“These types of injuries are very silent during the training… the athlete can train with the injury.”
Rectus Femoris Aponeurosis Injury: “We need time to remodel the scar tissue with long time isometrics, with static stretching, with dynamic stretching, with lumbopelvic control, and we have to work the stiffness with the sprinting, but with a progression and very strictly criteria.”
Rectus Femoris: “We have a muscle with three layers and with two tendons.”
Rectus Femoris: “In the kick, the proximal part acts like a whip. But the distal part acts as force generator.”
“The ultrasound is very important for the assessment and the gold standard is the MRI.”
“In myopneurotic injury, we use heavy slow resistance training. We use long time isometrics. But in myotendinous junction, it’s very important to use 1 minute of stimulus of passive stretching for decreasing the stiffness of tissue.”
Decreasing stiffness with a rectus femoris aponeurosis injury: “Static stretching, dynamic stretching, neurodynamics of the femoral nerve, foam roller, manual therapy, all the days because we have to decrease the non-functional stiffness.”
Rectus femoris: “It’s very important to do the stretching of this biarticular muscle of rectus femoris with a retroversion of the pelvis.”
“The two stimulus are the isometric stretch and passive stretch. The two stimulus are very important because the adaptation I think is the same, the decrease of stiffness.”
“For the Achilles tendon, the stretching, the compression is not good for the tendon, but in this myotendinous junction, it requires this decrease of stiffness and it doesn’t cause more damage. In my clinical practice, the patient has to do it all the days because (with palpation), the scar tissue is very stiff and we have to stretch this tissue.”
“I like to do blood flow resistance training because the vascular system of the myotendinos junction and the aponeurosis is lesser.”
Rectus Femoris injury cohort: “Kicking in soccer player is the highest injury rate and the rate of recurrence is very high for the central tendon injury.”
“The MRI is the gold standard but the MRI tells us the diagnostic but it doesn’t tell us about the patient. The prognosis, the sensation, is patient focused, not image focused. This is very important because with the image, the edema persists a lot of months following the injury. We can see the edema, but the edema cannot stop us… I think that MRI prolongs the return to play times.”
“The soleus muscle has a lot of variability between individuals and it’s possible by the demands on this muscle a basketball player can have a difference between a soccer player, more stiffness sports or more aerobic sports.”
Soleus aponeurosis injury: “The mechanism of injury is acceleration with a false step. And the false step, very similar to the Achilles tendon injury… fatigue is a factor, but the mechanism are running related.”
“Patients with more chronological age have a low quality connective tissue of the soleus muscle.”
Soleus aponeurosis injury: “The central tendon injury is the most commonly.”
“When we have an ACL injury, the quad inhibition is a factor that we manage during the early phase rehabilitation. And in a ligamentous injury of the ankle, we have a soleus inhibition.”
“When a patient suffers an ankle sprain with a ligament extraction or ankle fracture, we have a lot of soleus inhibition for a long time.”
“It’s like the quad (inhibition) and ACL, soleus (inhibition) and ankle sprains. This is the same.”
“The gold standard is the MRI in the soleus because it’s more accurate.”
“The soleus muscle is more silent than rectus femur. The athlete feel a short pain in a moment and calf stiffness but they don’t feel more symptoms.”
“In all the cases we can see the gap in the central (soleus) tendon. A visible gap can we see.”
Soleus injury: “The most challenging thing is the return to running.”
“I feel that stretching is not a good stimulus for central tendon and aponeurotic injuries of soleus.”
“The biological time and the literature is very important for the prognostic factor. I think that with a central tendon or aponeurotic injury, the literature tells us that I cannot put the athlete at the third week to running. It’s a mistake.”
“The biological time of aponeurotic tissue is longer than muscle. A muscle injury of soleus or a myofascial, three weeks, okay, but aponeurotic involvement, three weeks more.”
“The collagen of tendon is very hierarchical, but aponeurotic tissue doesn’t have these hierarchical properties and the structure is more disorganized than tendon.”
“In aponeurotic tissue, the transversal strain is four times the longitudinal strain.”
“The poor quality of the cross-links is the difference between an old athlete and a young athlete.”
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