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Phonophoresis in Physical Therapy

Ultrasound with Medication to Decrease Inflammation

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Updated March 01, 2012

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Phonophoresis is a form of treatment that is used during physical therapy. It involves the use of ultrasound combined with a medication gel. The medication is applied to the skin, and then ultrasound waves are used to help pass the medicine through the skin and into your injured body part.

To fully understand phonophoresis, you must first understand what ultrasound is and how it is used in physical therapy.

Therapeutic Ultrasound in Physical Therapy

Common Injuries Treated with Phonophoresis

Phonophoresis is used most often in the treatment of inflammation in a muscle, tendon, ligament or other soft tissue in the body. Therefore, phonophoresis is considered an anti-inflammatory treatment.

Inflammation is the natural healing process that occurs in the body after injury. The signs and symptoms associated with inflammation include pain, swelling, redness and increased temperature of the inflamed body part.

Occasionally phonophoresis is used to treat pain.

There are reports of phonophoresis being used to treat delayed onset muscle soreness (DOMS). DOMS is muscle soreness that occurs after vigorous exercise and usually lasts one to two days after exercise.

Phonophoresis is most often used to treat:

Medications Used with Phonophoresis

The medications most often used during phonophoresis treatment are those that help decrease inflammation. These anti-inflammatory medicines help reduce the pain and swelling that you may be feeling after an injury.

Anti-inflammatory medications that are used in the application of phonophoresis include, but are not limited to:

Lidocaine, a local pain medicine, is also sometimes used with phonophoresis.

If you and your physical therapist agree that phonophoresis may be a good treatment option for your specific condition, be sure to understand what medication is to be used and what his or her rationale is for using it. Some medications carry risks and side effects, even if applied to the skin.

Does Phonophoresis Work?

There is some published evidence that phonophoresis may help decrease pain and inflammation, but many of these studies are of poor design and are not seriously considered when analyzing the effectiveness of the treatment. A 1967 study, for example, demonstrated superior outcomes in patients receiving phonophoresis when compared to patients receiving ultrasound alone. But more recent studies have failed to duplicate these results.

Other studies published on the effectiveness of phonophoresis indicate that the medication used during the ultrasound treatment does not penetrate through the skin and, therefore, cannot help treat pain or inflammation.

One study on the effectiveness of phonophoresis in treating DOMS found that it did not help improve soreness when compared to a fake treatment of phonophoresis.

A 2006 review in the Physical Therapy Journal concluded that "no strong evidence was presented in any experimental study to suggest that adding a drug to the coupling medium [ultrasound gel] produced additional benefits compared with the use of US [ultrasound] alone."

Some clinicians argue that there is not enough evidence to support the use of phonophoresis in physical therapy, while others feel that the treatments provided with phonophoresis can be useful in decreasing pain and inflammation. Some argue that the placebo effect may lead physical therapists (and patients) to feel that phonophoresis is an effective treatment.

Bottom Line

Phonophoresis is a treatment that you may encounter in physical therapy if you have an injury that causes inflammation. It is used to decrease pain and inflammation in order to improve overall functional mobility.

In general, your physical therapy program should include active involvement whenever possible, and phonophoresis is a passive treatment. You cannot take phonophoresis home with you, and you cannot use it to self-manage your problem. It is important that you and your physical therapist work together to ensure that you have an active self-care program to help improve your condition and return to optimal function as quickly as possible.

Sources:

Griffin JE, Echternach JL, Price RE, et al. Patients treated with ultrasonic driven hydrocortisone and with ultrasound alone. Physical Therapy. 1967;47:594-601.

Gurney, AB etal. Absorption of hydrocortisone acetate in human connective tissue using phonophoresis. Sports Health. 2011 Jul/Aug; 3(4): 346-351.

Hoppenrath, T and Ciccone, CD. Is there evidence that phonophoresis is more effective than ultrasound in treating pain associated with lateral epicondylitis? Physical Therapy. 2006 Jan; 86(1): 136-140.

Penderghest, CE etal. Double-blind clinical efficacy study of pulsed phonophoresis on perceived pain associated with symptomatic tendinitis. Journal of Sport Rehabilitation. 1998 Feb; 7(1): 9-19.

Prentice, W. (1998). Therapeutic modalities for allied health professionals. New York: McGraw-Hill.

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