|
|
iontophoresis
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
iontophoresis - April 16, 2004 7:00:00 PM
|
|
|
cocoabchPT
Posts: 8
Joined: April 5, 2004
Status: offline
|
Is there any point in trying iontophoresis after a patient has had 3 cortisone shots with limited relief? I've seen doctors prescribe this in the past and I've always wondered why.
|
|
|
|
|
Re: iontophoresis - April 16, 2004 7:15:00 PM
|
|
|
j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
|
What condition is this for?
One might ask if there is any point in trying iontophoresis at all.
jon
|
|
|
|
|
Re: iontophoresis - April 17, 2004 4:36:00 AM
|
|
|
cocoabchPT
Posts: 8
Joined: April 5, 2004
Status: offline
|
Jon,
In this particular instance the diagnosis is plantar fasciitis. I've also seen this scenario with lateral epicondylitis.
Anna
|
|
|
|
|
Re: iontophoresis - April 17, 2004 8:01:00 AM
|
|
|
jma
Posts: 2409
Joined: August 24, 2000
From: NY
Status: offline
|
Hello,
You mentioned that this person received 3 cortisone shots with no relief. Has this person been using orthotics? I think there may be some biomechanical issues that is not being addressed, thus the chronic condition.
JMA
|
|
|
|
|
Re: iontophoresis - April 17, 2004 4:20:00 PM
|
|
|
j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
|
Anna, consider this reference:
Gudeman SD, Eisele SA, Heidt RS, Colosimo AJ, Stroup AL. Treatment of plantar fasciitis by iontophoresis of 0.4% Dexamethasone. A randomised, double-blind, placebo controlled study. The American Journal of Sports Medicine 1997;25(3):312-6.
The summary is that ionto is more likely to provide immediate pain relief. The caveat is that it is temporary and outcomes between groups were not different at one month. I've debated the benefits of temporary pain relief before. It seems to me that temporary pain relief is worth while if the time frame overlaps with permanent pain relief or that it is clearly sold as temporary.
Based on the biologic rationale for ionto use, it would seem unlikely that the patient should benefit from it failing steroid injection.
I don't plan on giving much advice as that would presume I actually know what I'm doing sufficient to give advice. If your willing, I would be curious what you end up doing and the results.
Good luck and thanks,
jon
|
|
|
|
|
Re: iontophoresis - April 17, 2004 6:47:00 PM
|
|
|
FLOrthoPT
Posts: 85
Joined: October 20, 2003
From: wellington, fl, usa
Status: offline
|
there's an article that is within the last 3 years in the journal of sports medicine I believe by some Docs in the Northern VA / DC area that had double blind placebo study with ionto, it has some good results and interesting to read. Also ask your local EMPI guy about the ionto research...Anyway the real thing I wanted to say is that maybe you are looking at this wrong. No one ever said you had to use ionto with dex. Try acetic acid, works great on bone spurs and areas that are more sub-acute/chronic. I still suggest using dex in the acute phase. Also, start thinking about whether or not you want to be using ice with your ionto Tx...
food for thought-
|
|
|
|
|
Re: iontophoresis - April 18, 2004 5:50:00 AM
|
|
|
cocoabchPT
Posts: 8
Joined: April 5, 2004
Status: offline
|
This particular patient has had PT for this before and could not tolerate it. I'm thinking along the same lines as Jon. Unless I'm confused ionto with dex will be even less effective than the cortisone shots. I didn't think of the acetic acid, that's a possibility.
Anna
|
|
|
|
|
Re: iontophoresis - April 18, 2004 12:46:00 PM
|
|
|
j
Posts: 74
Joined: January 7, 2004
From: wi
Status: offline
|
Anna, sounds like it is doubtful (based on time lines) that this patient has an inflammatory condition that requires and anti-inflammatory solution.
jon
|
|
|
|
|
Re: iontophoresis - April 18, 2004 1:17:00 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
the gold standard for localized steroid delivery is injection. If the gold standard doesn't work, there is no reason to believe ionto would work at all. And if ionto did provide relief then one would suspect it is the electrical charge of the unit providing the relief.
Doesn't make sense at all and is a waste of money. It is like using a lidoderm patch if localized lidocaine injection fails, makes no sense.
The conclusion of the "ionto and heel pain article" is "Conclusions. Although much has been written about the treatment of plantar heel pain, the few randomized controlled trials involve small populations of patients and do not provide robust scientific evidence of treatment efficacy. "
|
|
|
|
|
Re: iontophoresis - April 18, 2004 5:32:00 PM
|
|
|
PTupdate.com
Posts: 1474
Joined: October 8, 2001
From: Pittsburgh, PA USA
Status: offline
|
I don't hesitate to use ionto if an injection failed once, simply because the physician may not have hit his "target" with the injection, and the ionto, with a more broad dispersal, may do the trick.
However, if 3 injections failed, odds are the ionto is not the solution. More studies are showing that in chronic cases, especially lateral epicondylitis, there really are not many inflammatory cells present in the tissue biopsy...thus the reason why an anti-inflammatory treatment didn't work.
When plantar fasciitis (or what appears to be) does not respond to injections, therapy, orthotics, etc. one should consider either tissue degeneration at the insertion or entrapment of Baxter's nerve.
I am not aware of any studies indicating the acetic acid can work on mature bone. It is an option for immature bone, that is existing as a precipiate in the tissue. While not soluble in the pH of blood and normal tissues, it is can dissolve in lower pH environments, thus the reason why the ionto works. With more mature bone, I can't see this happening. FLOrthoPT, have you seen a study indicating otherwise?
John Duffy, PT OCS [URL=http://www.PTupdate.com]www.PTupdate.com[/URL]
|
|
|
|
|
Re: iontophoresis - April 19, 2004 12:20:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Hi Anna. If you do a straight leg raise with this patient with his ankle passively everted to end range, can you elicit his heel pain? If so, you may want to try treating his heel pain with some neural tension stretches targeting the tibial nerve. A medial calcaneal branch comes off the tibial nerve that travels near the attachment of the plantar fascia to the calcaneous. Entrapment or irritation to this nerve can mimic heel pain or plantar fasciitis. Since ionto and cortisone injections have failed, why not try and treat here if indicated with some neural tension stretching. Also, if they have an overpronated foot or pes planus you may want to address this with an orthotic. Correcting the overpronation also may eleviate any stress that is placed on the tibial and calcaneal nerves. I think there was a good case report in JOSPT several months ago on this. I will try and locate it for you. Good luck.
ArmyPT, OCS
[This message has been edited by ArmyPT (edited April 19, 2004).]
|
|
|
|
|
Re: iontophoresis - April 19, 2004 1:20:00 AM
|
|
|
nari
Posts: 1568
Joined: November 14, 2003
From: Australia
Status: offline
|
I fully support Army's suggestion.
For 10 years I have not treated PF locally (unless it is a blatant over-pronation) but have had permanent results with SLR +/- DF/EV/INV depending on what reproduces the specific pain.
It sounds like it is a neural tension, after all that has been tried so far.
Nari
|
|
|
|
|
Re: iontophoresis - April 19, 2004 1:39:00 AM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
Anna,
The calcaneal nerve entrapment and heel pain is well documented. Here are a couple of case reports that I thought were noteworthy. At the bottom is a link to the JOSPT case report. Good luck!
Army
Chronic calcaneal pain in athletes: entrapment of the calcaneal nerve?
Am J Sports Med. 1984 Mar-Apr;12(2):152-4.
Resident Case Report: Differential Diagnosis and Treatment of Subcalcaneal Heel Pain: A Case Report
JOSPT 2002 Mar Vol 32 No3 3
[URL=http://www.jospt.org/archive/ao.cfm?month=March&year=2002#]http://www.jospt.org/archive/ao.cfm?month=March&year=2002#[/URL]
|
|
|
|
|
Re: iontophoresis - April 19, 2004 2:42:00 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
If I was the referring doc, the above suggestions sound far more worthwhile than continued placebo, I mean ionto treatment.
The real question is...will therapy work or will this resolve with time alone. Find a treatment, stick with it and make your call.
|
|
|
|
|
Re: iontophoresis - April 19, 2004 4:33:00 PM
|
|
|
FLOrthoPT
Posts: 85
Joined: October 20, 2003
From: wellington, fl, usa
Status: offline
|
also try to remember thery say about 6 ionto Tx is where you can throw in the towel. I have also found that the more fairer skinned people cannot tolerate ionto well, and therefore cannot get the 80 dose that is truly recommended without being there for like 3 hours. The PT that did the research was Craig MArtmaan-Moe, he was with Dr.Nershel do a cross reference and you may get the good ionto article. I have only anecdotelly had good results with acetic. After an EMPI inservice I was inspired to try some of the other forms of ionto besides dex and had some really good results. I treated an MD who had a nast Ca2+ deposit of his supraspinatus and his best friend the ortho wanted to do surgery, but we all agreed to try to do ionto with acetic and ionto only. Two times a week at an 80 dose, no other Treatments, and 6 weeks the pain was gone, ROm 100% strength was better and I believed they did an ultrasound (not an MRI) do Dx it, and upon re-exam it was significantly diminished. Ask your local EMPI rep for ionto articles, I believe there is one re: acetic acid. Also remember to have the correct polarity..just about everything is a neg. charge so use you neg lead, I think only MGS04 (MAg sulfate?) is the only pos charge. Happy phoresing-
Ben
|
|
|
|
|
Re: iontophoresis - April 20, 2004 4:56:00 AM
|
|
|
cpagePT
Posts: 8
Joined: March 17, 2004
From: Boardman, OH
Status: offline
|
army pt, do you know any good references for neural tension stretching? thanks
|
|
|
|
|
Re: iontophoresis - April 20, 2004 5:16:00 AM
|
|
|
FLOrthoPT
Posts: 85
Joined: October 20, 2003
From: wellington, fl, usa
Status: offline
|
butler...
|
|
|
|
|
Re: iontophoresis - April 20, 2004 8:16:00 AM
|
|
|
Flexxion
Posts: 16
Joined: March 16, 2004
From: Miami, FL USA
Status: offline
|
I would also be interested in the articles or suggested literature for neural stretching of the lower limb... gracias!
Army PT?
|
|
|
|
|
Re: iontophoresis - April 20, 2004 5:08:00 PM
|
|
|
jma
Posts: 2409
Joined: August 24, 2000
From: NY
Status: offline
|
Hello,
Here is Butler's book. I hope to take the course soon.
Here is the info:
Mobilisation of the Nervous System
David S. Butler, Mark A. Jones
ISBN: 0443044007
Format: Hardcover, 265pp
Pub. Date: January 1991
JMA
|
|
|
|
|
Re: iontophoresis - April 20, 2004 9:40:00 PM
|
|
|
Alex Brenner PT MPT OCS
Posts: 1057
Joined: February 29, 2004
From: Kentucky
Status: offline
|
CPage and Flexxion,
I have not been to a Butler course although I have trained with some other PT's who have been to the course. In addition to Butler's text the JOSPT case report (cited above) demonstrates a lower extremity technique that would probably be worth adding to your tool box. I have had some success using this technique on patients with recalcitrant plantar pain. I perform the technique manually on the patient and then teach a home exercise version of it.
On a side note, text books are very expensive. I have a pretty good technique on purchasing them and thought I would share it. I have asked all my family members to give Barnes&Noble gift cards as gifts on those "minor" holdiays such as Father's day, Valentines day, Birthdays, Groundhog day etc. So instead of receiving another shirt tie or cologne I have been collecting these gift cards. A couple of times a year I am then able to purchase a nice text book. Just my thoughts. Good luck on the mobilzations!
Army
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.078
|
Printable Version
