is literally days/weeks.

It simply bears out the first core principle: correct movement is corrective.

So get yourself up and moving. Get strong, stretched and supple. Use walking assistance devices as needed and try to progress either in distance or time every day.

This WILL cause more inflammation. But it will do wonders to maintain your mobility. To recap, walking is an exercise that doubles up to build strength and keep you limber. 

Walk every day possible after you complete the rehab program below. 

Leg Lengthening: Conflicting Views on Stretch Intensity

Should you be stretching intensely or softly? The answer probably lies somewhere in the middle…

Once you begin your post-op rehab in full force (typically two weeks prior to surgery), you will find that while stretches can be uncomfortable and even painful—you can still feel a stretch sensation in the muscle belly and surrounding soft tissues.

However, once your body reaches a moderate to a high level of tightness, you will find that stretches are simply painful and do not produce any measurable “stretch sensation” in the muscles.

Therefore, we believe that stretching during rehab should be done with intensity only until you are too tight to feel a stretch sensation (this occurred at roughly the 4.5 cm mark for me in tibiae and 6 cm mark in femurs).

And then, once you are in the late stages of distraction—ease up on intensity and do a “light stretch”.

To read more about high intensity vs low intensity stretching, check out this pdf.3

Passive Stretching Secret: Dynamic Splinting (Dynasplint)

Speaking of stretching intensity, dump the rigid plastic splint made by Faulk Prosthetics and ask the doctor to give you the diagnosis of ankle contracture so that you can speak with a local Dynasplint Representative.

It’s easy: the rep will bring them to you at the hotel and instruct you upon their use—the cost: $175 per splint per month–$350 per month for both.

Dyna splints are the top of the line in passive stretching, and we cannot speak highly enough about these. Many credit their success in achieving 13cm + of height increase in 120 days.

Core Principles of Rehab

  • Every movement of the rehab program consists of “cells of 3”: stretch, isolation, compound. Myofascial or deep tissue work is often incorporated and comes before stretching. 
  • Build stability from ground to hip—not knee to feet or knee to hip (compound movements)
  • Complete each and every item of rehab with a purpose—work to form a “mind-muscle connection” so often proselytize by old-school bodybuilders
  • Again, correct movement is corrective; incorrect movement is degenerative. Use whatever rehab modalities necessary to open up movement (heating blanket, hot shower, stretching, exercises) and then move as much as possible

With these principles in mind, we’ve broken each part of the rehabilitation process into post-surgical phases so you may follow them to a Tee. 

Stretches & Exercises After Surgery: Part 1 (Hospital)

Your mission is simple: move, move, move.

You won’t be able to move much at all, but every single contraction and neuromuscular engagement of your muscles will fight the atrophy process as your body begins to quickly decay from a lack of ambulation.

These exercises will be the same if you have surgery for tibiae or femurs, or both.

Exercises while in the hospital:

  1. Foot Pumps
  2. Glute Squeezes
  3. Quad Squeezes

How many repetitions should you do of each? Start slow with sets of 5 repetitions and slowly add more repetitions and sets as you regain strength and neuromuscular activation of your muscles and soft tissues.

You will be required to walk using a walker in the hospital following the surgery—occupational therapists will come to your private hospital room to educate you and assist.

Some patients are total rock stars when it comes to walking after surgery. Others have an extremely difficult time (myself included). Don’t take it hard on yourself if you aren’t one of the luckier patients—this simply means you likely have a much more intense inflammatory response to surgery.

The biggest priority is keeping inflammation down. This means you need to keep your movements refined to non-weight-bearing exercises. We suggest taking it super easy the first two weeks. Give it 14 days of respite and you’ll be glad you didn’t jump the gun too soon.

With that said, older patients typically have less of an inflammatory response to surgery and therefore may have a much easier time regarding the transition from hospital to daily hotel life.

Non-Ambulatory Exercises & Stretches: Part 2

Until the majority of your surgical pain goes away around the 14-21 day mark, it will be difficult to walk (non-ambulatory) and thus complete the more advanced PT exercises.

That’s okay.

This part of rehab is designed to re-engage your muscles and soft tissues to aid healing and fight atrophy.

Why do this?

It will make sure that your recovery goes extremely smooth once you are much more mobile and able to walk around. For the exercises in this part of the rehab, you will simply be doing what you did in the hospital, but adding some extras as you can tolerate. Furthermore, all of the stretches and exercises for this part of rehab should be completed either sitting down or standing.

Victor (Cyborg4Life on YouTube) provided a decent starting point in one of his videos and we will use this as a basic template while adapting for our own uses because we know better: 4

  1. Foot Pumps
  2. Glute Squeezes
  3. Quad Squeezes
  4. Quad Squeezes with Towel Under Ankles
  5. Single-leg Raises (with a fully flexed quad muscle)
  6. Quad Squeezes with Towel Under Knees
  7. Heel Slides
  8. Seated Isometric Knee Flexion
  9. Abdominal Vacuums
  10. Clamshell (progressing to Supine Short-Lever)
  11. Dorsiflexion (progressing to resistance band)
  12. Hip Bridges
  13. Thomas Stretch with Strap (PT therapist Mike T at Paley’s came up with this one and it works great—ask a fellow patient to show you how)
  14. Lying Hamstring Stretch with Strap

This full routine is to be completed once every day while laying in bed and not wearing splints, working, etc. Just like with the hospital exercises, start with five repetitions of each exercise and slowly build up more repetitions and sets by adding more each day.

Finally, this routine should be ON TOP OF your formal PT. AKA if you do heel slides during PT at the Paley clinic—that doesn’t count.

Note: some patients who can tolerate weight bearing will be able to graduate to the advanced rehab section before ending the distraction phase.

Otherwise, the advanced + post distraction portion below is intended to be completed 1-2 weeks after stopping distraction (so your body has a few days to loosen up after being constantly stretched non-stop for weeks).

Rehab Program: Advanced + Post-Distraction

Congrats! You worked hard and you kept a lot of your pre-existing muscle and executive function of your legs and posterior chain. Or you slacked off and you’re very tight and can’t walk at all…

The choice is yours.

But for those that have devoted themselves to rehab so far, you should now be able to comfortably walk around using your walking assistance device (after warming up) and even walk with no assistance devices at all.

It is now that we begin the metamorphosis that will transform us into our final form.

As such, we approach rehab from a holistic, or “whole-body” approach. Basically, we want our entire body to function and move as a single unit. That means we must begin each session from the ground up. 

If you had leg lengthening surgery for your tibiae then you will begin with the feet and “move up” your body from there. If you had surgery for your femurs you will begin with the hamstrings and move up from there.

Do not make any alterations to this routine until you feel that you have a firm understanding of each movement and have the PT experience necessary to make changes or skip certain things to spend more time on others.

In other words, you might find you don’t need to work on your big toe activation (deep peroneal nerve innervation movement), hip abduction activation, or any other stretch/isolation/compound below. But do them anyway. 

This is non-negotiable: you must assess your initial starting point for all executive functions of the legs, ankles, and feet.

Finally, perform each “cell” in succession. AKA immediately after stretching for both legs, you begin the isolation exercise and then immediately perform the compound movement. Then rest. Then repeat through.

Example of one “cell” completed for the Anterior Tibialis muscle:

  1. Slant board left leg
  2. Slant board right leg
  3. Dorsiflexion left leg
  4. Dorsiflexion right leg
  5. Step down left leg
  6. Step down right leg

Ambulatory Exercises & Stretches: Part 3

At this point you should be able to walk and move around (ambulate) so we can get into more advanced physical therapy movements. 

Tibiae Surgery Cells

Feet – Building Tripodal Foot Stability

  • Stretch: Seated Soleus; while seated with one leg in front of you,, use a strap or other cloth to wrap around your upper foot and pull your toes towards your body
  • Isolation: Big Toe Activation; while seated with feet flat the on ground, push down with big toe as if pressing a big button on the ground (building tripodal foot stability – also innervates the deep peroneal nerve) 5
  • Compound: Stand and Squeeze. Stand up straight and tall, push against the ground with your big toe, squeeze your glutes/quads, and extend your hips fully. We want to imitate a completely natural standing position. Or in other words, no “duck ass” (AKA anterior pelvic tilt) or “ballerina foot” (AKA equinus contracture). Do timed sets and build up aka first set = 1 minute, second set = 3 minutes, third set = 5 minutes, etc.

Ankles – Alleviating Tension in Foot Extensors

  • Stretch: Foot Extensors. Extend your foot away from you like a calf raise.
  • Isolation: Pickup (while seated, use your feet to try and pick up a light shirt or washcloth from the ground) 6
  • Compound: Exercise: Walk on the balls of your feet/toes (use a walking assistance device if needed)

Anterior Tibialis – The Key to Successful Tibiae Surgery

  • Stretch: Slant Board.
  • Isolation: Dorsiflexion with a resistance band
  • Compound Exercise: Step down; while standing on a stair, grab the handrails, then step down and try to control your body weight (deceleration eccentric)

Calves – Gastrocnemius

  • Stretch: Slant Board
  • Isolation: Seated Calf Raises (both legs, one leg, or machine with LIGHT or no weight)
  • Compound Exercise: Standing Calf Raises (this is a balance drill as well; try not to use a walking assistance device for balance)

Femur Surgery Cells

Hamstrings – Loosening up the Posterior Thigh

  • Stretch: Assisted and non assisted toe touches as well as the thomas stretch
  • Isolation: Seated Isometric Knee Flexion; while seated on a bed with your feet flat on the ground and your calves firmly against the side of the bed, contract your hamstring isometrically against the bed while also squeezing your glutes.
  • Compound Exercise: Sit to Stands (deadlift form – lean your torso forward and “sit your ass back” to get a deep eccentric stretch)

Quads – Rectus Femoris

  • Stretch: Lying side quad stretch, kneeling quad stretch, or band-assisted quad stretch while lying on your stomach.
  • Isolation: Seated Knee Extension (flex your quads)
  • Compound Exercise: Lying single-leg raises with full flexed quad (just like the #5 exercise in the 14-exercise list above for weeks 1 and 2 post-op)

Abduction – Tensor Fascia Latae

  • Stretch: TFL (there are many videos on YouTube – find a stretch that you can do pain-free)
  • Isolation: Hip Abduction With Internal Femur Rotation – You can do this lying down on your side as well if needed
  • Compound Exercise: Walk up and then down stairs (hold the handrails you animal!)

Glutes – Hip Extension is EVERYTHING

  • Stretch: Abdominal Vacuums; this works the transverse abdominis–the internal wall of your abdominal region responsible in part for keeping your hips in alignment (to fight duck-ass or APT)
  • Isolation: Lying Hip Bridges
  • Compound Exercise: Walking with big, big steps and proper posture (use a walking assistance device if needed)

Upon completion of the full rehab routine in one sitting, rest only shortly and then complete your daily walk.

Crucial Items for Recovery

The following items are mostly negotiable and are simply things that you can buy to make your recovery go much smoother.

  • Stretching Strap
  • Slant Board
  • Bed topper – a latex bed topper (3” – three inches) can be purchased on amazon and provides much more support for your hips following femur surgery leading to better sleep.
  • Liquid foods – lactose-free milk was my savior to keep my calories and protein up while my appetite waned due to constant pain. If you cannot drink cow milk, find a liquid you CAN drink that is high in nutritional value.
  • Glucose – Gatorade provides a very necessary supply of quickly absorbable glucose that your body desperately needs to respond to the constant inflammatory response during recovery

A Word on Recovery

The entire process is excruciating so it’s important to keep your end goal in mind; getting taller.

Imagine breaking your legs, months of excruciating pain, or losing 10’s or 100’s of thousands of dollars just to lengthen half the amount possible because you slacked off on exercising and stretching. Or worse, seriously limit your quality of life or athletic performance.  

Money can make you taller, but the amount you can increase your height is largely dependent on your work ethic.

Stay active, get supple, and most importantly, keep busy with PT to make it all worthwhile


References

1Paley, D. (2019, February 12). Initial consultation. Paley Orthopedic & Spine Institute. <https://paleyinstitute.org/centers-of-excellence/stature-lengthening/the-paley-method/initial-consultation/#/>

2Wikimedia Foundation. (2021, June 14). Muscle atrophy. Wikipedia <https://en.wikipedia.org/wiki/Muscle_atrophy>

3The origin of the dynamic splint Dynasplint Principles. Dynasplint Systems Inc. (2006). <https://www.dynasplint.nl/website_files/document_33.pdf>

4Egonu, V. (2020, June 28). Physical therapy is key for limb lengthening surgery success! YouTube. <https://www.youtube.com/watch?v=EUrJjClu2qo>

5Foot Drop. (n.d.). <https://i.ytimg.com/vi/J7-L9MFRXD8/maxresdefault.jpg>

6Exercises For Foot Tendonitis. (n.d.). Pain Assist <https://www.epainassist.com/assets/alternative-therapy/2019/towel-pickup-exercises-for-foot-tendinitis.jpg>

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