Well what does that mean in English? Let me discuss a case when I was an intern;

            A young 35-year-old  female dental hygienists presented at the clinic with severe bilateral carpal tunnel. Her grip strength was so affected that she could not hold her dental instruments. When she went to sleep at night she was woken up from the pain, medications gave her temporary relief, bracing at night gave some relief, but she was always in pain and at times debilitating pain. She was at her wits end, and presented to the college for help. This had been going on for number of years but in the last six months the pain has become intolerable.               

My supervising clinician, himself practicing for over 40 years, said we need to use iontophoresis with magnesium sulfate, ultrasound, and manipulate that joint. We should see improvement in two or three therapies. I explained the procedure to the patient with all indications and possible complication and we moved forward. By the third therapy, she was out of pain most of the time, and was back to practicing as a dental hygienist without pain. She responded extremely well to care and was now able to return back to her job. So what happened, what did this therapy do ?

Iontophoresis is a unique treatment modality which has a number of physiological effects on the body. Besides its ability to push substances into the tissue,(drugs, medications, salts, anti-inflammatories), it also has the ability to physiologically change the structures of tissues by ion transfer. What this means, is that in this particular pathology, there was a constriction of the band of connective tissue around the wrist. This continues to constrict and put compress the underlying structures,(nerves, tendon, and vessels). What Iontophoresis does is physically reverse local inflammatory response of the body, as well as, softens the constricting tissues. This allows them to return back to a normal state of resiliency (stretch) and that subsequently reduces the pressure from the constricting band on the carpal tunnel.

To better understand this one particular physiological effect of Iontophoresis let me explain a research paper that was done at the college in regards to this modality.

                        Cadaver tissue from the wrist was removed that was visibly sclerotic and calcified. A known weight was placed on one end of the tissue, and the other end attached to a physical point. The length of the tissue was then measured. This is repeated a number of times with different cadaver tissue. Then half of the tissues were then subjected to iontophoresis for three 20 minute therapies. The tissue was then placed back for measurement with the same identical weight and measurements were taken. This was repeated three separate times. The cadaver tissues, all of the treated samples, were all increased in length, and their ability to stretch was improved. The non-treated tissue, where the same. The non-treated tissue, was then put through the exact same treatment regime, and then re-measured. All of the new treated samples had increased length and improved elasticity of the tissue. (Article published JMPT).

In today’s world iontophoresis is best known for pushing lidocaine or hydrocortisone into the tissue as a noninvasive way of injecting substances into the tissue. Or one of the other most notable is for treatment for patients with excessive sweating.

In the world of sports medicine and physical medicine it is rarely used. There was a time when it was used extensively but the art is slowly fading away to more aggressive surgical and pharmaceutical procedures. The reason for this is that Iontophoresis is not an apply and forget type of treatment. It must be closely monitored and proper training in order to utilize the equipment. For as much good as iontophoresis can do, it can cause just as much harm and tissue destruction. Application is a balance, too little and there’s no effect, too much and tissue damage will occur. Because of this many physicians are reluctant to utilize the equipment unless they do it themselves. There is a substantial potential for antigenic damaging effects. Even when applied properly the patient may sustain minor Iontophoresis burns which are painless and will heal in a short period of time.

INDICATIONS FOR IONTOPHORESIS

1. local anesthetics for pain
2. Edema reduction – hyaluronidase (anode) – increases absorption of fluid

– used w acute and chronic conditions

3. Inflammation (most common for use)
4. Skin conditions
5. Adhesive capsulitis/soft tissue adhesions
6. Calcific tendonitis,
7. Myositis Ossificans
8. Sclerolytic effects (softening)

Inflammation – indication for iontophoresis

1. Bursitis
2. Tendonitis
3. Plantar Fascitis (foot pain, heal spur)
4. Ligamentous strain/strain (Acute &Chronic)

Skin conditions – indications for iontophoresis

1. Small, open ischemic ulcers – zinc oxide (anode)
2. hyperhydrosis (excessive sweating)
3. Fungus infections, (copper sulfate),(under nail bed)

Iontophoresis has ability on a physiological level to change tissues structure by repelling calcium ions which will reverse calcific tendinitis and a number of other arthritic and inflammatory degenerative processes. Its ability to soften scar tissue, its ability to allow ligaments to regain elasticity and mobility, its ability to remove inflammation, and many other physiological effects are directly related to its ability to affect ions on a physiological and structural level. Its effects can be dramatic but once again it is just one tool and is not for everybody or all conditions. It comes with substantial risks and those risks can be minimized by proper technique and training.

In Summary;

Iontophoresis is the ability to introduce a substance through an electrical current. The current in itself has a large number of physiological   Properties/responses. This is by far the most  physical dangerous current to use in all physical medicine devices. When used improperly can cause substantial damage/harm to the body. The same type of current is used in electrical cauterization during surgical procedures. When properly used, the current has substantial physiological benefits for the treatment of a number of pathologies.

Dr. Finkle uses the unit for the following conditions;

• Carpal Tunnel Syndrome
• Plantar Fasciitis
• Tarsal Tunnel Syndrome
• Fungus Infections (with copper sulfate)
• Reduced chronic recurring inflammation ( with sodium salicylate and magnesium sulfate