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Synergistic Healthcare
Methodology
Using HCR and Synergy Mat on Lateral Ankle
Ligament Sprain Treatment
Marc Michnowski – Physiotherapist – ManualTherapy – 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
Pathophysiology
Single 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 sequels
AIM :
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 rehab
With Synergy HCR : Electromagnetic Microcirculation Stimulator
Medium frequency radio signal (0,447Mhz)
Applied by contact to biological tissue through 2 types of conducing
electrodes
To create minimum or maximum variation of bloodstream and
temperature in well identified areas
To 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 model
Electrical charges accumulate inside the insulating materials present
between 2 metal plates
Once 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 metabolism
Increased demand for oxygen and
nutrients and greater blood supply
Capacitive (insulated) High impedance active electrode
Armatures = 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 electrode
Armatures = 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 sprain
First 72 hours : acute phase
Lymphodynamic 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 exudate
Protect the newly-formed fibrin bonds from disruption
Promote collagen fibre growth and realignment
Day 3 = 10 : Inflammatory stage
Necessary stage in healing process to start repair mechanisms
Inflammatory cells invade area
Serotonin, 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 intensity
On the ankle area with passive and active mobilisations
⇒ Supply capillary and nutrients activities
⇒ Stimulate collagen production
Thermodynamic electrode application with high intensity
On 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 damage
To promote chemical and structural collagen changes
Until a normal tissue
Scar need to gain strength and flexibility
Muscles need more power and intelligent control level
Functional Proprioception skills
Low Impedance electrode application with high intensity
On 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 rehab
With 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 capacity
To :
⇒ 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 flat
Irregular surfaces stimulates microcirculation and acts on
mechanoreceptors present on the sole of the foot
Sports Recovery
Recovery
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.
Synergistic Healthcare Methodology for ankle sprain and sports recovery
Synergistic Healthcare Methodology for ankle sprain and sports recovery
Synergistic Healthcare Methodology for ankle sprain and sports recovery

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Synergistic Healthcare Methodology for ankle sprain and sports recovery

  • 1. Synergistic Healthcare Methodology Using HCR and Synergy Mat on Lateral Ankle Ligament Sprain Treatment Marc Michnowski – Physiotherapist – ManualTherapy – 23 av Niel, Paris, France – marctecartm@gmail.com
  • 2. 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
  • 3. Pathophysiology Single sprain : Isolated tear of ATFL +/- CFL Complex sprain : Additional damage of : -  PTFL -  peroneal tendon tears -  cartilage impingement -  tibio fibular ligament = surgery
  • 4. Poor sprain medical managements = long term adverse sequels AIM : 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
  • 5. Soft tissues healing process : Trauma Tear - bleeding Clot formation Inflammation Proliferation Repair Remodelling Scare tissue Hours days weeks months
  • 6. Need to increase metabolism without ill consequence for the new formed tissue
  • 7. How SHM supports ankle sprain rehab With Synergy HCR : Electromagnetic Microcirculation Stimulator Medium frequency radio signal (0,447Mhz) Applied by contact to biological tissue through 2 types of conducing electrodes To create minimum or maximum variation of bloodstream and temperature in well identified areas To act in biochemical processes and activate natural repaired mechanisms of human body
  • 8.
  • 9. 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
  • 10. In physical model Electrical charges accumulate inside the insulating materials present between 2 metal plates Once reached saturation, the capacitor contains the energy as long as it is used
  • 11. 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 metabolism Increased demand for oxygen and nutrients and greater blood supply
  • 12. Capacitive (insulated) High impedance active electrode Armatures = 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
  • 13.
  • 14. Resistive(unisolated)Low impedance active electrode Armatures = 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
  • 15.
  • 16.
  • 17. 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
  • 18. HCR treatment for lateral ankle sprain First 72 hours : acute phase Lymphodynamic 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
  • 19.
  • 20. 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 exudate Protect the newly-formed fibrin bonds from disruption Promote collagen fibre growth and realignment
  • 21. Day 3 = 10 : Inflammatory stage Necessary stage in healing process to start repair mechanisms Inflammatory cells invade area Serotonin, histamin and …, are released Local vasodilatation and capillary permeability increase Macrophages absorb necrotic tissues and attract fibroblasts Basic collagen matrix fabrication is starting
  • 22. 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
  • 23.
  • 24. 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
  • 25. Focus on gentle ROM to not disrupt scar and muscles strengthening Low Impedance electrode application with medium intensity On the ankle area with passive and active mobilisations ⇒ Supply capillary and nutrients activities ⇒ Stimulate collagen production Thermodynamic electrode application with high intensity On peroneal and anterior leg muscles with active contractions ⇒ Promote blood flow inside muscles ⇒ Improved muscle tone trophicity ⇒ Assist strengthening
  • 26.
  • 27.
  • 28.
  • 29. Days 21 = 6, 12 weeks and more …. : Remodelling period New scar tissue needs regular stress and tension without damage To promote chemical and structural collagen changes Until a normal tissue Scar need to gain strength and flexibility Muscles need more power and intelligent control level Functional Proprioception skills
  • 30. Low Impedance electrode application with high intensity On 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
  • 31. SHM to support proprioceptive rehab With 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 capacity To : ⇒ Prevent new sprain for future ⇒ Reduce the motion of an eventual other sprain
  • 32.
  • 33. 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
  • 34. Some of them are not flat Irregular surfaces stimulates microcirculation and acts on mechanoreceptors present on the sole of the foot
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  • 36.
  • 37. Sports Recovery Recovery 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
  • 38. 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.
  • 39. Because of the effects show before, Using SHM with HCR can help to sports recovery.