Sports Injuries & Sport Optimization: At The Compounding Lab we compound many preparations that support and assist in creating wellness in all areas of Pharmacy. We compound many products for application and the duration of treatment to help improve and reduce sports injuries.* Ketoprofen 10%, 15% or 20% in liposomal creams and gels to treat sprains, strains and inflammation. A pea-sized amount of the gel is rubbed with a moist fingertip into the skin three to four times daily. An aqueous solution of that drug can also be administered by iontophoresis, or the medication can be prepared as an ultrasound gel for use in phonophoresis.* Dexamethasone 0.4% in an aqueous solution for iontophoresis to treat sprains, strains and inflammation. That concentration of dexamethasone can also be prepared in PLO for application immediately after a sports-related injury to minimize inflammation. In those cases, a pea-sized amount of the gel is rubbed with a moist fingertip into the skin.* Acetic acid 2% or 4% in an aqueous solution administered by iontophoresis to reduce scar tissue.* A combination of baclofen 5%, lidocaine 10% and guaifenesin 10% or 20% in cream to prevent muscle cramps or treat them immediately* Lidocaine 4%, adrenalin 0.05% and tetracaine 0.5% (LAT) in a spray or hydroxyethylcellulose gel to treat cuts and abrasions. This preparation is applied immediately after injury.* Muscle relaxants such as guaifenesin (usually 10% or 20%) in gel or cream or cyclobenzaprine 0.5%, 1% or 2% . The mechanism of action of those drugs determines which is selected to treat muscle strain. Cyclobenzaprine is administered topically or by ultrasound, and guaifenesin in cream is applied topically three to four times daily until relief is noted.These customized topicals that we use for sports injuries are not commercially available. Athletic trainers should work with a compounding pharmacist and a physio or doctor to devise treatments for the injuries their athletes usually sustain. They should also keep an adequate supply of those medications on hand for immediate use or long-term therapy. It is our goal to put athletes back into their field of play as safely and quickly as possible, and compounding pharmacists can often help. They can provide us with therapeutic tools to restore the injured athlete to pre-injury fitness.
The Compounded Viewpoint
Mary-louise Condon is a certified compounding pharmacist, a clinical pharmacist and the owner of The Compounding Lab Pharmacy in Australia, . She is also the compounder who provides most of the customized topicals for injured athletes. “The Compounding Lab is a compounding-only pharmacy with a wide range of services,” “Our patients range in age from 8 weeks to 98 years, and many of the injuries that occur during sports competition (sprains, muscle inflammation, contusions) also afflict nonathletes.“Sports medicine today has a broad definition. It’s not just about athletes any more; it’s also about the average individual, the patient in rehabilitation and the weekend warrior. For example, the gels and creams used to treat sports injuries can be used by podiatric or orthopedic patients, people undergoing physical therapy, individuals who have everyday aches and pains and arthritis sufferers.” Gore always works with a physician who provides a prescription for the compounds prepared. “My goal is to enhance the practice of sports medicine by the trainer, the physician or the physical therapist to improve outcome. Compounding often provides more and better treatment options for doing so.”Our most often requested sports medications are topical gels that are not available commercially. “Topical medications convey the drug directly to the site of injury and produce minimal adverse effects,”. “Some of the most effective topicals we prepare contain combinations of various anti-inflammatories or corticosteroids such as ketoprofen, dexamethasone, diclofenac, indomethacin, naproxen sodium, ligocaine or magnesium sulfate plus methylsulfonylmethane (MSM) in Lipoderm. Many of these preparations are very effective as a pregame rub and are popular remedies for the weekend warrior’s anticipated overuse injuries.“LAT gel, which can be used to minimize bleeding from scrapes and cuts, is frequently requested. When the cuts begin to heal, we prepare our ‘special blend’ (a cream that accelerates the healing process) for our patients.has applied for a patent on that preparation, which is very promising as a wound-care treatment.Also popular is an electrolyte-balancing preparation that contains a combination of potassium chloride, sodium chloride, magnesium and calcium carbonate. It is available in capsules or as a powder that must be mixed with a liquid, and the formulation can be adjusted to meet athletes’ specific rehydration needs. Unlike some commercially available electrolyte products and supplements that may be unregulated in content, the concentration of ingredients in the compound is carefully monitored by the compounding pharmacist. “We also prepare capsules of magnesium glycinate, which reduces postgame stiffness and soreness and promotes restful sleep,” said Gore. “The compounds requested most frequently for sports-related trauma, though, are those used to treat soft-tissue injuries: dexamethasone 0.4% or ketoprofen 10% in cither PLO or in an aqueous solution for use in iontophoresis, ketoprofen 10% or 20% solid anhydrous, diclofenac 10% solid anhydrous or indomethacin 10% or 20% solid anhydrous. To treat calcifications, we prepare an aqueous solution of acetic acid 4% for administration by iontophoresis.”Gore is now researching the half-life of various nonsteroidal anti-inflammatory drugs (NSAIDs) to determine whether better, safer topical formulations could reduce the number of doses administered daily. “I like to think outside the box,” he said. “For example, topical ketoprofen is often applied three or four times daily by student athletes or patients, but oral NSAlDs like oxaprozin can be compounded in a PLO gel for once-daily topical use. That preparation is not commercially available but could be very effective and safe in treating soft-tissue injuries.Dr. Knost has found that topical compounds can be very effective in the Knost’s prescription of choice for treating the scrapes and soft- tissue injuries sustained during competition is ketoprofen 20% in penetration-enhancing vehicles. “In sports medicine, compounded ketoprofen cream is incredibly effective,” he said. “It provides immediate relief, and it’s very safe-I don’t know what I’d do without it. It’s an excellent treatment for contusions, sprains (especially twisted knees), strains, insect bites and crush injuries. I often give my injured patients a 10-mL syringe filled with the cream for later application. I’ve also prescribed it for patients who have trochanteric bursitis, which often afflicts weekend warriors or those who have just started an exercise program. It provides relief from tennis elbow in 10 minutes, and it’s a great treatment for osteoarthritis of the fingers. Compounds like this cream provide my patients with effective treatments that aren’t available commercially.”For additional information on the treatment of sprains, strains and abrasions, contact Patrick M. Knost, MD, 1106 Corker Street, Placerville, CA 95667. E-mail: firstname.lastname@example.orgWilliam R. Wills is the owner of Grandpa’s Compounding Pharmacy in Placerville, California. He prepares ketoprofen 20% cream and other formulations for Dr. Patrick Knost and a host of other physicians who treat sports- and work-related injuries. “Compounds provide practitioners with a greater variety of treatment options,” said Wills. “Every sports medicine chest should be equipped with a compounded topical anti-inflammatory like ketoprofen 20% cream for use as a pregame rub or a treatment for sprains and strains. Guaifenesin 20%, a muscle relaxant, can be added to the ketoprofen cream or used as the sole ingredient in a cream base to relieve muscle tightness in seconds. Bruises, scrapes, cuts, abrasions and other injuries (including open wounds) can be treated with a topical preparation containing vitamins B5 and B6 in PLO. That preparation has anti-infective properties, inhibits bleeding, provides analgesia without anesthesia and promotes rapid healing. It causes the worst bruises to resolve within 4 days and heals blisters very rapidly.“Athletes do have health problems other than injuries,” Wills notes. “For refractory athlete’s foot, we can compound an anti- fungal, antibacterial ‘foot bomb’ containing a customized combination of ketoconazole, miconazole, clotrimazole, terbinafine, ibuprofen, nystatin and/or tea tree oil in Dermabase.“Because they convey prescribed drugs immediately to targeted tissues, topical compounds are very effective in treating injuries and chronic pain. Most of those medications are not available commercially. There are no contraindications to their use, and they produce no adverse effects. We can use them to treat and resolve many sports-related injuries without causing more problems for our patients.”