Synergistic Healthcare Methodology

Using HCR and Synergy Mat on Lateral Ankle Ligament Sprain Treatment

Marc Michnowski – Physiotherapist – Manual Therapy – 23 av Niel, Paris, France – marctecartm@gmail.com

���90% of sprains are ankle’s

85% of ankle sprains are lateral

Per day :23000 in USA 6000 in France 5000 in UK

20 % of all athletic injuries

Statistics

PathophysiologySingle sprain : Isolated tear of ATFL +/- CFL

Complex sprain :Additional damage of : -  PTFL-  peroneal tendon tears-  cartilage impingement-  tibio fibular ligament

=> surgery

Poor sprain medical managements ���=> long term adverse sequelsAIM :Avoid any recurrence and chronicity regardless of their length of treatment.

Failure means :- Early onset degenerative joint and tendon diseases - Disability- Impairment- Late surgery

NB : ankle is not the best prosthetic surgery location

Soft tissues healing process :

Trauma

Tear - bleeding

Clot formation Inflammation Proliferation Repair Remodelling

Scare tissue

Hours days weeks months

Need to increase metabolism without ill consequence for the new formed tissue

How SHM supports ankle sprain rehabWith Synergy HCR : Electromagnetic Microcirculation Stimulator

Medium frequency radio signal (0,447Mhz)Applied by contact to biological tissue through 2 types of conducing electrodesTo create minimum or maximum variation of bloodstream and temperature in well identified areasTo act in biochemical processes and activate natural repaired mechanisms of human body

Stimulates electrolyte movements present in cells and in the surrounding environment

Activate the metabolic activities, vascularization and temperature increase

How ?Synergy HCR exploits capacitor’s principle

In physical modelElectrical charges accumulate inside the insulating materials present

between 2 metal platesOnce reached saturation, the capacitor contains the energy as long as it

is used

In biological model

The HCR device :

Radiofrequency generator

One metal active electrode insulated (capacitive) or not (resistive)

One return electrode uninsulated who closes the circuit

System mobilizes charges in tissues in form of electrolytes capable of influencing cellular metabolismIncreased demand for oxygen and nutrients and greater blood supply

Capacitive (insulated) High impedance active electrodeArmatures => metal electrode coated with insulating material

=> organic tissue and return metal plate

Major activity around the active electrode because of the insulating material

Lymphodynamic => minimal temperature variations specific to lymphatic drainage

Thermodynamic => greater increase in circulation and temperature specific to muscle contractures

Resistive(unisolated)Low impedance active electrodeArmatures => metal active electrode

=> metal return plate electrode

Insulating component is missing :

Bone, ligament and tendinous tissues and also fibrotic tissues poor in electrolytes are playing the insulator function

Circulatory and temperature enhancement are concentrated at their levels

Effects of HCR application ��� ���enhancement

micro circulation

•  Inflamed tissues • Reduction of oedema

Enhancement vasodilatation

•  Long standing oedema • Muscle spasms• Circulatory deficit•  Impingement tissues

Enhancement internal tissue temperature

• Scar • Lymphedeam• Strong muscle spasm• Joint stifness• Fibrous tissue

Time and Intensity

HCR treatment for lateral ankle sprainFirst 72 hours : acute phaseLymphodynamic electrode application with high intensity on the lymph nodes (groin and popliteal areas)⇒ Stimulate lymphatic circulation

Thermodynamic electrode application with high intensity on calf and peroneal muscles⇒ Increase blood flow, speed up the bleeding collection resorption⇒ Create a temperature difference between the upper leg and ankle area ⇒ Treat the muscle defence spasms Return plate electrode under the calf or the thigh

Lymphodynamic electrode application with minimum intensity on ankle⇒ Start to drain the inflammatory exudate ⇒ Decrease pain level

Lymphodynamic electrode application with high intensity on groin and popliteal lymph nodes

Goals for this period :

Reduce local tissue temperature, pain, inflammatory exudateProtect the newly-formed fibrin bonds from disruptionPromote collagen fibre growth and realignment

Day 3 => 10 : Inflammatory stage Necessary stage in healing process to start repair mechanisms

Inflammatory cells invade areaSerotonin, histamin and …, are released

Local vasodilatation and capillary permeability increase

Macrophages absorb necrotic tissues and attract fibroblasts

Basic collagen matrix fabrication is starting

Low Impedance electrode application with smart intensity Around the ankle area, on ligaments and tendons⇒ Stimulate capillary activity⇒ Promote and assist natural inflammation activity

NB : too high intensity can exacerbate the inflammatory pain

Lymphodynamic electrode application ⇒ To continue draining action

Smart Manual Therapy on ankle and foot joints to recover specific mobilities

Day 10 => 21 : Proliferation phase

Fibroblasts continue de produce more rigid collagen

New capillary system constitutes the granulation tissue

Collagen replaces dead cells

New tissue begin to grow with new ending capillaries

New scar is maturing but it is only 15 % as strong as normal tissue

Focus on gentle ROM to not disrupt scar and muscles strengthening

Low Impedance electrode application with medium intensityOn the ankle area with passive and active mobilisations⇒ Supply capillary and nutrients activities⇒ Stimulate collagen production

Thermodynamic electrode application with high intensityOn peroneal and anterior leg muscles with active contractions⇒ Promote blood flow inside muscles⇒ Improved muscle tone trophicity⇒ Assist strengthening

Days 21 => 6, 12 weeks and more …. : Remodelling period

New scar tissue needs regular stress and tension without damageTo promote chemical and structural collagen changes

Until a normal tissueScar need to gain strength and flexibility

Muscles need more power and intelligent control level Functional Proprioception skills

Low Impedance electrode application with high intensityOn ankle and leg areas with deep massage and more effective mobilisations

⇒ Increase of the internal temperature of fibrotic tissues

⇒ Perfused fibrotic tissues who are not

⇒ Increase their viscoelasticity, induce collagen changes

⇒ Decrease joint adhesives states stiffness without damage

SHM to support proprioceptive rehabWith Synergy Mat : different density memory form mats

Ankle sprain procures a perturbation of the proprioceptive body system

Because trauma mechanism speed is faster than the normal joint defence neuromuscular response

It s important to reactivate and to enhance this sophisticated capacityTo :

⇒ Prevent new sprain for future⇒ Reduce the motion of an eventual other sprain

Using different surface to walk and to do foot exercises is a good way to reach those goals

Synergy Mat purposes different sizes, surfaces and diverse levels of instability

It propose to responding to the needs of customized training and proprioceptive rehabilitation

Without putting any load on the joints

Some of them are not flatIrregular surfaces stimulates microcirculation and acts on

mechanoreceptors present on the sole of the foot

Sports RecoveryRecovery

Reserved time for the organism to induce a metabolic action superior than normal activity during which all activities' participating systems

underwent restructuring

Time during which, athletes should allow to joints, muscles, tendons regeneration but also permit to their metabolism to eliminate waste and

build reserves

Each competition or practice session causes a proportional energy cost to the intensity and muscle request time.

Organism accumulates biologic perturbations during efforts.

Organism requires a recovery time.

Also it is important to take into account the mental cost created by the physical activity.

It induces a stress more or less positive.

Because of the effects show before,

Using SHM with HCR can help to sports recovery.