By Randy Southerland
Chiropractors have long emphasized the art of their profession. Most adjustments
are done by hand—in keeping with the original Greek meaning of chiropractic—and
a doctor’s skill, knowledge and intuition play a paramount role in finding
the subluxation that needs correction.
Yet, for all the seemingly low tech nature of the adjustment and various forms
of analysis such as leg checks, members of the profession have always sought
and been quick to adopt advanced technology to aid in the analysis of a patient’s
condition.
Ever since chiropractic’s early days, various kinds of instruments have
played a leading role in the care of patients. Heat measuring instruments were
widely used in B.J. Palmer’s day and, attesting to their usefulness, are
still used by a significant number of doctors—particularly upper cervical
specific practitioners.
At the dawn of the 21st Century, the modern DC has a much wider range of high-tech
diagnostic tools at his disposal. While many doctors continue to use leg checks
and palpation as their primary means of detecting subluxations, many others
have opted to use technology that presents a more objective and easier to replicate
analysis of a patient’s condition.
Over the years a number of companies have provided doctors with a wide array
of instruments for different kinds of analysis. They are used by chiropractors
of differing philosophies and techniques. Some make them an integral part of
their patient care to provide pre- and post-analysis of an adjustment. Others
use them as patient education and marketing devices to demonstrate the validity
of chiropractic and promote patient retention.
These instruments tend to fall into three broad categories. These include thermography,
electromyography or EMG, and biomechanical measuring devices.
Thermography: Finding the Hot Spot
Hippocrates, the “father of medicine”, used thermography 200 years
ago, says Fred Hether, D.C.C.T., a founding member of the ICA Council on Thermography
and a past president of the Chiropractic Institute of Thermography. Thermography
is a diagnostic technique to measure heat patterns on the body using color.
Symmetrical patterns are normal and asymmetrical patterns are abnormal.
Hether says Hippocrates would place mud on a patient’s back and watch
how quickly it dried. This way he was able to tell if there was more heat on
the left or right side. Even the father of medicine knew of the importance of
nerve flow to the spine. According to a 1990 textbook on thermography, D.D.
Palmer, the founder of chiropractic, used the back of his hand to locate “hot
boxes” along the spinal column in an effort to detect differences in surface
temperature from one side to the other.
“The good thing about thermography is you can make an adjustment on the
subluxation and recheck it to see if it got better before having to resort to
surgery. That’s the main reason chiropractors are interested in thermography.
It’s a asymmetrical picture that you can change to a symmetrical picture,”
says Hether.
Temperature has long been a helpful factor in analysis and diagnosis. But for
as long as thermography has been in practice, it’s been highly misunderstood.
The biggest misconception surrounds the temperature of the skin. Most people
think a high or low temperature denotes a problem, but that’s not the
case, notes Hether. When you’re measuring the temperature on both sides
of the spine and there’s a different temperature on each side, that denotes
a problem. “The significance is that the temperature is different. It’s
not how hot or cold—it’s that the temperature is different,”
notes Hether.
The Chiropractic Institute of Thermography reports several thermographic instruments
since the early 1920s. Dossa Evans used the thermocouple and B.J. Palmer introduced
the neurocalometer, a device with two heat-detecting probes. The Nervo-Scope,
which allowed results to be recorded by connecting the device to a strip chart
recorder, and Thermeter were developed in the ‘40s. These instruments
functioned as differential heat reading instruments. The Derma Therm-O-Graph
(DTG), an infrared temperature detecting instrument, is still in use today.
Several years later Drs. Glen Stillwagon and Vernon Pierce started developing
an instrument which would give a temperature differential segmentally from sacrum
to occiput. Eventually the pair invested their interests in electronic infrared
thermography and developed the Visi-Therm.
Today temperature-based analysis equipment continues to enter the chiropractic
arena. In his Ormond Beach practice, Hether uses a DTG and the Visi-Therm.
“The Visi-Therm is low-resolution thermography. It’s easy to use
and cost-effective. It’s price is equivalent to an X-ray machine,”
says Hether. “The Visi-Therm has a wand with sensors that you use to scan
the spine or a specific body part. In 14 seconds you have a picture on your
computer screen, and you can immediately tell if the temperature is the same
on both sides. There is a color variation for each temperature, and you can
set the color to change at every tenth or four-tenths of a degree.”
One of the problems with some of the early devices was that it was often difficult
to get consistent results. According to studies by the Stanford Research Institute,
readings from the neurocalometer could be influenced by how hard the probes
were pressed against the skin.
Roger Titone, founder and president of Titronics Research and Development a
major producer of paraspinal infrared thermographic scanners, recalls a discussion
he had with Dr. Myron Brown, now Executive Vice President/Provost at Sherman
College of Chiropractic, who was then a practitioner in Iowa.
“So I went to Myron and he had one of the Pierce-Stillwagon DTGs, which
was a single probe flat pack,” says Titone. “He showed that to me
and said ‘this thing reads a different temperature every time I use it.
And when I hold it, it changes temp right in my hands.”’ The Cornell-educated
engineer headed a company that had recently developed a temperature sensor for
use in the “hot seam” welding of roofs. Taking the device borrowed
from Brown, Titone added a barrel grip that included a bore that allowed one
of his own roofing sensors to see only a small area of skin. Using his son’s
modeling clay, he moved the interior sensor closer to the actual infrared sensor.
Returning to Brown’s office, he allowed the doctor to scan him several
times. Unlike the results from older instruments, each graph was now identical.
The redesign produced an extremely accurate instrument that was much easier
to use and handle. Based on suggestions from doctors, the engineer added two
barrels so that readings could be taken from both sides of the spine. During
the 1980s he added a software program that could provide analysis of the graphs
and look for repeating patterns that serve as an indication of subluxations.
In the years since then, other companies have combined his instrument with various
kinds of software programs to fit the needs of different doctors.
The Muscle Tells the Tale
Chiropractors were also quick to adopt the use of surface electromyography (SEMG)
as a means for measuring the muscle tension that might reflect an underlying
subluxation. The device had been a great step forward for medicine because—unlike
the older EMGs which used a needle electrode inserted into the muscle—this
device could measure a broad area of the muscle using simple electrodes applied
to the skin.
“What I like about it is it gives me an accurate picture of where my patients
are right now,” says Dr. Jessica Shelley, a Cleveland, Ohio-based practitioner
who uses the Chiropractic Leadership Alliance’s Insight Millennium Subluxation
Station. “Whereas an X-ray gives you an accurate objective picture of
someone’s structure, this (device) gives you insight into their function.”
The Insight device gives its users not just SEMG, but also includes a rolling
thermograph, an inclinometer and algometer.
The software package included with the Insight—like many similar devices—can
produce colorful graphic print outs that can be shared with patients.
“I don’t do (the readings) on a patient every time they come in
to the office,” says Shelley. “I do it on the initial exam and we
do it on the re-exam. Then they really have something they can look at, which
shows how their body has changed, because you have that graphic representation
which is really helpful for them.”
While Shelley’s own practice is entirely referral-based, CLA promotes
its instrument package as a marketing tool for doctors that can be used during
spinal screenings and as means of demonstrating to patients that they are making
progress.
Measuring The Body
For all their attention to devices that measure the body’s internal clues
regarding subluxations, many doctors also make use of instruments that provide
information about biomechanical functions such as gait and posture.
One of the most familiar of these devices is the ubiquitous S.A.M.s unit. This
frame and bi-lateral scales platform measures posture and allows for simulation
of the results of an adjustment.
This product—which includes a host of ancillary products designed to recruit
new patients—is often used primarily in marketing. Low cost and easy to
use, it provides the doctor with a means of demonstrating biomechanical shortcomings
to potential patients.
Doctors looking for more precise—and more high tech—devices to measure
gait and posture may choose any of a variety of force platform type products.
A good example of these products can be found in the WinPosture, produced by
PODOTechnology. This precision force plate can measure postural balance and
sway. Sensors can give readouts on gait. While the company’s tools are
designed primarily as an analysis tool for doctors, PTs and other healthcare
professionals, software incorporating training games can be used to teach patients
in rehab to improve balance through measuring center of gravity.
The devices are used in both wellness and rehab practices, according to Nancy
Weineweber, manager of Medical Accounts at PODOTechnology.
Many doctors also make use of range of motion devices and isometric muscle strength
measurement instruments such as those provided by Myogauge Corporation and other
companies. These products measure limitations in head, arm, back or other movements,
while other testing equipment digitally measures and documents the amount of
force needed to move a restraining force in a vertical or horizontal direction.
These instruments, which are available at varying prices and varying degrees
of complexity, provide doctors with a wide choice of instruments. Many have
incorporated them into their practices to one extent or another, using them
to help determine treatment or to simply ensure compliance and retention. More
importantly, however, these devices also put the profession that much closer
to validating the science of the adjustment.
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