Scott Hulm: Unraveling Aponeurotic Strain Injuries
Dec 06, 2024
Episode 164: In this episode of the Informed Performance Podcast, Scott Hulm, a Senior AFL Rehabilitation Physiotherapist at the Western Bulldogs, shares insights from his extensive experience in sports physiotherapy and his ongoing PhD research. A recognized expert in injury prevention, rehabilitation, and performance optimization, Scott delves into the complexities of muscle-tendon unit injuries, with a focus on the aponeurosis, hamstring strain injuries, and high-speed running biomechanics.
✏️Topics Discussed
▪️ Anatomy and Function of the Aponeurosis
▪️ Adaptations of aponeurosis
▪️ Challenges in Managing Soleus and Rectus Femoris Injuries
▪️ Differentiating Aponeurosis and Typical Muscle Strain Injury
▪️ How we can use principles of physiotherapy management to accelerate aponeurosis injury
Key Points
- The muscle-tendon unit (MTU) consists of free tendon connecting muscle to bone, muscular tissue, and aponeurotic structures. Aponeuroses are large connective tissue sheets that provide a scaffold for muscle attachment, with specific variations across different muscles.
- Aponeuroses interact with the extracellular matrix, including connections through epimysial and perimysial tissues. This complex interaction contributes to the intricate nature of the MTU, which has implications for injury types and locations.
- Terminology for aponeurotic structures varies in literature, including terms like intramuscular tendon, intramuscular aponeurosis, and fascia. While largely similar, these terms may reflect slight differences in structure or function depending on the specific muscle being described.
- Free tendons and aponeuroses behave differently under load. Free tendons typically deform uniaxially along the longitudinal axis, while aponeuroses exhibit multi-axial deformation due to muscle attachments and intramuscular pressure changes.
- Aponeuroses accommodate muscle tissue expansion through transverse stretch, which has been observed in both animal and human studies, particularly in calf muscles. This ability is attributed to the presence of superficial, branching, oblique, or transverse collagen fibers.
- The mechanical behavior of aponeuroses may vary between muscles. While well-studied in calf muscles, the behavior of cord-like aponeurotic structures in muscles like the biceps femoris may differ and requires further investigation.
- Aponeuroses possess both elastic and viscoelastic properties, allowing them to transmit force longitudinally like free tendons while also accommodating multi-axial deformation patterns to support muscle tissue function.
- The transverse modulus of aponeuroses is greater than that of free tendons, allowing for greater stretch capacity. Additionally, aponeuroses exhibit regional differences in stiffness and non-uniform strain patterns along their length.
- Computational modeling approaches, such as three-dimensional models of the soleus muscle, have shown that altering the stiffness properties of aponeuroses can influence muscle shape changes and fascicle strain.
- Understanding aponeurosis function and injury mechanisms requires consideration of multiple factors, including specific muscle architecture (e.g., pennation angle, fascicle length, muscle volume), mechanical properties, and intrinsic material properties of the tissue.
Where you can find Scott:
• ResearchGate
• X/Twitter
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