Date post: | 22-Jan-2018 |
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Synergistic Healthcare Methodology
Using HCR and Synergy Mat on Lateral Ankle Ligament Sprain Treatment
Marc Michnowski – Physiotherapist – Manual Therapy – 23 av Niel, Paris, France – [email protected]
���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.