Traditional Neurologic Exam:  Most MD's and DO's do a very good traditional neurologic exam.  This includes checking sensation, reflexes, and looking for weakness.   However, there are a few additions that a medical practitioner looking for soft-tissue problems should add.  The most significant of these is a more thorough sensory exam.  The back of the head, neck, shoulders, arms, hands, upper back, low back, hips, thighs, legs, and feet should be tested with a needle or pin for side to side differences.  This should then be correlated with the rest of the soft-tissue exam to look for clues to nerve irritation that may be occurring at any level.  In addition, the skin texture should be observed for differences due to neuropathy at the levels being tested.

Range of Motion:  Most MD's do a very cursory exam of range of motion.  The soft-tissue exam includes range of motion in all directions of movement for all joints being tested.  The range of motion of the joints above and below the area of pain is an important as the area that hurts.  For instance, the average range of motion exam for the neck might include look left/right as well as up/down.  The soft-tissue exam includes range of motion for the neck as well as both shoulders, the upper back, and sometimes lower back (all for the complaint of neck pain).   In addition, the shoulder range would be broken down into glenohumeral (the shoulder joint) as well as scapulo-thoracic (the shoulder blade on the ribs) and sternoclavicular (where the collar bone meets the sternum).  In addition, the exam is evaluated for problems that may be leading to limited range.  For instance, is an irritated nerve causing the neck to have poor extension?

Myofascial Tightness:  Most MD's don't look for tightness in specific muscle groups that may be causing pain.  A good soft-tissue exam of the neck would check for tightness in the splenius cervisus, splenius capitus, sub-occipitals, infraspinatus, levator scapula, semispinalis capitus, sternocleidomastoids, upper trapezius, subscapularis, rhomboids, and scalenes.  All of these require a different maneuver.

Segmental Movement:  Very few MD's have been trained how to look for poor range of motion in individual spinal joints, yet this is often a source of problems for many patients in pain.  The soft-tissue exam in the neck looks at each spinal level:  OA, AA, C2-C3, C3-C4, C4-C5, C5-C6, C6-C7, C7-T1 and evaluates movement in multiple directions, looking for tightness that may be leading to pain.   The movement of distant segments outside of the painful area are also evaluated for their contribution to the overall pain syndrome.

Nerve Tension:  Very few MD's have had much training in tight nerves.  Nerves need to be mobile like joints, when they loose their ability to give, numbness, tingling, and radiating pain can result.  A good soft-tissue exam evaluates the give and tension of the nerves in all four extremities.

Segmental Spinal Stability:  Very few practitioners check for the strength of the spinal stabilizing muscles.  Since pain can result when the muscles designed to stabilize the spine get weak, a good soft-tissue exam looks for weakness in these muscles.  For instance, in the neck, the strength of the longus colli and lower cervical multifidus must be evaluated.  in addition, if these muscles are weak, the SCM, Splenius Cervisus, and Semispinalis Capitus must also be evaluated for over-pull and substitution patterns.

Posture:  A good soft-tissue exam exam looks for postural abnormalities that may be leading to pain.  For instance, is an irritated facet joint in the neck causing the opposite shoulder and ribs to sit high?  Are problems with extension at L2 causing the neck to be forward?  Posture is the big picture that tells the practitioner how all of the other exam elements fit together like pieces of a puzzle.

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