DR. W.N. DUDLEY, D.C. Howell, Michigan
Dr W. N. Dudley is a graduate of the Palmer College of Chiropractic and practices in Howell, Michigan. He is a member of the American Chiropractic Association and the Michigan State Chiropractic Association. He has had other professional papers published in the ACA journal.
The following brief study using thermography war conducted with 40 patients to determine phlebitis of the lower limbs and its resolution through chiropractic adjustment.
Thermographic scans are used in the detection of emission variables of heat patterns from an object.1 Thermographic scans are harmless, easily done, rapidly recorded and well documented. The variety and consequences of abnormal emissions have not yet been completely cataloged. A fairly uncomplicated area of study is the heat emission of an inflamed vessel in the extremities of a human.2-4 A vessel with increased heat will be outlined on the thermographic equipment and be definable and recordable by a photograph of the oscilloscopic presentation. Precise measurement of fractions of a degree in temperature variation can be done.
Thermography can detect inflamed joints, inflamed veins or arteries, loss of circulation, or any combination thereof.5,6 Joint changes are also noted as well as true inflammatory processes.7
Thermography, unlike x-ray, is harmless and displays function rather than anatomy.8 That is, an incompetent vessel, clot or hemorrhage can be seen. Infarct of an extremity can be easily determined by absence of heat and circulatory function. Deep vein thrombosis is also detectable by a somewhat simple but specialized technic;9 however, this study is not within the scope of this paper. The concern here is the determination of low back pain associated with phlebitis of the lower limbs.10,11
Thermographic scans are done on both anterior and posterior portions of the legs. The scan immediately shows elevated thermal areas definable as veins which are not seen in surface visualization. The display is graphic and the inflamed veins outline immediately. The scan may then be entered as a permanent record by means of Polaroid photography or a similar photographic device. The photo is then kept for comparison and further evaluation to determine if the inflammation controls. Frequently, thermographers will precisely measure and record the thermal variable but not photograph it.
Follow-up rescans should show a return to normal after a short time of spinal correction and, when necessary, wrapping the specific inflamed area with elastic bandage. Usually supportive hosiery is not needed except in extremely diffuse inflammation.
This study of the lower extremities and their contribution to the production of low back pain was taken from a random sample of an active practice which routinely used thermography. The study involved 40 patients, 31 female, nine male, ranging in age from 29 to 82 years, with an average age of 56 years. Of the 36 cases where the height and weight were measured, the average height was 64.25 inches and the average weight was 164 pounds. Unfortunately, there were no statistics available regarding low back pain produced by phlebitis in respect to the total incidence. More study needs to be done in this area.
As a matter of routine examination, 99% of the group was x-rayed and the status of the spines ranged from ancient collapsed discs and severe osteoarthritis to spines that were innocent of pathology, curvature or obvious subluxation. Two of the youngest patients in the study had venal ligation, three were diabetic.
Rarely could a patient define the area of inflame vein that was displayed through thermography; in most cases the patient could only describe an over-all painful sensation in the limb. It might be assumed that the presenting symptom of leg or back ache occurred only after prolonged inflammation. It was not uncommon to find one leg with thermal elevation or vein inflammation and the other leg with no increased thermal reading. Yet the "hot" leg was not painful. A thermal elevation of as much as four degrees was seen on four occasions which could have been the result of deep vein thrombosis, phlebitis or diffuse myositis. It was not uncommon to find the right leg, as an example, inflamed and the left leg scans innocent. Yet, the left leg was painful, One explanation might be that there was a weight shift from the inflamed leg to the "normal" limb symptoms of back ache.
One clinical situation was shared by four patients; they were unable to lie face down on the adjusting table. Apparently traction of the vessel was uncomfortable. All patients exhibited a restlessness and a desire to ambulate. Pain was produced more often upon sitting than standing.
Figure 1. shows the posterior view of the Iegs. Figure 2 shows the anterior view. Black shows the cool areas and white shows the warm areas. The warmest and whitest portion on Figure 1 is, of course, the back of the knee. The inflamed veins outline easily on thermovision, In Figure 2 the anterior of the leg vein definition is readily seen. The anterior portion of .the mid-calf is commonly the warmest area. The knee is not arthritic by thermographic definition. Veins that can be visibly seen do not commonly exhibit as inflamed veins, and, when measured by precise thermographic definition, the distinction can be made. Therefore, one can be easily confused by superficial visualization of the body part. The vessels here are not visible to the naked eye, but with thermography the display is immediate. Supportive hosiery should be worn, along with specific wrapping of smaller intensively inflamed areas, with a caution that the wrap should not be tight enough to produce edema at the ankle.
Often the chiropractic adjustments will shift the weight back upon the inflamed leg, requiring it to function. However, no specific corrections were judged to be applicable to all cases. Routine pelvic adjustment, along with specific lumbar veletebra adjustments with the abdominal piece allowed to be free, seemed to suffice, Often the most effective adjustment was the pelvic or lumbar roll. Ischial pressure from the inferior with the inner hamstrings tendon firmly held offered a good deal of comfort and frequently aided the patient in immediate ambulation.
The cervical spine should not be overlooked, for, in work that is in progress, the author has found that vascular disturbances of distant parts may have influence upon the cranial or facial circulation. The frequency of the incidence of low backpain produced by prolonged malfunction of the lower limb nerves which in turn allow inflammation of the venal system needs to be established. However, ignorance of the secondary inflammation does not allow a recovery of the patient without prolonged and painful expenditure of time and a possibility of endangering the wellbeing of the patient.
References
1. Barnes, R. B.: "Thermography of the human body," Science,140: 870,1963. 2. Smessert A., Befeler, D., Hicks, R. G., Connell, J., Jr: "Evaluation of sympathetic blocks," Amer J Surg, 103: 5, 594.
3. Branemark. P. I. and Nilsson, K.: "Thermographic and micro vascular studies of the peripheral circulation," Biblio Radiol, no 5.
4. Buwalda. G.: "Vascular disorders in leg arteries," Biblio Radiol, 5: 121, 1969. 5. Aarts, N. J. M.: "Thermography in malignant and inflammatory diseases of bones," Boerhaave Post grad Ed, 1969.
6. Mawdsley, C., et al: "Thermography in occlusive cerebrovascular disease," Brit Med J, 31: 3, 521.
7. Ryan, I.: Thermography. Aurt Radiol, 1323,1969.
8. Cooke, E. D.: "Deep vein thrombosis," paper read at Johns Hopkins Thermographic Seminar, Johns Hopkins Hospital, Baltimore, Maryland, June 1375.
9. Uematsu, S.: Medical Thermography, Theory and Clinical Application, California: Brentwood Publishing Co,1976.
10. Borg, S. B. and Mallner, L. E.:Thermography,"Medical Thermography,1973. 11. Dudley, W. N.: "Thermography," ACA J of Chiro, 8: S-30,1974.
THE ACA JOURNAL OF CHIROPRACTIC/March 1977 Vol, XI, S--29