The use of non-invasive diagnostic methods in pediatric spinal disorders is of great importance. While the use of x-rays is well-documented and is critical in trauma cases, the routine use of x-rays in pediatric care is controversial, especially with serial radiographic studies.
Pediatric chiropractic care ranges in the profession from the treatment of visceral disorders to neuromusculoskeletal disorders, including the vertebral subluxation complex, sports injuries, asthma, enuresis, scoliosis, whiplash injuries, cephalalgia, etc. One of the problems in treating infants, children, and adolescents, is their inability to give a clear, meaningful history and symptom complex. Many times they will not complain of a disorder or the parent will minimize the child's complaints.
Since IRT is an objective, non-invasive test of neurophysiology, and symmetry from right to left is expected for homologous parts, IRT is a useful assessment procedure for pediatric diagnosis. IRT has been shown to be a highly sensitive, specific and reliable test in the world scientific literature. IRT is helpful in documenting both somatic problems as well as viscerosomatic reflexes, since both systems are rooted within the sympathetic nervous system and IRT is a test of the sympathetics.
While chiropractic treatment is mechanical in nature, it is accepted that our treatment has a positive effect not only on improved biomechanics but improved neurophysiology.
In cases of sports injury, IRT has been documented to be useful in assessing the common patellofemoral pain syndrome which is imaging as patellar hypothermia. This is in contrast to internal derangements which are hyperthermic. It is also useful in traction apophysitis cases such as Osgood Schlatter's disease and Haglund's disease, which image as focal hyperthermia and revert to normal upon corrective treatment. It is also useful in the treatment of adolescent runners in differentiating shin splints, compartment syndromes, and stress fractures.
IRT's greatest contribution is in the early diagnosis of reflex sympathetic dysfunction (RDS). In cases of spinal disorders, IRT is helpful in the differential diagnosis of radiculopathy facet syndrome, myofascial pain syndromes, and reflex sympathetic dysfunction. In radiculopathy cases, there will most typically be:
- Decreased thermal emission noted in the extremity dermatome/thermatomes that will be consistent throughout the study.
- Increased thermal emission at the spinal level.
In facet/scleratogenous/vertebrogenic dysfunction cases there will be spinal hyperthermia with little or no extremity findings indicative of instability. In myofascial pain syndrome cases there will be focal hyperthermias over the cutaneous area of the trigger point. In RSD cases there will be a vast cooling over the whole region with a great temperature differential.
IRT is also helpful in "whiplash" injury cases. The child can be assessed for pathoneurophysiology as a result of the hyperextension/hyperflexion trauma to the spine and sympathetic nervous system. Many cases of children with minimal complaints after the accident have shown thermal asymmetries compatible with cephalalgia, nerve fiber dysfunction, facet segmental dysfunction (subluxation), and myofascial irritation patterns.
Conclusion
IRT is a safe, non-invasive diagnostic test of neurophysiology that is suitable for chiropractic pediatric care. It is helpful not only as a diagnostic test but as a treatment assessment tool for children under chiropractic care. IRT has been documented as useful for the treatment and assessment of sports injuries whiplash injuries sprain/strains, RSD cephalalgias, and radiculopathies.
David J. BenEliyahu, D.C., CCSP, DNBCT
Selden, New York