1. The document discusses a methodology for using high-frequency current (HCR) and Synergy Mats to treat lateral ankle ligament sprains. 2. HCR is applied at different intensities and locations over time to stimulate microcirculation, reduce edema, enhance vasodilation, and increase internal tissue temperature during the acute, inflammatory, and remodeling phases of healing. 3. Synergy Mats with different surfaces are used for proprioceptive rehabilitation exercises to reactivate the neuromuscular system and prevent future sprains. The document also notes that recovery time is needed after exertion to allow regeneration of joints, muscles and tendons.

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

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

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

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

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

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

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

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

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.