Heterotopic ossification is endochondral ossification that occurs outside the bone.  Understanding why it occurs can help us find ways to induce endochondral ossification within the bone.  The biggest issue with inducing a new growth plate in bone is the permissive local environment criteria.  The bone likely has to be degraded in some way to induce a neo-growth plate as the existing bone environment likely puts a constraining factor on growth.

Identifying the Cellular Mechanisms Leading to Heterotopic Ossification.

“Heterotopic ossification (HO) is a debilitating condition defined by the de novo development of bone within non-osseous soft tissues, and can be either hereditary or acquired. The hereditary condition, fibrodysplasia ossificans progressiva is rare but life threatening. Acquired HO is more common and results from a severe trauma that produces an environment conducive for the formation of ectopic endochondral bone. Despite continued efforts to identify the cellular and molecular events that lead to HO, the mechanisms of pathogenesis remain elusive. It has been proposed that the formation of ectopic bone requires an osteochondrogenic cell type, the presence of inductive agent(s) and a permissive local environment. To date several lineage-tracing studies have identified potential contributory populations. However, difficulties identifying cells in vivo based on the limitations of phenotypic markers, along with the absence of established in vitro HO models have made the results difficult to interpret. The purpose of this review is to critically evaluate current literature within the field in an attempt identify the cellular mechanisms required for ectopic bone formation. The major aim is to collate all current data on cell populations that have been shown to possess an osteochondrogenic potential and identify environmental conditions that may contribute to a permissive local environment. This review outlines the pathology of endochondral ossification, which is important for the development of potential HO therapies and to further our understanding of the mechanisms governing bone formation.”

“of the 80 % of war victims who suffer major extremity trauma during combat injury, approximately 64 % of these patients go on to develop some degree of HO”

“Current evidence suggests that the formation of ectopic bone in vivo requires three primary conditions: (1) a cell type capable of osteogenic differentiation, (2) the presence of inductive agents and (3) a permissive local environment”

“o date many contributory biological factors have been implicated in the aetiology, including the bone morphogenetic proteins (BMPs), inflammation, prostaglandin E2, hypercalcemia, hypoxia, abnormal nerve activity, immobilisation and dysregulation of hormones”

“Tissue damage leads to the infiltration of immunological cells (monocytes, neutrophils and leukocytes) through the local vasculature. Resulting fibro-proliferation of an as yet unknown cell population is accompanied by hypoxia and the generation of brown adipose tissue at the site of damage. The presence of adipose tissue is hypothesised to lower the local oxygen tension leading to the establishment of a chondrogenic environment. Neovascularisation accompanies chondrogenesis and provides an avenue through which systemic cell types (endothelial cells, pericytes etc.,) may enter the injury site, and potentially contributed to osteochondrogenic differentiation. A subsequent increase in local oxygen tension promotes chondrocyte maturation and hypertrophy. The collagenous matrix deposited by these cells is then remodelled and ossified to form endochondral bone”<-If we induce such factors in the bone we can create new growth plates in there too.

“MSCs have frequently been shown to form endochondral bone when cultured under appropriate conditions (e.g. under hypoxia and/or in the presence of TGF-β)”

“MSCs may also contribute to chondrocyte hypertrophy and the progression of HO via their immunomodulatory effects, primarily through the production of anti-inflammatory cytokines and nitric oxide (NO)”

Several cell types are listed that are capable of heterotopic ossification are likely present in bone.

“Bone marrow HSC side population    Lin−/Sca-1+/cKit+/CD45+”

“Mesenchymal precursor cell (MPC)    CD44+/CD49e+/CD73+/CD90+/CD105+”

“MSC    CD73+/CD90+/CD105+”

“cells presenting the glutamate transporter GLAST were found to contribute to the formation of ectopic bone, and that these GLAST+ cells appeared to be distinct from the Tie2+ population”

” a significant upregulation in transcriptional activity in key osteogenesis-related genes (ALPL, BMP-2, BMP-3, COL2A1, COLL10A1, COL11A1, COMP, CSF2, CSF3, MMP8, MMP9, SMAD1 and VEGFA) in patients that developed HO compared to those who did not.”

Influence of transcutaneous electrical stimulation on heterotopic ossification: an experimental study in Wistar rats.

“Heterotopic ossification (HO) is a metaplastic biological process in which there is newly formed bone in soft tissues, resulting in joint mobility deficit and pain. Different treatment modalities have been tried to prevent HO development, but there is no consensus on a therapeutic approach. Since electrical stimulation is a widely used resource in physiotherapy practice to stimulate joint mobility, with analgesic and anti-inflammatory effects, its usefulness for HO treatment was investigated. We aimed to identify the influence of electrical stimulation on induced HO in Wistar rats. Thirty-six male rats (350-390 g) were used, and all animals were anesthetized for blood sampling before HO induction, to quantify the serum alkaline phosphatase. HO induction was performed by bone marrow implantation in both quadriceps of the animals, which were then divided into 3 groups: control (CG), transcutaneous electrical nerve stimulation (TENS) group (TG), and functional electrical stimulation (FES) group (FG) with 12 rats each. All animals were anesthetized and electrically stimulated twice per week, for 35 days from induction day. After this period, another blood sample was collected and quadriceps muscles were bilaterally removed for histological and calcium analysis and the rats were killed. Calcium levels in muscles showed significantly lower results when comparing TG and FG (P<0.001) and between TG and CG (P<0.001). Qualitative histological analyses confirmed 100% HO in FG and CG, while in TG the HO was detected in 54.5% of the animals. The effects of the muscle contractions caused by FES increased HO, while anti-inflammatory effects of TENS reduced HO.”

“The formation of heterotopic bone may be due to muscle trauma (myositis ossificans). It is common in people who have undergone total hip arthroplasty , those with spinal cord injuries, and victims of head trauma, all of which often lead to long periods of immobilization of the affected limbs.”

“skeletal muscle serves as a physical safeguard for the other organs and is anatomically located immediately beneath the skin, so it represents the most damaged organ in the body. Although skeletal muscle is characterized by the presence of fatty and connective tissues that originated from nonmyogenic mesenchymal progenitors, those progenitors were initially identified in BM”

“Muscle contraction occurs by the deposition of calcium in muscle tissue, and this stimulates the sliding of actin and myosin myofibrils, which characterizes the contractile process”

“electrical stimulation helps the deposition of calcium, causes changes in oxygen content and pH, stimulates expression of growth factors, and recruits help in osteoblast migration and secretion of extracellular matrix (ECM), leading to bone formation.”

“Mechanotransduction refers to the process by which the body converts a mechanical stimulus into a cellular response”

Cholesterol accumulation caused by low density lipoprotein receptor deficiency or a cholesterol-rich diet results in ectopic bone formation during experimental osteoarthritis.

“Osteoarthritis (OA) is associated with the metabolic syndrome, however the underlying mechanisms remain unclear. We investigated whether low density lipoprotein (LDL) accumulation leads to increased LDL uptake by synovial macrophages and affects synovial activation, cartilage destruction and enthesophyte/osteophyte formation during experimental OA in mice.

LDL receptor deficient (LDLr−/−) mice and wild type (WT) controls received a cholesterol-rich or control diet for 120 days. Experimental OA was induced by intra-articular injection of collagenase twelve weeks after start of the diet. OA knee joints and synovial wash-outs were analyzed for OA-related changes. Murine bone marrow derived macrophages were stimulated with oxidized LDL (oxLDL), whereupon growth factor presence and gene expression were analyzed.

A cholesterol-rich diet increased apolipoprotein B (ApoB) accumulation in synovial macrophages. Although increased LDL levels did not enhance thickening of the synovial lining, S100A8 expression within macrophages was increased in WT mice after receiving a cholesterol-rich diet, reflecting an elevated activation status. Both a cholesterol-rich diet and LDLr deficiency had no effect on cartilage damage; in contrast, ectopic bone formation was increased within joint ligaments (fold increase 6.7 and 6.1, respectively). Moreover, increased osteophyte size was found at the margins of the tibial plateau (4.4 fold increase after a cholesterol-rich diet and 5.3 fold increase in LDLr−/− mice). Synovial wash-outs of LDLr−/− mice and supernatants of macrophages stimulated with oxLDL led to increased transforming growth factor-beta (TGF-β) signaling compared to controls.

LDL accumulation within synovial lining cells leads to increased activation of synovium and osteophyte formation in experimental OA. OxLDL uptake by macrophages activates growth factors of the TGF-superfamily.”

“multiple injections of members of the TGF-super family, such as TGF-β or BMP-2, directly into the knee joint of the mouse caused abundant enthesophyte/osteophyte formation”

It is the year 2015 but sometimes the best content to explain one’s frustrations in life was already discussed and worked out years before. Let’s rewind time. In 2001, the underground Pick-Up-Artist community was just starting out in online forums and discussion boards. The internet was the tool that allowed many sub-cultures to develop from people of similar interests, passions, and obsessions to come together to discuss the issues that concerned them the most.

Trying to meet, and attract beautiful women to date, have sex with, and marry has been a desire and focus for young men of our species since time began. Young men has always desired to find some type of magic spell or potion to get attractive girls to like them as much as they like the girls. When two females get together, almost always inevitably the conversation lead to talking about dating, sex and relationships. Relationships are complicate, just like the desires, needs, and hangups in people. This is why humans find inter-dynamic drama between humans so interesting. Psychology is well known as one of the most common college majors because people are so fascinated with themselves and how their own minds work. We are the subject of most of our fascination, if not obsessions. Millions of books have been written about the human experience in the areas of sociology, ethnic studies, memoirs, and psychology. It is a very selfish behavior but that is what we are made of.

Drama is what makes the boredom of our everyday lives go away. The baby-internet allowed for this ancient practice of attracting a “hot” female to be focused at a higher intensity until it caused a complete global phenomena. Young men today now know about the art of picking up girls because the internet has been so effective in getting messages and information to spread to all the people in the world.

Finding the best mate possible is obviously one of the most critical and resource intensive endeavors one will take in life, if not the most critical since we are just animals. We are born, we breathe, we eat, we defecate, we look for a mate to reproduce with to pass on our genes (unconsciously ala The Selfish Gene), we have sex, we have offspring, we raise our offspring to an age which they can fend for themselves and have offspring of their own, we grow old, we die. As males of our species, we have hundreds of millions of sperm at any one moment compared to the fertilizing female egg, which is only a few hundred throughout her lifetime. From just a biological resource point of view, the females are the bottle neck in our species, from turning into a virus that just overruns the entire planet. Females will always do the choosing of which male mating partner is worthy of having sex with. Accept that as a normal, healthy, horny, sex-desiring heterosexual male, you will never have the type of power as a female when it comes to accessibility for a reproductive partner.

What is well known is that there is a minority group of men, whether 1% or 10% , which will have more sexual opportunities and chances than the rest (99% or 90%). What makes these men different from the rest of the men who don’t get as many chances to have reproductive success is that they are considered more valuable in females eyes than the others. If you lines up all 3.5 Billion men in a row and let the other 3.5 billion females choose, obviously any person looking at the data of female selection will notice some obvious patterns.

The most obvious of all these patterns is that females on average, want their mating male partners to be bigger aka taller than them, and more than that, taller than the average height of the males in their local tribe. For the longest time, size in terms of height or stature was the most dominant factor when it comes to what females find attractive. We know from epidemiologists that the average height of a nation is an extremely accurate and good predictor of the quality of life in one’s country. There are exceptions, (like Bosnia, Senegal and South Sudan) but the general principle is that taller people on average indicate that they have better genes and fitness, from million years of evolutionary development.

When humans moved further away from the monkeys , turning from paleolithic/hunter-gatherer to farmer/grower and began to call themselves “civilized” the concept of 1) money, 2) land ownership, and 3) property (number of cattle, camels, pigs)  became the 2nd concept of value which women started to believe in. Being wealthy and having land and resources became the 2nd core factor of what women found valuable since we have become “civilized”.

However, civilization has only been going on for 10,000 years so far. Evolution and what we are hard-wired to behave has been around for 1 million years. As animals, the female sex has the brain instinctually program to desire men who are bigger/taller. Taller men on average have higher levels of testosterone levels, and exhibit slightly higher levels of violent/dominant tendencies and behavior. In any prehistoric tribe, there may have been only 50 individuals.  Out of the 50, maybe only 5-7 females are in their reproductive years. Based on the higher birth rate of male/female, there would be around 6-9 men for the 5-7 females. This means that certain men will fail to pass on their genes. Back in the prehistoric age, you can not show off your bank account to impressive women. As a young, virile, horny man you only have a few ways. You show off your strength, your courage, or your dominance. Being clever, witty, or with a good sense of humor helps on occasion in getting 1 girl out of the 7 to find a slightly weaker men “cute”  or “adorable” and she might choose him, but any level of jealousy from the larger men who are more violent means the smaller guy who might be less capable gets killed over the larger guys wanting to take more women for themselves, ala harem style.

Dominance among men in tribes is most easily established through greater height. It can also be established from being wider in torso, with broad shoulders, large arms, and large hands. However, physiologically speaking, all boys fill out as they turn into older real men. This means that the factor of bulk/width is negated. You can’t exercise your way to longer bones or taller height. Almost all men can over time exercise to become wider and more muscular. This means that no matter how much the shorter man tries to exercise to make themselves wider aka “bigger”, their effort can be negated by the taller male who puts in some effort and makes them just as wide as the shorter men. Based on proportions alone (shoulder bone size), the taller men putting in the same level of effort can become wider (on average) than the shorter man.

As it was famously claimed by the UK based program Secrets of the Sexes – Episode 2: Attraction (Documentary)  who looked at what attracted women to men, one of the researchers just said “Just be tall. Don’t go to the gym, don’t exercise. Just be tall“. This reveals something which will aggravate all men. As men we are proactive and take a lot of action and initiative in what we want. When we want something, most of us will do the work to reach our goals. We are strivers.  We are willing to spend hours in the gym to work our bodies to look better in front of the mirror, but there is nothing that we can do to get taller. This is what puts the short guy into a bind. We are stuck in a position which we can’t control.

Ultimately, I go back to the most famous phrase ever used in the original PUA community. Attraction is not a choice– David DeAngelo.

Basically, women can not choose to mate/breed with the shorter men since their brains were not developed to think that way. There will be exceptions to any rule, with a minority of women being okay with mating with someone shorter than them, but the general rule is that for men, being taller is better. There are some disadvantages of being tall like not being able to fit in airplane seats, not finding long enough pants, etc. but those problems are more nuisances which are the result of “civilization”. If you really asked tall men if they are willing to trade their tall height for having a more convenient life, most would refuse since they understand at some level that they are “better” than their shorter peers. They can be extremely ignorant, uneducated, and crass, but they will still find great confidence and happiness in being taller than their more successful and rich male peers. That is their form of identity which they can use to ride out the struggle and disappointment that each human has to deal with in life. For some men, being taller than others can be the most important factor in life since they have nothing else to be proud of.

Have anyone ever noticed why does it seem like the most obnoxious vocal racists always seem to be (stereotypically) southern, hill-billy, red-neck hicks who are not well educated and don’t have a lot of money? – The real answer is psychological which stems from a ego defense mechanism known as compensation. Because being “white” is the only thing that they have that they can put their identity to to make themselves feel better about themselves. They may be poor, uneducated, uncouth, and crass, but they are “white”. The white red-neck can look at his more well-off rich, educated black neighbors but still believe that they are better than their neighbor because they are “white”. No matter what happens, you can’t take their identity, their “whiteness” away. Eventually the issue of “race” becomes what they decide to focus their energy, time, and effort on. They want to preserve what they think is their primary source of identity. The KKK could be a reaction response to the fact that the old black slaves have started to do better in life than the poor whites, who felt their sense of superiority slipping. The KKK want to keep the black american population down at the bottom, to validate their own self-worth. This is exactly the same as height. Once you are white or “tall”, that doesn’t go away no matter how badly you screw up your life and how many poor choices and decisions you make. You will always have the fact that you are intrinsically white/tall to fall back upon psychologically to sooth any damaged ego. The human mind is really ingenious in that way.

I do frequent the reddit.com/r/short sub-group and a recent thread (available here) does have one women just being probably as honest with her feelings as possible. A responder would write to her and explain in words why she is trying to absolve herself of being accountable but this is what this guy doesn’t get. Words are useless. Being angry at a women for bashing and talking shit about short men does nothing except make her resolve and opinions stronger. Trying to convince a women by talking with them that they are being “illogical” or “not rational” or “not make any sense” doesn’t work.

What these type of women are really saying is this message…

I know myself, and I know what I like. I don’t give a fuck about what you say, and I don’t care what you think (maybe I used to when I was younger and more naive and concerned about the opinions of other people but not anymore) since I am going to live my life as I want to. Nothing you say or write out into words is going to make me change my mind or what I have felt most of my life. Maybe this automatic reaction and feeling I have is not completely organic but manufactured from hollywood & media marketing but I just can’t help it. Deal with It.

When the women than adds something like “my last boyfriend was 6′ 4” this is their way of saying to future men who wish to be her potential future romantic partner that they literally don’t measure up to what the girl expects in a guy, from her references in her past experience. This is also a way for the women, who could be very young, nubile, extremely attractive, and highly prized to filter out men. Height is probably the best, most effective way to filter out a large portion of men out of their selection pool. (remember, having too many choices is a bad thing. Having less choices makes it easier). With anything else, any other factor, like education level, level of hygiene, fashion sense, income level, ownership of property, the men the female previously rejected can take their rejection and use their bitterness/anger as fuel to better themselves in that area of life and then come back to the girl to prove her wrong and then show off their new improved life. The height filter is amazingly effective in making sure that the millions of men who would want to mate with the attractive female can never come back into the picture (aka potential mating partner in the selection process/pool) since they can’t change that area of their life. 

Half of the time, the girl can be a real bitch and use intentionally to inflict emotional daggers at men that to hurt/piss off men who are shorter than their arbitrary height requirements, but for the other half, it is a way to let go of certain men who are chasing after her nonstop by giving an excuse that the guy can not back from aka letting them down easily (instead of saying to the guy’s face” I am just not attracted to you”). Height requirements is an effective rule of thumb to follow in making a mate selection choice. Some men do it too, but not to the same level or degree.

I may not have been part of the PUA scene which had been big maybe a decade ago, but the old David DeAngelo phrase “Attraction is not a choice” is the most succinct phrase to explain females preference for taller men than anything I could have thought of. For short men and brothers out there, we are at an advantage being given the short end of the stick in terms of genetics, but that is okay since height is the not only factor that effects how women will look at us. There are things we can do. Few of us will never face rejection. Almost no men will get every single girl he wants.

Sometimes no matter how much we do accomplish and make in terms of money, we still can’t win against the taller guy, because we are just animals acting out our neurological patterns which have been pre-programmed into our heads from birth. Shorter men have to try harder, and that is the way life operates. Stop complaining. Accept it.

So is there nothing we can do as men who have it harder than others? What can we do? – Become Mister Right. Think Different.

The first Yokota/Zhang patent doesn’t provide that much insight but the second study provides a potential device that gives an alternative method of bone lengthening.  The study is confusing so I’d appreciate any second opinions.

Mechanical bone loading to reduce arthritic pain

“mechanical loading of the knee to downregulate nerve growth factor beta (NGFb), which is believed to be a major cause of pain in arthritic joints.”

“the joint loading may be performed at between 0.5 N and IO N, preferably at 1 N, and the fluid flow may be performed at, for example, 5 dyn/cm2. In one aspect, the results described herein suggest that gentle knee loading analogous to massage therapy is beneficial not only to enhancing bone formation and accelerating wound healing but also to preventing NGFP-induced nerve growth and pain perception in cartilage.”

” it has been recently suggested that a consequence of compressive loading is production of hydrostatic pressure as well as fluid flow to cartilage.”<-Hydrostatic pressure in bone could be a key to induce neo-growth plates.

“In osteoarthritis, chondrocytes are known to be exposed to flow shear presumably due primarily to synovial fluid and high amplitude of fluid flow reproduces the hallmarks of osteoarthritis in vitro. The frequency of 5 Hz might not be representative of massage to humans by hands but more pertinent to those by vibrator for foot massage. In another embodiment as described herein, the levels of loading in vivo have been optimized herein to produce anabolic response in the bone and cartilage.”

“Cyclic compression was applied to the mouse right knee using a custom-made piezoelectric loading device following reported methods. The mouse was mask-anesthetized using 2% isoflurane, and lateral loads to the knee were applied for 5 min at 5 Hz with a peak-to-peak force of 1 and 3 N.”

“Knee loading at 1 N but not at 3 N decreased the phosphorylation level of p38 (p- p38) in the cartilage”

“it was discovered herein that joint loading, illustratively, of a knee at 1 N, reduced mRNA levels of NGF and its low affinity receptor, p75 in cartilage and subchondral bone. Additionally, it was discovered that, in cartilage, joint loading, illustratively, of a knee at 1 N, reduced the phosphorylation level of p38 MAPK (p38-p) and activity of Racl GTPase. Additionally, it was discovered that, fluid flow at, for example, 5 and 10 dyn/cm2, reduced mRNA levels of NGFP and p75{neuron related gene} in C28/I2 human chondrocytes.”

“Nerves are known to exist in trabecular bone of the epiphysis, and are believed to grow in response to NGF{it’s possible that the growth of these nerves could affect height growth} . Although healthy cartilage is not believed to consist of vascular or neural tissues, arthritic cartilage is believed to lose its ability to remain aneural and avascular. It has been reported that dynamic loading to cartilage evokes stimulation of matrix synthesis{Could enough matrix synthesis increase height}, as well as regulation of enzymatic activities of matrix metalloproteinases. In addition to the reported regulatory role in matrix homeostasis, in one embodiment of the invention herein the results herein point out that mechanical stimuli at moderate amplitudes regulate transcription of NGF and its receptor in cartilage and chondrocytes.”

“both gentle mechanical loading and salubrinal share the Racl -mediated signaling pathway for – mRNA expression of NGF. In myocardial remodeling, it is reported that deficiency of Racl reduces stress to the endoplasmic reticulum. Since the elevated phosphorylation level of eIF2ot by salubrinal also suppresses stress to the endoplasmic reticulum, the observed linkage of salubrinal to Racl appears to be consistent with downregulation of NGF .”  Note that an increase in Rac1 expression was linked to an increase in chondrogenic marker genes.  This suggests that gentle mechanical loading may not be best for inducing exogenic bone mesenchymal chondrogenesis(neo-growth plate) and more extreme load may be needed.

This next paper is listed at the end as a related method:

System and Method for Joint Restoration by Extracapsular Means

“A system and method for joint restoration by extracapsular means includes an actuator operable to apply a force to a portion of a bone to effect a change in the joint space geometry. One embodiment of the system includes an actuator operable to apply a cyclic loading to subchondral bone of a femur, wherein loads of a predetermined magnitude are alternately applied and released. Between periods of cyclic loading, rest periods are provided where no load is applied. Over time, the femoral joint surface is remodeled in accordance with the location, direction, magnitude, and frequency of the loading.”

“Osteocytes sense the increased strain environment, and respond accordingly. When bone tissue is damaged as in the micro-cracking that occurs in the presence of excessive stress or strain, osteoclasts remove the necrotic osteocytes. This activates growth factors held in the osteocytes, such as bone morphogenic protein (BMP) or transforming growth factor (TGF) beta 1.”

“At sufficiently high stress levels, deformation will occur with time, leading to “creep-failure”, or deformation that does not recover once the load is removed. The creep response of bone is significantly larger in younger bones as compared to older bones.”

“Similarly, when bone is measured on a large scale, it exhibits very classical (single elastic constant) behavior, but when the scale is reduced down to the trabecular level or below, the behavior becomes much more viscoelastic in nature, and tends to follow a Cosserat (multiple elastic constants) curve. This allows for much higher than predicted (by the classical approach) strain limits before failure occurs. In order for bone formation to be initiated, the magnitude of mechanical strain of the bone must surpass some threshold. Therefore, for restorative remodeling to occur, this threshold must be exceeded, while not causing failure”

” Trabecular bone can be found inside the condylar region of a femur, and alongside the cortical bone. The trabecular bone transfers the loads from the subchondral bone to the cortical bone, and the subchondral bone is that bone which supports the articular regions of the joint surfaces. Each different type of bone may undergo different deformation mechanisms. For example, cortical bone in particular exhibits “cement line slippage” between the osteons, which accounts for an ISF type (almost viscoelastic) behavior when applied to localized regions. This is typically considered the reason bone is a “tough, non-brittle” material. It is also a response that is dependent on the direction of the applied load-a result of the oriented structure of bone”

” a more rapid load onset results in a more rapid bone change. Conversely, a slower application of a load results in a smaller change, but thickening of the bone to handle the higher stress. Thus, a static load may build more dense bone, but a dynamic load may cause greater overall deformation of the bone.”<-Thus we should probably try to make sure that the clamping is the least static possible.  Constantly increasing clamping force is one way.

” the system components described herein can take advantage of the properties of bone that allow the bone to deform under constant stress via a “creep” or plastic deformation mechanism. The system components can push on the underside—e.g., the trabecular side—of the deformed subchondral bone, forcing a change of surface dimension on the joint surface (opposing) side of the subchondral bone. The subchondral bone may be softened to facilitate the reshaping process by drilling, cracking, laser etching, ultrasonically, biologically or by chemically treating the subchondral or the underlying cancellous bone, or by any other means in conjunction with the use of the system of the present invention, either to facilitate the initial movement, or during subsequent treatments. The devices according to the present invention may be permanently implanted in the bone, or can be removed after the desired results are obtained.”<-Can we induce a similar plastic deformation mechanism but in order to increase height.

“the term “static load” as used herein does not imply that a load that can or will never change; rather, the term refers to a load that is either constant for some period of time, or a load that is applied so slowly as to approximate a constant load. This is distinguished from a dynamic load, which may be a single load applied very quickly, or may be a cyclic load of constant amplitudes and/or frequency, or one of varying amplitudes and/or frequency.”<-So we may want to rapidly clamp then unclamp in order to get a single load applied rapidly.

” the present invention has applications where shortening or lengthening of bone is desired to restore a normal joint geometry, and little or no joint surface remodeling is required. For example, a system including piezoelectric actuators can be applied to one or both sides of a joint to correct an angular displacement. ”

” For example FIG. 14 shows a tibia 76 having a system 78 in accordance with the present invention attached to it. The system 78 includes a linear actuator 80, which can be used to apply a static load, a cyclic load, or some combination thereof to the tibia 76. When a system, such as the system 78, includes two or more such actuators, one can be inserted in the cortical region and over time “grow” one side—e.g., the lateral side—and another can be inserted on the medial side to contract the bone. This effects an angular change at the joint line, and restores a more appropriate mechanical joint alignment.”<-For our purposes, we’d just set the two actuators to length bone.

 

“FIG. 14 shows a system in accordance with another embodiment of the present invention, the system including a linear piezoelectric actuator to increase the length of a tibia;”

“FIG. 15 shows a system in accordance with another embodiment of the present invention, the system including a plurality of linear piezoelectric actuators to increase the length of a tibia as an alternative to an osteotomy”

Nowhere does it state that this would be limited to individuals with opten growth plates and in fact there are no visible growth plates on this bone.

This is an example of a linear actuator:

Note that I have no idea whether this actuator is sufficient in any way to provide a lengthening force on the bone.  It is just an example.

Note that the linear actuator is used in addition to the invention.  It seems that MIchael has considered using a linear actuator for a height increase device before.

” a swelling memory polymer can be used to provide expansion in a predetermined direction to a predetermined volume, thereby exerting pressure against the containing tissues. Shape memory alloys, such as Nitinol (Ni-TI) can also be used. Such alloys, commonly used in bone staples, can be formed as “muscle wires” and inserted into the cortical bone, where they lengthen in response to outside stimuli.”

“A shape memory alloy could also be formed as a spring, and configured to lengthen (or contract) upon application of an electrical current, for example, an 80 mA current at 20C”

This is how he describes inserting the device into the bone:

“creating an aperture[opening] in the bone proximate the articular surface, thereby making accessible an internal portion of the bone generally opposite the articular surface;
accessing the internal portion of the bone through the aperture in the bone; and
applying the at least one loading condition to the internal portion of the bone, thereby facilitating structural changes in the bone supporting the articular surface”

Then he describes inserting the device into the bone:

“wherein the at least one loading condition is applied to the bone with a joint restoration system including a housing having an aperture therethrough, and an elongate member configured for insertion into the aperture in the housing, the method further comprising attaching the housing to the bone such that the aperture in the housing is generally aligned with the aperture in the bone, and
wherein applying the at least one loading condition to the internal portion of the bone includes inserting the elongate member through the apertures such that the elongate member contacts the internal portion of the bone and applies a force thereto.”

“the joint restoration system further including a compression member configured to cooperate with the housing to apply a force to the elongate member, the method further comprising inserting the compression member into the housing such that it contacts the elongate member and imparts a force thereto, thereby facilitating the application of the force to the internal portion of the bone by the elongate member.”

Here he describes the bone lengthening method:

“The method of claim 1, wherein the at least one loading condition is applied to an external portion of the bone such that the certain structural change includes at least one of an increase in a length of the bone or a decrease in a length of the bone.”

” The method of claim 6, wherein the at least one loading condition is applied to the bone with a joint restoration system including an electromechanical actuator, the method further comprising:
attaching the actuator to the external portion of the bone; and operating the actuator to apply the at least one loading condition to the external portion of the bone.”

” piezoelectric devices will often have displacements in the 100’s of micrometers, which will not provide enough travel to effect desired bone growth in many patients. To overcome this limitation, the actuator is provided with a secondary movement mechanism. The secondary mechanism is configured to provide a ratcheting, positive lock that outwardly extends the extendable component by some discrete amount. This allows the application of a stepwise series of 100 micrometer piezoelectric adjustments, until a total bone displacement of 1-5 mm displacement is achieved.”

The paper A LINEAR ACTUATED TORSIONAL DEVICE TO REPLICATE CLINICALLY RELEVANT SPIRAL FRACTURES IN LONG BONES, describes one potential way a linear actuator can be applied to bone.  Although the device therein does not seem to be applied along the longitudinal axis as suggested by the patent but rather on the top and bottom of the bone.

This paper describes the use of a linear actuator to move a nail in distraction osteogenesis.  Note that in the patent above it specifically states there there is no osteomy required for this device to lengthen bone.

I found another paper that studied the LSJL knee device here.

I happened upon this paper however which was published at a conference and has potential new insights.

FEA analysis of a portable knee rehabilitation device

“The knee loading device examined in this paper only remains effective for small levels of deformation. The intended displacement of the working device is very small, a maximum of only 6.35mm, and therefore the device cannot accommodate large deformations as such deformations will greatly decrease the effective range of motion of the device.”<-So the device mentioned in this paper can only deform the bone by a maximum 6.35mm and likely less than that as just because the device can be displaced by 6.35mm doesn’t mean it will displace the bone by 6.35mm.

According to mechanostat theory, you have to deform the bone by at least 1500microstrain or 0.15% of a bones original length to get into the plastic deformation range to actually stretch the bone out permanently.

The average adult femur is 2.34 cm in diamater and the maximum displacement is the same regardless of femur shape and size.  The diameter of the femur is what matters as the device loads laterally.  The maximum displacement force is well over what is needed to plastically deform the bone.  But remember that the maximum displacement force is not actually how much the bone is deformed and the bone is being loaded laterally and not being stretched.  By loading laterally a moderate stretching force should be applied but not by the entirety of the deformation.

So it is not that the device can induce an increase in deforming the bone but it is possible by changing the microenvironment via degradation of cortical bone, initiation of mesenchymal condensation, and an increase in chondrogenic signaling.

If you click on the link above to see the study and look at figures 2 and 3, you can see that the device looks remarkably like a clamp.

“The described joint loading modality applies lateral loads to synovial joints.”

“To apply such [the needed] load, a device would need to have a means of producing a transverse force directly to the end of a long bone, such as at the knee{My current working theory is the load needs to be applied at the the epiphysis with the intent to maximize bone on bone contact and not on the synovial joint} . A cyclic force applied in such an area would force a slight shift of the fluid within the bone towards the opposite end of the bone in a controlled fashion.  While no such device currently exists for use on humans{I think a clamp device can serve such a role}, a new joint study seeks to develop a portable device designed for human use to be used in future testing.”<-For our purposes we would likely want more fluid flow as to induce cortical bone degradation and mesenchymal condensation.

“a pressure of approximately 6.90KPawas used as the load for each vertical pad [in a potential joint loading device]. The pressure equates to approximately 40 N over the entire surface area which is the desired maximum load for the device.”

An Irwin Quick Grip 12-inch can generate 300lbs of force.

300lbs is 1334N which is well over 40N but it is likely that you are not going to be able to generate that force however it is also likely that you will generate over 40N of force.

“stress is equal to force divided by cross-sectional area and strain is equal to change in length divided by original length. Stress and strain are related by Hooke’s Law, which states that stress is directly related to strain by a factor known as the Modulus of Elasticity, which is unique to every material.”

To effectively measure strain we’d have to be able to measure microchanges in bone length which I do not see as being possible at this juncture.

“Given the duty cycle of 5 minutes of daily operation per patient with a 1
Hz frequency loading function during operation; or 300 cycles per operation, this device is designed to last for 2683 uses. The choice of 1 Hz as one example was linked to daily
human physical activities such as walking. The device is able to induce loads up to 20 Hz, and it is a future task to evaluate appropriate loading frequencies.”<-Given that walking does not traditionally increase bone length we would likely use a different frequency.  But using a clamp it’s very hard to get such frequencies.  20Hz is equal to 20times per second and it would be virtually impossible to rapidly unclamp and reclamp in that amount of time.

What my current LSJL method instead tries to progressively clamp harder and harder(while still being mindful not to clamp to the point of too much pain) to increase the number of “cycles”.

It should be noted that nothing in this study mentions using this device for longitudinal bone growth but the other studies that Yokota et al. have done on the joint loading modality suggests that it could.  If you look at figure 1B(in the study link above), you can see that joint loading puts pressure on the cortical bone from the medullary cavity.  At a sufficient enough pressure, there could be degradation of the cortical bone and there was evidence of this in a diagram in one LSJL study.  The degradation of cortical bone is highly significant as one of the key events of fusion is the joining of the cortical bone of the epiphysis to the diaphysis.  By degrading cortical bone, we can reverse some of the constraining effects of cortical bone on future longitudinal bone growth.  After all, a key event in distraction osteogenesis is the inducement of a cortical bone fracture.

Here’s a paper from Korea about a new longitudinal bone growth supplement that may be promising:

Effect of KH-BaRoKer-SeongJangTang based on traditional medicine theory on longitudinal bone growth

“KH-BaRoKer-SeongJangTang (KBS) is a recently developed formulation by using traditional drugs considering traditional medical theory of Oriental books such as ShinNongBonChoGyeong and JuRye, which has been used to improve the growth of child in Korea. Although KBS is usually prescribed to many children who are in retard for their age, its pharmacological effects have not been fully understood in experimental models. The aim of this study was to evaluate the effects of KBS on bone growth. Growth plate thickness and bone parameters such as bone volume/tissue volume (BV/TV), trabecular thickness (Tb.Th), trabecular number (Tb.N), connection density (Conn.D), and total porosity were analyzed by means of microcomputed tomography. Serum insulin-like growth factor-I (IGF-I) levels were measured by enzyme-linked immunosorbent assay. Hepatic IGF-I mRNA expression was analyzed by real-time polymerase chain reaction. Phosphorylation of signal transducer and activator of transcription5 (STAT5) was investigated using Western blot analysis and immunohistochemistry. The thickness of growth plate was increased by KBS. BV/TV, Tb.Th, TbN, Conn.D, and total porosity were improved by KBS. Hepatic IGF-I mRNA and serum IGF-I levels were elevated by KBS. Phosphorylation of STAT5 was increased with administration of KBS. These results suggest that KBS would be helpful to children who are in retard for their age through the elevation of IGF-I.”

Increase in Stat5 phosphorylation, increase in IGF-1, and increase in growth plate thickness could be indicative that the supplement could increase growth.

“Male ICR mice (4 weeks old) and diets were purchased from Dae-Han Experimental Animal Center (Eumsung, Republic of Korea), acclimated for 7 days, and then randomly assigned for 2 weeks to adequate protein (CON, 20% protein) or low protein diet (PEM, 4% protein) . The protein source used was casein. Except for the protein content, the two diets were identical and isocaloric. After 2 weeks, mice were divided into five groups, CON (adequate protein diet + distilled water (DW)-administered group); PEM (low protein diet + DW-administered group); KBS (low protein diet + KBSadministered group); Arg (low protein diet + Arg-administered group); Glu (low protein diet + Glu-administered group). The mice were fed indicated diet, administered each material three times a week for 12 weeks, housed four to six per cage in a laminar air-flow room, and maintained at a temperature of 22 ± 1℃, a relative humidity of 55 ± 1% throughout the study.”

So it seems that this supplement is an IGF-1 mimetic.  Whether this can increase height in children with normal IGF-1 levels depends on the bodies negative feedback mechanisms.

“Binding of GH to GHR activates receptor-associated intracellular tyrosine protein kinase Janus kinase 2 (JAK2), which phosphorylates signal transducer and activator of transcription 5 (STAT5). The phosphorylated STAT proteins translocate to the nucleus, where they bind to specific DNA sequences and regulate gene transcription. Among the signal cascades from the GHR, the JAK2-STAT5 pathway is regarded as a major pathway that mediates the action of GH on gene transcription in the liver. This pathway was shown to be responsible for the transcriptional action of GH on IGF-I. IGF-I is a mitogenic factor for various cells and plays an important role in cell growth and survival, and the majority of plasma IGF-I is biosynthesized in the liver”

Two of the ingredients of the supplement are listed to be arginine and glutamine which aren’t exactly game changing.  A detailed list of the ingredients are given in Table 2 of the paper(link provided).

 

The kbs growth plate and the general bone architecture does look a little bit better than the Arginine group.

“Effect of KBS on tibial growth plate thickness. (A) Representative 3D CT images of knee joint showing growth plate. (B) The thickness of excised bone growth plate was determined on five points. CON, adequate protein diet + DW-administered group; PEM, low protein diet + DW-administered group; KBS, low protein diet + KBS-administered group; Arg, low protein diet + Arg-administered group; Glu, low protein diet + Glu-administered group”

So the supplement didn’t have much more benefit over arginine.

“The lengths of proximal tibia growth plate in the CON and PEM groups were 112.82+/- 4.18 and 86.43+/-1.47, respectively. The growth plate lengths in the KBS, Arg, and Glu groups were 119.05+/- 6.48, 118.75+/- 4.81, and 87.82+/- 6.38, respectively. KBS and Arg significantly enhanced the longitudinal bone growth, whereas Glu did not”

Interestingly, the serum IGF-1 levels were lower than the contAnother major ingredient was a variation on the Hominis Placenta Extract.  Given that the source is the human placenta which is very powerful, it is possible that this extract has of yet undocumented effects.  And many species eat the placenta.rol group in the KBS group and lower than that in the Arginine group.

“Carthami Tinctorii Fructus increased the level of serum IGF-I and lengths of femur and tibia, however, its effect was very small and transient”

Something we can ascertain is that maybe excess IGF-1 levels don’t have that large of a benefit on height.  As the excess IGF-1 levels of KBS versus arginine groups did not result in increased height.

KBS and Arginine increased growth plate thickness by about the same amount so it’s hard tell whether KBS has additional effects beyond arginine.  The difference between KBS and Arginine growth plates are so small and the variance is so large that it’s hard to attribute the difference to anything other than normal variation.

It’s possible that KBS could increase longitudinal bone growth but whether that affect is greater than Arginine is unknown

Here’s the study on Carthami Tinctorii Fructus:

Determination of mineral content in methanolic safflower (Carthamus tinctorius L.) seed extract and its effect on osteoblast markers.

“Safflower (Carthamus tinctorius L.) seeds are used as a folk medicine to enhance bone formation or to prevent osteoporosis in Korea. Therefore, the methanolic extract of safflower seeds (MESS) containing high mineral content, such as calcium (Ca), potassium (K) and phosphorous (P), was evaluated for the role on osteoblast (Ob) markers of Sprague-Dawley rats. In serum of 3 to 11 weeks (wks) old rats, both osteocalcin (OC) content and bone-specific alkaline phosphatase (B-ALP) activity increased to their maximum levels in 4-7 wks. Hence, 3 wks old rats were selected for 8 wks oral treatment of MESS, resulted in the significant increase of Ob markers in serum such as OC content (4-8 wks), B-ALP activity (1-2 wks) and insulin-like growth factor I (IGF-I) level (1 wk), and the growth parameter such as the length of femur (2-8 wks) and tibia (4 wks). On the basis of Pearson’s correlation coefficient, there were a moderate correlation between OC and B-ALP at 8 wks, a low correlation between OC and IGF-I at 1, 4 and 8 wks, a moderate correlation between OC and femur length at 1, 2 and 8 wks, and a moderate correlations between OC and tibia length at 1 and 8 wks of MESS-treated groups. The result reveals that the changes of OC correlated at low to moderate level with the changes of B-ALP activity, IGF-I content and femur and tibia length in the MESS-treatment period. On the other hand, there were a strong correlation between IGF-I and femur length at 2 wks and moderate correlation between IGF-I and tibia length at 1, 2 and 8 wks of MESS-treated groups.”

“A Korean herbal formulation, Gami-Honghwain, is comprised of crude ingredients from safflower seeds and hominis placenta.”

“There are reports about chemical components of the safflower. Its leaves contain eight flavonoids, some of which showed potent antioxidant activities. Its seeds also contain numerous polyphenolic compounds such as lignans, glucosides, flavonoids and serotonins”

The increase in tibia and femur length ranged from 3-5%.  Note though that a 3% increase of someone who’s 5’9″ brings them to 5’11”.  And at all data points the treated group had longer bones than the control group.

“. In the aqueous extract from safflower seeds, there are K (2.306 μg/g), P (1.043 μg/g), Mg (0.474 μg/g), Al (0.175 μg/g), Fe (0.100 μg/g), Ca (0.075 μg/g), Zn (0.070 μg/g), Na (0.066 μg/g), Cu (0.055 μg/g) and Sr (0.022 μg/g). In the MESS, there are Ca (3.752 μg/g), K (1.313 μg/g), P (1.161 μg/g), Na (0.177 μg/g), Fe (0.170 μg/g), Zn (0.042 μg/g), Mg (0.023 μg/g), Al (0.019 μg/g), Cu (0.015 μg/g) and Sr (0.002 μg/g).”<-None of these seem to be novel compounds except for Strontium which is found in small amounts in normal human food.  Since Strontium amounts are so small it would be possible to be deficient in it and extra dietary strontium may increase longitudinal bone growth.

An interesting article appeared in the online website The Daily UK today which made me think about the issue of height from a perspective which I never put any effort into before. I refer to the story of Lena Dunham standing next to Taylor Swift Here.

In certain parts of the internet, where men talk about the post-modern version of dating and relationships, a concept has come out called “The Red Pill”, which promotes this idea that what men today think women want and what women really want are very different. These men believe that at the most basic, instinctual level, each heterosexual female wants a dominant, strong, masculine men as based on our savage animal origins.

A central public celebrity which is brought up often to portray the stereotypical image of what is wrong with the American and/or Westernized women of today is Lena Dunham.

Lena Dunham has been vilified by many of these internet blogging men for being too self-accepting of the changes in the female figure. Weight has been traditional the issue/factor that the post-modern men and the post-modern female has the most contention over.

In this day and age where young girls are being constantly being exposed to images of strong powerful women who proclaim to be feminist, they are taught that it is okay to be overweight and not have the type of figure that men desire. Self-acceptance and being fully comfortable with one’s body is very important. In retaliation, the young heterosexual males find these type of women who prefer to stay “overweight” or “full-figured” difficult to find a relationship with stating that they want the old more traditional feminine type of women, which is obviously just a glorified fantasy of something which never really existed. .

Anger, Spite, and Venom has been spewed on both sides, sometimes going as far as threats of sexual assault and bodily harm. Of course, anyone can be sort of a problem as long as they hide behind a screen and stay in anonymity. A sense of self-entitled runs high on both sides.

However, now the issue of height has been brought up. This is where things get interesting. Lena Dunham has been branded a feminism of this modern age, which she seems to be comfortable with that label. When it comes to weight, she has almost no problems. She had taken pictures of herself naked squatting down holding a piece of cake before. She was being overly expressive in showing of the excess of her body to the world.

This recent story that has appeared suggests that she has to content with the other anthropometric measurement which is making her realize that maybe this whole movement of body acceptance is a little harder than believed.

Remember the basic tenet of trying to compare weight and height.

• Weight is something you can change with a little bit of effort, work and discipline
• Height is something that is almost impossible to change

What my point is that when people like Lena Dunham and other feminists are talking about weight issues, and body acceptance, they are focusing on the wrong thing.

There is no need to argue for or against any topic dealing with weight, because weight can be changed and molded to whatever level we desire. 

It is height that is what most important. Your level of stature is what is most important, which is what someone like Lena Dunham realizes she will always be inferior to. With her brand of feminism, she chooses to not wear high heeled shoes, which just makes her look even shorter to her female counterparts, who are trying to accentuate their “tallness”.

It is not the fat-shaming guy online that Lena has to content with (since she can easily dismiss those guy as losers) but another female, who happened to be taller than her, who chooses to dress in a classy way, with her tall female friends.

Suddenly you are put on the spot and realize just how “different” you look compared to the others, your own peers,, who you thought before was at the same level as you, only to see from a more objective point of view that they are much higher than you, literally. The other thing that you realize is that there is nothing that you can do about this factor, unlike weight which you can work on.

What do you do when you realize that you have been fighting the easy fight but have always shied away from the hard fight?

• To gain acceptance of weight is easy.
• To gain acceptance of height is near impossible.

If this girl was to really want body acceptance, she should have focused on height first and foremost and not even consider dealing with the issue of weight. I find it tragic that many modern feminists seem to be putting too much energy and focusing on the wrong thing in life. They should instead be working towards women and men finding body acceptance over their height, not weight.