W.N. Dudley, DC, PC is a member of the ACA and it postgraduate lecturer at National College of Chiropractic and has used thermography since1970. A past president of the International Thermographic Society and a diplomate of the American Board of Clinical Thermography, D. W. Dudley is board certified in thermography by the ACA's Council on Diagnostic Imaging. He has authored numerous articles about thermography and has presented his papers around the world! Dr. Dudley is in private practice in Howell, Mich.
A review of facial views seen with thermography reveals that profound changes occur after cervical adjustments administered in clinical chiropractic practice. These changes can have significant effects on cranial circulation. A study was performed by Capistrant to determine if carotid occlusive disease could be detected by thermographic means. A total of 315 patients were examined, and a provocative and standard head clamp was applied to the patients to temporarily occlude the superficial temporal artery.
Following the cervical manipulation, thermograms of the patients' faces were performed. Four patterns displayed which substantiated the theory that thermal measuring equipment can be used as a tool to recognize internal carotid occlusive disease. This finding may be especially valuable, since recognition of the early stages of arterial reduction could be an indication of impending stroke.
The thermograms revealed patterns on the patients' foreheads which were described as "candle-like" in their outline (Figure 1). Four patterns were described, each one being a depiction of vascular flow reduction in the carotid artery.
FIGURE 1.
It was with this finding in mind that Capistrant signs (CS) were observed when using thermographic examinations. It was noted that after adjustments to the cervical spine, often there was improvement of the CS observed during follow-up scans. Causing change in the flow of the carotid artery is not difficult if CS are used as criteria. It may be true that adjustment to the cervical spine primary has that effect. Yet, scans showed an improvement in forehead display. Therefore, either there was an unknown effect of the adjustment upon the carotid artery, or there was another mechanism at work.
FIGURE 1.
FIGURE 2.
FIGURE 3.
FIGURE 4.
FIGURE 5.
Figures 1, 2, 3, 4 and 5 are images of electronic thermograph. They are images generated using an infrared camera to detect infrared emission from a source. The images are then converted, by computer, to color or black and white views which are colorized.
Prior to the scan, patients were equilibrated in the protocol established by the International Thermographic Society. When viewing the thermography images, infrared emission is indicated by a color bar on the lower portion of an image, with the coolest temperature left and the warmest on the right. (Figures 2 and 3) (Figures 4 and 5). Further substantiation was sought, and physical examination revealed that Adson's sign was positive on the same side as the cooling of the forehead.2 An attempt was made to observe cooling into the digits with a positive Adson's. However, perhaps the circulation is not efficient or the thermographic gear is not sensitive enough, since no cooling has been seen to date. Perhaps if the patient could hold his or her breath longer, cooling of the digits might be revealed, but respiration is necessary.
If the Adson's sign is positive, then there is traction on the subclavian artery by the scaleni and reduction to the radial pulse follows.3 Apparently, there also is alteration to the carotid artery which is a branch of the subclavian. If the scaleni of traction changed, release of the scalene could be accomplished, perhaps the cervical adjustment, and traction on the subclavian, carotid and the radial artery could be restored. Improvement in flow over the fore head and an absence of Adson's sign would substantiate the belief that the scaleni contraction has been reduced. Cases have been monitored for decades, and the conclusion is that Adson's sign is not only evidence of reduction o flow to a radial pulse, but also to the carotid artery. This finding it demonstrated by the improvement of the CS and the arrest of Adson's sign after a cervical adjustment is performed.
Improvement of the CS does not occur in some cases, and the CS has been seen to exist for 15 years without apparent complication Thermographic examinations have indicated that CS has stayed on the same side, in a high percentage of cases and has been stable, even after cervical adjustment, but produces little observable effect.
Another area that cooled was the cheek on the side of Adson's sign and CS. A cool cheek was seen in most cases before the CS. After cervical correction, both the cheek and the CS (if it existed) showed an improvement in flow.
A similar approach was taken to spinal correction as with CS alone, to improve cheek flow. In most cases, cheek cooling was noted before forehead cooling, but most often cooling of both areas occurred simultaneously, if Only to a small degree.
It was the facial cooling and cervical correction that led to a false conclusion that adjustments have an effect primarily on the vascular systems.4 Simply, it is the cervical correction, performed in the correct manner, which reduces traction of the scaleni upon the subclavian artery and which balances the cervical spine. This reduces the scaleni traction and thereby affects the carotid and radial arteries secondarily.
A time factor for recovery of facial display after cervical correction is necessary to allow for a "normalizing." This normalizing process can be as rapid as two to three minutes or may take as long as several days--or may never even occur. Deciding factors are the duration of the traction, trauma, age, nutritional status, etc. Many times blood pressure is abnormal when compared side-by-side, and a balance of pressure can be achieved if the scaleni musculature stopped its traction by a cervical spinal correction.
Adson's sign is evidence that there is uneven traction and an imbalance in the cervical spine. Therefore, scaleni contraction upon subclavian arteries can be remedied by cervical spine adjustment.
Since Adson's sign is produced by traction of the scaleni on a subclavian artery, a CS apparently is a secondary indication of chronic scaleni contraction. It is surely simple to cause proof of Adson's existence; however, if flow to the forehead improves, it must be seen by thermography. This last statement is true in a high percentage of instances. However, cervical adjustment surely does not improve carotid artery flow when there is sclerosis in the artery.
Opposite corrections were done (i.e, right CS, right Adson and cool right cheek), and a left mid-cervical correction was done, since the cervical X-rays defined a left cervical curve. The correction followed established parameters of adjustive practice. The temperature losses of the cheek and CS worsened, and Adson's remained positive. When the correction was changed to comply with the thermal and Adson indications, the cervical curve corrected and the thermal images normalized.
The cervical curve returned to mid-line within a short time, although it had existed for one year; it has not re-instituted itself some 18 years later. The experiment was repeated on numerous occasions, and the results have been the same, except in those cases where the anatomical variant of the internal and external carotid artery arises independently from the subclavian.
Patients who displayed a fourth Capistrant area at the palpebrum often have other positive signs. Anisocorea and consensual reflexes may be slow or absent, and these cases present with migraine-type headaches, which are thought to be oculomotor neuropathies. Since the oculomotor nerve also supplies the palpebrum with a sensory branch, these neuropathies did not show thermographic evidence of recovery. Most patients with the fourth area display over the palpebrum expressed relief, but there was little stability to either the relief or the correction. It is helpful to use thermographic scans to document the efficacy of the spinal correction. On occasion, the thermal information produces physiologic information that documents an unexpected impact.
References
1. Capistrant, TD. "Thermographic Facial Patterns in Carotid Occlusive Disease." Radiology. 100(1): 89 (1971).
2. Chisud, JC. Correlative Neuroanatomy and Functional Neurology. Lange Medical Publications, 1985.
3. Dudley,WN. "Findings Using the Adson Sign." ACA Journal of Chiropractic. 9(11): 87-88 (1972).
4. Dudley, WN. "Facial Thermography and Adjustment." ACA Journal of Chiropractic. 8: 54-56 (1974). 23
Journal of the American Chiropractic Association/December 1996