When you go to a chiropractor’s office for the first time or any musculoskeletal expert for that matter there are some basic things that you should look out for to make sure you are receiving the appropriate care. Far too often I hear about patients who have not been properly examined or treated. Usually this just results in care being a failure but sometimes this can have disastrous consequences. As a Primary Spine Practitioner I want to educate the public on what to look out for so that they are being treated with care that is up to par. Usually when we talk about appropriate care we are talking about the standards of care. Sometimes different patients need different examinations or treatments but as long as these standards of care a roughly seen during your initial visit you should feel comfortable knowing that you are being cared for appropriately. This is the first of a series of blogs explaining some of the standards that you should have performed during a musculoskeletal examination. This first blog post is on the neurological examination.
The Neurological Examination
The Neurological is one of the most important parts of a musculoskeletal examination this is especially true if you are presenting for neck pain, headaches, or low back pain. It can tell us information ranging in importance. It can let the doctor know more specifically what needs to be worked on all the way up to letting the doctor know when a patient needs to be sent to the hospital immediately due to an emergency. Without the neurological examination a practitioner might miss vital information. At its most basic level a neurological examination should normally include deep tendon reflexes, muscle strength testing, and sensory testing.
Deep Tendon Reflexes
You are probably familiar with the deep tendon reflex part of the exam. During this part of the exam a practitioner will take a reflex hammer and test your reflexes to make sure nothing is amiss. The doctor rates the reaction that you have to the hammer strike on a scale of 0-4. A 0 is no response and a 4 is a complete contraction of the muscles that does not relax on its own. While everyone has a different normal the reflex that is most common for asymptomatic individuals is a 2. A 2 is a quick but solid response.
Muscle Strength Testing
During this a practitioner will have the patient hold a specific position to ensure that the muscles that are being innervated are working properly. For instance I might have a patient hold this position while I push down on their arm. Generally this is performed on both the upper extremities as well as the lower extremities. Depending on how the test is performed the specific movement can be correlated to a nerve root exiting the spine. This is graded on a scale of 0-5. A 0 is no contraction of the muscle regardless of how hard the patient tries and a 5 is when the patient is able to fully resist the doctors applied force.
Sensory Nerve Testing
Finally we have sensory testing. This is often done with a pin wheel but can also be done in other manners. The goal of this is to make sure the patient can sense things equally from one side of the body to the other. This is often done over dermatomes but there are variants of this test that are performed not over dermatomes. Dermatomes are areas of skin that are innervated by specific nerve roots coming from the spinal cord. The practitioner is checking for any areas that might either have decreased or increased sensation. The practitioner does this by testing one side against the other. Normal is when a patient can feel the application on both sides and it is to an equal extent.
If this is being done your probably in good hands
This is not a comprehensive list of everything that can be done during a neurological examination. Sometimes far more will be done. There are also times when parts of the neuro exam are unnecessary such as when someone suffers a strain a deep tendon reflex is not going to be useful information. However in general you should be looking out for a neurological examination whenever you go to an in for an initial examination.