Putting ions to work in physical therapy

This week, I have 8 Questions about Iontophoresis for Brad Sharples, PT, DPT, CSCS, NSCA-CPT.

Brad has been a physical therapist in North Idaho for more than 16 years. A graduate of the University of Idaho, Brad earned his master's in physical therapy and doctorate in physical therapy from Idaho State University and completed certifications as a Certified Strength and Conditioning Specialist and Certified Personal Trainer through the National Strength and Conditioning Association.

Brad works at his clinic, In Touch Physical Therapy, located in Post Falls.

Q. Brad, physical therapists have many useful tools to help promote healing and recovery for their patients. One such tool is the use of Iontophoresis in your practice. Can you give us a general understanding of Iontophoresis?

A. Iontophoresis is the use of an electrical current to deliver a medication to a patient. Iontophoresis operates on the principle of electrical potentials. The delivery electrode or pad, which contains the medication to be administered, has the same charge as the medication. As like charges repel, this drives the medication across the intact skin. The return electrode or pad has the opposite charge of the medication. As opposites attract, this pulls the medication toward the return electrode.

Q. It is my understanding that inflammation, edema, chronic pain and even reduction in calcium buildup can be treated with the use of Iontophoresis. How effective has Iontophoresis been in treating these conditions?

A. Iontophoresis can be an effective tool in conjunction with a comprehensive physical therapy plan of care, including a proper evaluation, use of manual techniques, and appropriate exercise prescription. In my experience, Iontophoresis has been effective, particularly since we've incorporated higher medication concentrations and higher treatment doses.

Q. What is the most common sports injury you treat with Iontophoresis?

A. Tendonitis, such as lateral epicondylitis ("Tennis Elbow") or medial epicondylitis ("Golfer's Elbow"), would be the most common sports injury I treat using Iontophoresis. I've also used Iontophoresis in the treatment of bursitis, tenosynovitis, such as de Quervain's Syndrome, and calcific tendonitis.

Q. Since Iontophoresis is using mild electrical current, is there pain and discomfort when it is applied?

A. Using the older Iontophoresis units - the higher intensity, 3.0-4.0 milliamps - could result in some discomfort, similar to mild stinging or sticking your tongue on a 9 volt battery, for the duration of the treatment. At In Touch Physical Therapy, we use the Hybresis System, which activates the patch using 3.0 milliamps for just a few seconds. The patch then delivers the medication at a trickle without any discomfort as the patient wears it.

Q. What is a typical or average amount of time per treatment and number of sessions you would need before you would see improvement?

A. Using older Iontophoresis units resulted in treatment times usually around 20 minutes for a 40 milliamp-minute dose. If a patient could tolerate some discomfort, the intensity of electrical stimulation could be turned up, resulting in shorter treatment times. Since we use the Hybresis System at In Touch Physical Therapy, we are able to administer the highest dose, 80 milliamp-minutes, in less than 10 minutes in the office.

A treatment patch with the medication is applied to a patient and activated using a controller. Only mild discomfort may be felt for a few seconds as the patch is being activated. Once the patch is activated, the patient can leave as the patch delivers the dose over a two-hour period without any discomfort. I would expect to note some improvement in just a few treatment sessions using Iontophoresis.

Q. With regards to injury recovery, does the use of Iontophoresis during physical therapy speed up the healing process in some cases?

A. Physical therapy facilitates one's natural healing processes. Iontophoresis does not directly speed up the healing process, but it allows us to move a patient through their rehabilitation more rapidly.

In the case of most tendonitis and bursitis applications, it reduces the pain and inflammation associated with the condition, so we are able to progress through that stage of their recovery faster and with less discomfort. As such, some patients have referred to the patches we use as "Happy Patches."

Q. Do all physical therapists incorporate Iontophoresis into their practices, or is it more of a specialty application?

A. All physical therapists have the ability to incorporate Iontophoresis into their practice, if they have the appropriate equipment.

Q. Is Iontophoresis used in other areas of the medical community, or is it primarily used in physical therapy?

A. Although it may be used in other areas of the medical community, such as occupational therapy, I believe Iontophoresis is primarily used in physical therapy.

Judd Jones is a director of the Hagadone Corp.