Thermography: A New Perspective on an Old Test

Its Value in the Clinical Chiropractic Practice

The presence of thermography in chiropractic practice has diminished over the last several years with the fall in its reimbursement. This is an unfortunate circumstance, because the medical profession and dental profession have embraced thermography. This article will help the reader understand the practice and its value in the chiropractic profession today.

Thermography has been utilized in medical practice since the beginning of medicine itself. In fact, the father of medicine, Hippocrates first used thermography by covering a person in mud, then observing where on the anatomy the mud dried first, thus establishing the site of the pathology.1 D.D. Palmer used skin surface temperature to aid in diagnosis. He referred to these "hot boxes" by using the dorsal aspect of his hand to locate areas of subluxation.2

Fortunately, thermography has become much more sophisticated. It cannot be overstated how valuable its application is in the chiropractic practice. Because it is unique in accurately assessing the physiological state of the patient's sympathetic nervous system, it is an extremely valuable tool in the diagnosis and management of many conditions.

Thermography is used as much in veterinary medicine as in allopathic medicine. It is used in small animal medicine and with equine and large animal practice. One study was used to help diagnose a traumatic coccygeal muscle injury in English Pointers (limber tail). Thermography was used to help diagnose the problem.3 Another study used heat to detect back pain in horses. The authors of this study stated that "infrared thermographic imaging is the most sensitive objective imaging currently available for the detection of back disease in horses."4 The author of this study says that this same procedure, or ITI, is a physiologic test that identifies vasomotor tone overlying other superficial tissue factors. Chronic back pain usually involves vasoconstriction at the affected sites.

Diagnosis through heat also has broad applications in medicine and dentistry. Dentists use thermography to assess facial pain, TMJ conditions, implants, root canals, facial nerve injuries and other ailments. Suspected pathology of teeth or gums, which cannot be identified clinically or radiographically, but possibly through ITI, warrants investigation. Neuropathic facial pain is still too often misdiagnosed as tooth pain of dental origin, resulting in unnecessary dental extraction or endodontic therapy.5 Thermography is used to diagnose TMJ conditions. Computer measurements using facial thermography distinguish normal patient populations from symptomatic patients with acute TMJ pain.6 Vascular heat emissions can identify facial pain syndromes where other diagnostic tests may not be as beneficial.7

Thermography is being used to identify reflex sympathetic dysfunction, and is one of only three diagnostic tests to diagnose this condition. It is shown to be an effective way to monitor near-surface blood flow in the limbs of RSD patients and to be sensitive to changes accompanying painful conditions.8,9 An article in the Journal of Pain describes the use of infrared thermography (IRT) to analyze sympathetic vasoconstriction in CRPS patients.10

For patients experiencing back pain, thermography is being used to assess conditions of the facet joints, discs, myofascial conditions, nociceptive ones and nerve entrapments. A study by the UCSF Department of Radiology concludes that lumbar thermography is a "sensitive examination for detecting those patients who will demonstrate lumbar spinal CT abnormalities, and should play an important role in the diagnostic screening of low back pain syndrome patients."11

Thermography is also an important adjunctive diagnostic tool in the assessment of radicular symptoms. In a study comparing IRT to CT, MRI and myelography, IRT was able to accurately assess radicular involvement in all of the involved cases.12

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