Applying Iontophoresis

Physical therapists who use this modality can ease pain symptoms and facilitate recovery.

When you are in pain, the first thing you need is relief. If an intervention is going to ease symptoms and facilitate recovery, it's worth trying.

Iontophoresis can achieve this goal. Although iontophoresis has been around since the 1970s, new applications have patients buzzing. Iontophoresis is a noninvasive technology that delivers water soluble, ionic drugs or other compounds through the skin using microprocessor-controlled electrical current. By delivering medications, iontophoresis can control inflammation and pain, decrease edema and calcium deposits, improve scar quality, and control sweaty palms and feet.

Traditionally, iontophoresis is performed in a clinic or doctor's office. However, portable microcircuitry electrodes can be convenient in home environments. Portable microcircuitry electrodes run at a low current and work well for sustained applications, compared with clinician-operated devices. These wearable devices run from 3 to 24 hours, so you can receive treatment and continue daily activities without interruptions.

Although iontophoresis delivers less medica­tion than a local injection, it packs a powerful punch by providing higher local concentrations than oral administration. Typical injection dos­ages range from approximately 0.5 mg for small joints up to 4.0 mg for large joints. Iontophoresis delivers 8 to 13 ug/0.5 gm of exercised tissue, about 100 times less than an injection. However, oral dosages result in concentrations of 7 to 200 mg/0.5 gm of exercised tissue, or 1,000 times more than the amount delivered by iontophoresis.

The medication introduced to the body through iontophoresis bypasses the gastrointestinal tract. This is important for several reasons. First, medi­cation-sensitive areas typically aren't irritated and you'll experience fewer side effects. Second, iontophoresis delivers medication to a specific injury site. Third, this modality reduces the incidence of constipation, a problem if you use pain medications and anti-inflammatories.

Of the drugs used, dexamethasone sodium phosphate is the most common choice. But other solu­tions are producing excellent results. For instance, ketoprofen is an alternative nonsteroidal anti-inflammatory drug that treats many of the same conditions as dexa­methasone, such as tendinitis, bursitis, arthri­tis, spinal stenosis, acute sprains and strains. Potassium iodide is the recommended choice for treating scar and tendon adhesions. Potassium iodide can soften and remove collagen, which allows an area to be molded and stretched. And acetic acid is the drug of choice for treating soft tis­sue mineralization, including heel spurs, calcific tendinitis and myositis ossificans.

Although most people tolerate iontophoresis, some may experience discomfort. To ensure tolerance, your clinician can prescribe wearable microcircuitry units. During therapy, a clinician will increase intensity to a comfortable tolerance and let you say when to stop.

Some people may experience a tingling or "pricking" sensation during iontophoresis application. You shouldn't shave the treatment area on therapy days, as your clinician will try to avoid areas with any cuts or irritated skin. Skin should always be cleaned to remove any oil, dirt or lotion prior to iontophoresis.

If you have a small cut or opening in the skin beneath the electrode, the clinician will move it to a new location. Electricity takes the path of least resistance and travels through open or new skin, instead of intact, mature skin.

Iontophoresis may lead to some mild, temporary skin reactions. For example, some people may develop pink sunburn-like marks on the skin under the electrode.

But don't mistake these marks for burns. Burns are rare and these marks may be a transient histamine reaction due to electric current. In some cases, small, raised white bumps will appear. Don't scratch the area. The redness and bumps usually disappear within 12 to 24 hours.

Most patients require approximately 6 iontophoresis treatments, which are usually administered 24 to 48 hours apart. Depending on the severity and acute or chronic nature of your condition, your clinician may determine that as few as 4 or as many as 12 treatments may be necessary.

Iontophoresis can be an important healing com­ponent that helps you move into hands-on treat­ment modalities for conditions such as sciatica. By relieving pain, your clinician can progress to other tech­niques that address specific problems, which enables you to resume higher levels of function.

Charles C. Donley, PT, owner/director of Regional Rehab in Spring Hill, Fla., and Lisa J. Allen, PT, owner of BioMechanic Physical Therapy in Leesburg, Va., provided information for this article.


Have you heard of or treated patellar adhesions post BTB ACL graft with potassium iodide?

Jessica ScheplerJuly 17, 2016

Dear PT Jan,
Unfortunately insurance companies pretend that Iontophoresis is still experimental and will not reimburse for this well tested and documented successful modality. i charge the patients for the delivery electrodes ($15) and they must pick up their own medicine (DEX usually) from the pharmacy.

Lisa Allen,  Owner,  BioMechanic Physical TherapyJuly 10, 2016
Lansdowne, VA

Ms. Blair, I recommend exercising before application of Iontophoresis so that the drug is not flushed out of the area by increased circulation. I routinely apply Iontophoresis last in my treatment, along with ice, also to decrease circulation.

Lisa Allen,  Owner,  BioMechanic Physical TherapyJuly 10, 2016
Lansdowne, VA

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