Effects of diclofenac sodium gel phonophoresis in sports activities induced grade-l ankle sprain

Authors

DOI:

https://doi.org/10.15391/prrht.2023-8(4).05

Keywords:

diclofenac sodium gel, therapeutic ultrasound, sports activities, ankle sprain

Abstract

Purpose: the purpose of this study was to evaluate the effect of diclofenac sodium gel phonophoresis in grade -l ankle sprain.

Materials & Methods: 54 patients were randomly included in this study and allocated equally into two groups. Group-1 was managed with therapeutic ultrasound (digital ultrasound machine, a product of HMS marketed in India with frequency of 1 MHz and 3MHz) with diclofenac sodium gel and group-2 was managed with therapeutic ultrasound with aquasonic gel. Therapeutic ultrasound with diclofenac sodium gel, marketed under the name of Voltaren, was administered at a frequency of 1MHz, an intensity of 0.8 W/cm2 with continuous mode (1:1) for five times a week for 2 weeks. The patients were examined by using Numeric Pain Rating Scale (NPRS) and Foot and Ankle Disability Index (FADI). They were assessed on the baseline, after 1st week, and after 2nd week of treatment.

Results: one way ANOVA test was used to determine the significant difference at the 0.05 level of significance. There was reduction in NPRS and FADI p-value 0.000 after 2nd week of treatment in group-1 and group-2. But on the basis of mean difference score of NPRS and FADI, group-1 was better effective in terms of reduction of pain and improvement of function periodical manner (Table 3).

Conclusion: significant dose-dependently relief was observed in NPRS and FADI for pain in disability for each group treated with diclofenac sodium gel compared with aquasonic gel using ultrasound. Acoustic streaming increased these benefits significantly when used after topical application of diclofenac sodium gel, and the dose-dependent effects of diclofenac sodium gel using therapeutic ultrasound.

References

Aghazadeh-Habashi, A., Yang, Y., Tang, K., Lőbenberg, R., & Doschak, M.R. (2015). Transdermal drug delivery: feasibility for treatment of superficial bone stress fractures. In Drug Delivery and Translational Research, 5, 540-551. https://doi.org/10.1007/s13346-015-0257-8

Alghadir, A.H., Iqbal, Z.A., Iqbal, A., Ahmed, H., & Ramteke, S.U. (2020). Effect of chronic ankle sprain on pain, range of motion, proprioception, and balance among athletes. International Journal of Environmental Research and Public Health, 17(15), 5318. https://doi.org/10.3390/ijerph17155318

Altman, R., Bosch, B., Brune, K., Patrignani, P., & Young, C. (2015). Advances in NSAID development: Evolution of diclofenac products using pharmaceutical technology. Drugs, 75, 859-877. https://doi.org/10.1007/s40265-015-0392-z

Atlas, S.J., & Deyo, R.A. (2001). Evaluating and managing acute low back pain in the primary care setting. Journal of General Internal Medicine. 16, 120-131. https://doi.org/10.1046/j.1525-1497.2001.91141.x

Barkin, R.L. (2015). Topical Nonsteroidal Anti-Inflammatory Drugs: The Importance of Drug, Delivery, and Therapeutic Outcome. American Journal of Therapeutics, 22(5), 388-407. https://doi.org/10.1097/MJT.0b013e3182459abd

Brady, R.J., Dean, J.B., Skinner, T.M., & Gross, M.T. (2003). Limb length inequality: Clinical implications for assessment and intervention. Journal of Orthopaedic and Sports Physical Therapy, 22(5), 388-407. https://doi.org/10.2519/jospt.2003.33.5.221

Da Cunha, R.A., Hazime, F.A., Da Silva Martins, M.C., Ferreira, M., De Castro Pochini, A., & Ejnisman, B. (2016). Translation, cross-cultural adaptation, and clinimetric testing of instruments used to assess patients with ankle sprain in the Brazilian population. Journal of Orthopaedic and Sports Physical Therapy, 46(12), 1042-1050. https://doi.org/10.2519/jospt.2016.6218

Davis, I.S., Bowser, B.J., & Mullineaux, D.R. (2016). Greater vertical impact loading in female runners with medically diagnosed injuries: A prospective investigation. British Journal of Sports Medicine, 50, 887-892. https://doi.org/10.1136/bjsports-2015-094579

Delahunt, E., Coughlan, G.F., Caulfield, B., Nightingale, E.J., Lin, C.W. C., & Hiller, C.E. (2010). Inclusion criteria when investigating insufficiencies in chronic ankle instability. Medicine and Science in Sports and Exercise, 42(11), 2106-2121. https://doi.org/10.1249/MSS.0b013e3181de7a8a

Deniz, S., Topuz, O., Atalay, N.S., Sarsan, A., Yildiz, N., Findikoglu, G., Karaca, O., & Ardic, F. (2009). Comparison of the effectiveness of pulsed and continuous diclofenac phonophoresis in treatment of knee osteoarthritis. Journal of Physical Therapy Science, 21(4), 331-336. https://doi.org/10.1589/jpts.21.331

Draper, D. (2016). Low Intensity Ultrasound for Promoting Soft Tissue Healing: A Systematic Review of the Literature and Medical Technology. Internal Medicine Review, 2(11). https://doi.org/10.18103/imr.v2i11.271

Efe, T., Sagnak, E., Roessler, P.P., Getgood, A., Patzer, T., Fuchs-Winkelmann, S., Peterlein, C.D., & Schofer, M.D. (2014). Penetration of topical diclofenac sodium 4 % spray gel into the synovial tissue and synovial fluid of the knee: A randomised clinical trial. Knee Surgery, Sports Traumatology, Arthroscopy, 22(2), 345-350. https://doi.org/10.1007/s00167-013-2408-0

Fini, A., Bassini, G., Monastero, A., & Cavallari, C. (2012). Diclofenac salts, VIII. Effect of the counterions on the permeation through porcine membrane from aqueous saturated solutions. Pharmaceutics. 4(3), 413-429. https://doi.org/10.3390/pharmaceutics4030413

Fokunang, C. (2018). Overview of non-steroidal anti-inflammatory drugs (nsaids) in resource limited countries. MOJ Toxicology, 4(1). https://doi.org/10.15406/mojt.2018.04.00081

González De Vega, C., Speed, C., Wolfarth, B., & González, J. (2013). Traumeel vs. diclofenac for reducing pain and improving ankle mobility after acute ankle sprain: A multicentre, randomised, blinded, controlled and non-inferiority trial. International Journal of Clinical Practice, 67(10), 979-989. https://doi.org/10.1111/ijcp.12219

Hale, S.A., & Hertel, J. (2005). Reliability and sensitivity of the foot and ankle disability index in subjects with chronic ankle instability, 40(1):35-40. Journal of Athletic Training. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1088343/

Heijink, A., Gomoll, A.H., Madry, H., Drobnič, M., Filardo, G., Espregueira-Mendes, J., & van Dijk, C. N. (2012). Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy, 20(3), 423-435. https://doi.org/10.1007/s00167-011-1818-0

Herzog, M.M., Kerr, Z.Y., Marshall, S.W., & Wikstrom, E.A. (2019). Epidemiology of ankle sprains and chronic ankle instability. Journal of Athletic Training, 54(6), 603-610. https://doi.org/10.4085/1062-6050-447-17

Humphrey, V.F. (2007). Ultrasound and matter-Physical interactions. In Progress in Biophysics and Molecular Biology, 93(1-3), 195-211. https://doi.org/10.1016/j.pbiomolbio.2006.07.024

Khalid Humadi, S., & Abdulaziz Shekho, H. (2015). EFFECT OF LOW INTENSITY PULSED ULTRASOUND ON REPAIR OF TENOTOMIZED ACHILLES TENDON OF RABBIT. Basrah Journal of Veterinary Research, 14(1), 236-249. https://doi.org/10.33762/bvetr.2015.102441

Kozanoglu, E., Basaran, S., Guzel, R., & Guler-Uysal, F. (2003). Short term efficacy of ibuprofen phonophoresis versus continuous ultrasound therapy in knee osteoarthritis. Swiss Medical Weekly. https://doi.org/10.4414/smw.2003.10210

Lai, P.M., Collaku, A., & Reed, K. (2017). Efficacy and safety of topical diclofenac/menthol gel for ankle sprain: A randomized, double-blind, placebo- and active-controlled trial. Journal of International Medical Research, 45(2), 647-661. https://doi.org/10.1177/0300060517700322

Larkins, C.G., Brady, A.W., Aman, Z.S., Dornan, G.J., Haytmanek, C.T., & Clanton, T.O. (2021). Evaluation of the Intact Anterior Talofibular and Calcaneofibular Ligaments, Injuries, and Repairs With and Without Augmentation: A Biomechanical Robotic Study. American Journal of Sports Medicine, 49(9), 2432-2438. https://doi.org/10.1177/03635465211018645

Lionberger. (2010). Topical nonsteroidal anti-inflammatory drugs for the treatment of pain due to soft tissue injury: diclofenac epolamine topical patch. Journal of Pain Research, 223. https://doi.org/10.2147/jpr.s13238

Mandarakas, M., Pourkazemi, F., Sman, A., Burns, J., & Hiller, C. E. (2014). Systematic review of chronic ankle instability in children. Journal of Foot and Ankle Research, 7(1). https://doi.org/10.1186/1757-1146-7-21

Mattacola, C.G., & Dwyer, M.K. (2002). Rehabilitation of the ankle after acute sprain or chronic instability. In Journal of Athletic Training, 37(4), 413-429. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC164373/

Mulgaonkar, A.P. (2014). Explorations in Targeting Low Intensity Focused Ultrasound for Neuromodulation. In ProQuest Dissertations and Theses. https://escholarship.org/uc/item/5kb2w0kw#main

Nieman, D.C. (2008). The Dual Roles of Neutrophils and Macrophages in Inflammation: A Critical Balance Between Tissue Damage and Repair. Yearbook of Sports Medicine, 2008, 119-120. https://doi.org/10.1016/s0162-0908(08)79217-1

Predel, H.G., Giannetti, B., Seigfried, B., Novellini, R., & Menke, G. (2013). A randomized, double-blind, placebo-controlled multicentre study to evaluate the efficacy and safety of diclofenac 4% spray gel in the treatment of acute uncomplicated ankle sprain. Journal of International Medical Research, 41(4), 1187-1202. https://doi.org/10.1177/0300060513487639

Predel, H.-G., Hamelsky, S., Hagen, M., & Giannetti, B. (2011). T636 EFFICACY AND SAFETY OF TOPICAL DICLOFENAC DIETHYLAMINE 2.32% GEL IN PATIENTS WITH ACUTE ANKLE SPRAIN: A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED STUDY. European Journal of Pain Supplements, 5(S1), 91–91. https://doi.org/10.1016/s1754-3207(11)70310-8

Saliba, S., Mistry, D.J., Perrin, D.H., Gieck, J., & Weltman, A. (2007). Phonophoresis and the absorption of dexamethasone in the presence of an occlusive dressing. Journal of Athletic Training, 2008, 31-32. https://doi.org/10.1016/s0162-0908(08)79275-4

ter Haar, G. (2007). Therapeutic applications of ultrasound. In Progress in Biophysics and Molecular Biology, 93(1-3), 111-129. https://doi.org/10.1016/j.pbiomolbio.2006.07.005

Van Den Bekerom, M.P.J., Van Der Windt, D.A.W.M., Ter Riet, G., Van Der Heijden, G.J., & Bouter, L.M. (2012). Therapeutic ultrasound for acute ankle sprains. European Journal of Physical and Rehabilitation Medicine. https://doi.org/10.1002/14651858.cd001250.pub2

Warden, S.J., Stewart, R.L., Fuchs, R.K., Kessler, C.K., Avin, K.G., & Cardinal, R.E. (2006). Ultrasound Produced by a Conventional Therapeutic Ultrasound Unit Accelerates Fracture Repair. Medicine & Science in Sports & Exercise, 38(Supplement), S26. https://doi.org/10.1249/00005768-200605001-00998

Wehling, M. (2014). Non-steroidal anti-inflammatory drug use in chronic pain conditions with special emphasis on the elderly and patients with relevant comorbidities: Management and mitigation of risks and adverse effects. In European Journal of Clinical Pharmacology, 70(10), 1159-1172. https://doi.org/10.1007/s00228-014-1734-6

Wikstrom, E.A., & Brown, C.N. (2014). Minimum reporting standards for copers in chronic ankle instability research. In Sports Medicine, 44(2), 251-268. https://doi.org/10.1007/s40279-013-0111-4

Zacher, J., Altman, R., Bellamy, N., Brühlmann, P., Da Silva, J., Huskisson, E., & Taylor, R. S. (2008). Topical diclofenac and its role in pain and inflammation: An evidence-based review. In Current Medical Research and Opinion. https://doi.org/10.1185/030079908X273066

Downloads

Published

2023-12-14

How to Cite

Anshika Singh, Sumit Raghav, Latika Gulyani, Gunjan Chaudhary, & Anirudh Srivastava. (2023). Effects of diclofenac sodium gel phonophoresis in sports activities induced grade-l ankle sprain. Physical Rehabilitation and Recreational Health Technologies, 8(4), 203–210. https://doi.org/10.15391/prrht.2023-8(4).05

Issue

Section

Original research article