Phonophoresis

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 Description
Use of therapeutic ultrasound to assist in
diffusion of medication through the skin
Increases the diameter of skin portals to allow
the medication to pass
Pores
Hair follicles
Sweat glands

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 Biophysical Effects
Medication is introduced over a large area
Relative to an injection
Noninvasive
Medication may not be filtered by the liver
Reducing metabolic elimination of the medicine

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 Transdermal Application
Medication must diffuse through:
Enzymatic barrier of the epidermis
Stratum corneum
Rate-limiting barrier to absorption
Medications must be able to diffuse across this barrier
Medication is stored in subcutaneous tissues
for some time before being diffused deeper

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 Skin Influences
Medication uptake is improved when the skin
is:
Well hydrated
Has a high density of skin portals
Highly vascularized
Relatively thin
Younger skin tends to have better diffusion
characteristics than older skin.

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 Ultrasound Influences on Diffusion
Thermal Effects
Increase kinetic energy
Increase portal cross-section
Increase circulation
Increase capillary permeability
Nonthermal Effects
Altered cell resting potential
Increased cell membrane permeability
Increased molecular permeability

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 Phonophoresis Medications
Either prescription or nonprescription
Low molecular size and weight
Most medications used can be applied
transdermally without ultrasound
Controlled medications require a prescription
for the patient being treated
Medication is often mixed in an inert base
Base must be able to transmit ultrasonic energy

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 Common Medications
Type Indications Example
Corticosteroid Inflammation Hydrocortisone
Dexamethasone
Salicylates Inflammation
Pain
Anesthetic Pain Lidocaine
Trigger points

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 Application Tips
Moist heat pack prior to application:
Increase blood flow
Increase kinetic energy
Increase skin portals
Following treatment
Leave medication on skin
Cover with an occlusive dressing
Moist heat pack re-application may assist in
further absorption

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 Low-frequency US Phonophoresis
Parameters:
1 Mhz output frequency
1.25 W/cm2
Pulsed output
Benefits:
Allows medications with a larger size and weight
to diffuse
More efficient medication delivery

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