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McKenzie Assessment
Cerebellar Testing
Scanning Speech - British Constitution
Additional Information Scanning Speech
Nystagmus
• • •
Additional Information Nystagmus
Finger to Nose
• • •
Additional Information Finger to Nose
Finger to Finger
• • •
Finger to Finger Additional Info
Rapid Movement - Thigh Slap
• • •
Additional Information Rapid Movement
Lumbar Spine
Visual Inspection
Torso Shift
• • •
Relevant?
Antalgic Sitting
• • •
LS Lordosis
• • •
Erector Group Tone Prone
• • •
Erector Group Tone Seated
• • •
Correction of Posture
• • •
Hip Positioning Left (foot)
• • •
Hip Positioning Right (foot)
• • •
Additional Observation Info
LS Neuro
LS REFLEXES ALL 2/4
NON 2/4 LS Reflexes
MMT LS All 5/5
NON LS 5/5 MMT
Heel Walk
• • •
Toe Walk
• • •
Dural Tension Left Leg
• • •
if positive referral to
Dural Tension Right Leg
• • •
if positive referral to
Muscle Testing
MMT Glut Med Left
• • •
MMT Glut Right
• • •
MMT Psoas Left
• • •
MMT Psoas Right
• • •
External Oblique Left
• • •
External Oblique Right
• • •
Palpation
TL erector Left
• • •
TL erector Right
• • •
QL Left
• • •
QL Left
• • •
Glut Med Left
• • •
Glut Med Right
• • •
Pirformis Left
• • •
Pirformis Right
• • •
TFL Left
• • •
TFL Right
• • •
Graston Screen Hamstring (adhesion tissue)
• • •
Direction
• • •
PA Pressure
• • •
At The Level
• • •
Manual Traction Left
• • •
Manual Traction Right
• • •
New Field
Motion Palpation Restrictions
Cervical Spine Restrictions
• • •
Thoracic Spine Restrictions
• • •
Lumbar Spine Restrictions
• • •
SI Joint
• • •
Ribs (PA)
• • •
AROM
Pretesting Symptoms
AROM LS EXTENSION
• • •
Additional Information
AROM LS FLEX
• • •
Additional Information
AROM LS R SIDE GLIDE
• • •
Additional Information
AROM LS L SIDE GLIDE
• • •
Additional Information
Static Position
Static LS Extension
• • •
Additional Information
Repeated Motion
LS Flexion
• • •
Additional Information
Repeated Extension
• • •
Additional Information
Heels to Glutes
• • •
Additional Information
Patient Over Pressure
• • •
Additional Information
Doctor Assisted Overpressure LS
• • •
Additional Information
Mobilization of the LS
• • •
Additional Information
Side Glide L
• • •
Additional Information
Side Glide L PT overpressure
• • •
Additional Information
Side Glide L DR overpressure
• • •
Additional Information
Side Glide R
• • •
Additional Information
Side Glide R PT overpressure
• • •
Additional Information
Side Glide R DR overpressure
• • •
Additional Information
Supine Rotation L
• • •
Additional Information
Supine Rotation L w PT overpressure
• • •
Additional Information
Supine Rotation L w DR overpressure
• • •
Additional Information
Supine Rotation R
• • •
Additional Information
Supine Rotation Right w PT overpressure
• • •
Additional Information
Supine Rotation R w DR overpressure
• • •
Additional Information
Other ROM Findings
Additional Information
Orthopedic Test
Spine Orthos (Positive)
• • •
Spine Orthos (Negative)
• • •
Functional Screen
Side Plank Duration L/R
/
Plank in Seconds
Hamstring Tension Test L/R
/
3 month old supine (seconds)
Modified Thomas L
• • •
Modified Thomas R
• • •
Active SLR Left
• • •
Fail SLR
• • •
Active SLR Right
• • •
Fail SLR
• • •
Resisted SLR Torque Test Left
• • •
Resisted SLR Torque Test Right
• • •
6 Inch Step Down L
• • •
Instability in cornonal plane
• • •
6 Inch Step Down L
• • •
Instability in cornonal plane
• • •
Lunge Screen L
• • •
Instability in cornonal plane
• • •
Lunge Screen R
• • •
Instability in cornonal plane
• • •
Hip Extension Test L 1st mm fires
• • •
Hip Extension Test L 2nd mm fires
• • •
Hip Extension Test L 3nd
• • •
Hip Extension Test L 4th
• • •
Pelvic Rocking
• • •
Hip Extension Test R 1st mm fires
• • •
Hip Extension Test R 2nd
• • •
Hip Extension Test R 3nd
• • •
Hip Extension Test R 4th
• • •
Pelvic Rocking
• • •
Cervical Spine
Visual Inspection
Posture
• • •
Chin Protrusion
• • •
Lumbar Spine Lordosis
• • •
Upper TS Kyphosis
• • •
Prone on Elbows Upper TS Extension
• • •
Wry Neck
• • •
Relevant?
Posture Correction
• • •
Additional Visual Inspection
Neurological
CS MMT ALL 5/5
CS NON 5/5 MMT
CS REFLEXES ALL 2/4
CS NON 5/5 MMT
Light Touch
Hyper/Hypo
• • •
Sharp Dull
Hyper/Hypo
• • •
Vibration
Hyper/Hypo
• • •
Palpation
Manual Traction
• • •
Additional info
Suboccipital palpation Left
• • •
Suboccipital palpation Right
• • •
Levator Scap palpation Left
• • •
Levator Scap palpation Right
• • •
Upper Trap palpation Left
• • •
Upper Trap palpation Right
• • •
Pec Minor palpation Left
• • •
Pec Minor palpation Right
• • •
Pec Major palpation Left
• • •
Pec Major palpation Right
• • •
Anterior Scalene palpation Left
• • •
Anterior Scalene palpation Right
• • •
Additional Info
Manual Muscle Testing
Motion Palpation Restrictions
Cervical Spine Restrictions
• • •
Thoracic Spine Restrictions
• • •
Lumbar Spine Restrictions
• • •
SI Joint
• • •
AROM
Pretesting Symptoms
Additional Information
AROM CS FLEXION
• • •
Additional Information
AROM CS RETRACTION
• • •
Additional Information
AROM CS EXTENSION
• • •
Additional Information
AROM CS L ROT
• • •
Additional Information
AROM CS R ROT
• • •
Additional Information
AROM CS L LF
• • •
Additional Information
AROM CS R LF
• • •
Additional Information
Static Positioning
Prone On Elbows
• • •
Additional Information
REPEATED MOVEMENT
CS Flexion - Loaded
• • •
Additional Information
CS Flexion - Unloaded
• • •
Additional Information
Repeated Retraction - Loaded
• • •
Additional Information
Repeated Retraction - Unloaded
• • •
Additional Information
Repeated Retraction & Extension - Loaded
• • •
Additional Information
Repeated Retraction & Extension - Unloaded
• • •
Additional Information
Retraction & Extension Loaded PT Ovepressure
• • •
Additional Information
Retraction & Extension Unloaded PT Ovepressure
• • •
Additional Information
Retraction & Extension - Loaded Dr Overpressure
• • •
Additional Information
Retraction & Extension Unloaded Dr Overpressure
• • •
Additional Information
Mobilization Loaded
• • •
Additional Information
Mobilization Unloaded
• • •
Additional Information
RROT
• • •
Additional Information
LROT
• • •
Additional Information
Orthopedics
CS Ortho Positive
• • •
Cervical Spine Orthos Neg
• • •
Other CS notes
Functional Screen
Julls Test
• • •
Positive Julls Signs
• • •
Quadruped Rocking
• • •
Patient Positioning
• • •
T4 Wall Screen
• • •
Thoracic Spine
AROM
Pretesting Symptoms
AROM LS EXTENSION
• • •
Additional Information
AROM LS Flexion
• • •
Additional Information
AROM TS L ROTATION
• • •
Additional Information
AROM TS R ROTATION
• • •
Additional Information
REPEATED MOTION
Prone of Elbows (TS)
• • •
Additional Information
Repeated Extension (TS)
• • •
Additional Information
Repeated Flexion (TS)
• • •
Additional Information
RROT (TS)
• • •
Additional Information
LROT (TS)
• • •
Additional Information
Additional TS Info
Shoulder
Scapular Positioning Left
• • •
Scapular Positioning Right
• • •
Shoulder positioning Left
• • •
Shoulder positioning Right
• • •
Other Visual Observation
Palpation
Pec Major palpation Left
• • •
Pec Major palpation Right
• • •
Pec Minor palpation Left
• • •
Pec Minor palpation Right
• • •
Levator Scap palpation Left
• • •
Levator Scap palpation Right
• • •
Teres Minor palpation Left
• • •
Teres Minor palpation Right
• • •
Biceps palpation Left
• • •
Biceps palpation Right
• • •
Inferior Glide
• • •
Inferior Glide
• • •
AC joint Palpation
• • •
AC joint Palpation
• • •
Supraspinatus Insertion Left
• • •
Supraspinatus Insertion Right
• • •
Shoulder AROM
Left Shoulder
Active ROM Left
Left Shoulder Flexion
• • •
Additional Information
Left Shoulder Extension
• • •
Additional Information
Left Shoulder Abduction
• • •
Additional Information
Left Shoulder Horizontal Abduction
• • •
Additional Information
Left Shoulder Horizontal Adduction
• • •
Additional Information
Left Shoulder External Rotation
• • •
Additional Information
Left Shoulder Internal Rotation
• • •
Additional Information
Resisted Motion
Left Shoulder Flexion
• • •
Additional Information
Left Shoulder Extension
• • •
Additional Information
Left Shoulder Abduction
• • •
Additional Information
Left Shoulder Horizontal Adduction
• • •
Additional Information
Left Shoulder Horizontal Abduction
• • •
Additional Information
Left Shoulder External Rotation
• • •
Additional Information
Left Shoulder Internal Rotation
• • •
Additional Information
Repeated Motion
L Shoulder Repeated IR (HBB)
• • •
Additional Information
L Shoulder Repeated Ext
• • •
Additional Information
L Shoulder Repeated Add
• • •
Additional Information
L Shoulder Repeated Horizontal ABD
• • •
Additional Information
L Shoulder Repeated ER Flex
• • •
Additional Information
Right Shoulder
Active Range of Motion
Right Shoulder Flexion
• • •
Additional Information
Right Shoulder Extension
• • •
Additional Information
Right Shoulder Abduction
• • •
Additional Information
Right Shoulder Horizontal Abduction
• • •
Additional Information
Right Shoulder Horizontal Adduction
• • •
Additional Information
Right Shoulder Internal Rotation
• • •
Additional Information
Right Shoulder External Rotation
• • •
Additional Information
Resisted Motion
Right Shoulder Flexion
• • •
Additional Information
Right Shoulder Extension
• • •
Additional Information
Right Shoulder Abduction
• • •
Additional Information
Right Shoulder Horizontal Abduction
• • •
Additional Information
Right Shoulder Horizontal Adduction
• • •
Additional Information
Right Shoulder External Rotation
• • •
Additional Information
Right Shoulder Internal Rotation
• • •
Additional Information
Repeated Motion
R Shoulder Repeated IR (HBB)
• • •
Additional Information
R Shoulder Repeated Ext
• • •
Additional Information
R Shoulder Repeated Add
• • •
Additional Information
R Shoulder Repeated Horizontal ABD
• • •
Additional Information
R Shoulder Repeated ER Flex
• • •
Additional Information
Shoulder Orthopedics
Shoulder Orthos (Positive)
• • •
Shoulder Orthos (Negative)
• • •
Shoulder Ortho Notes
Functional Screens
T4 Wall Screen
• • •
L Pec Minor Supine Shoulder Press (inches)
• • •
R Pec Minor Supine Shoulder Press (inches)
• • •
Shoulder Mobility Screen Left on top
• • •
Shoulder Mobility Screen Right on top
• • •
Quadraped Scapular Rock Left
• • •
Quadraped Scapular Rock Right
• • •
Shoulder ABD Test Left
• • •
Shoulder ABD Test Right
• • •
Crashing Scapula Test Left
• • •
Crashing Scapula Test Right
• • •
Weighted Flexion before pain L
• • •
Weighted Flexion before pain R
• • •
Weighted Abduction before pain L
• • •
Weighted Abduction before pain R
• • •
GIRD TEST L
• • •
ER/IR Dominance
GIRD TEST R
• • •
ER/IR Dominance
Elbow Wrist
Visual Observation
Elbow Positioning Seated neutral L
• • •
Elbow Positioning Seated neutral R
• • •
Elbow Positioning 90 shoulder flex L
• • •
Elbow Positioning 90 shoulder flex
• • •
Quadraped Loading 90 of Extension Left
• • •
Quadraped Loading 90 of Extension RIGHT
• • •
Palpation
Compression Distal Radial-Ulna Left
• • •
Additional Information
Compression Distal Radial-Ulna Right
• • •
Additional Information
Spread Distal Radial-Ulna Left
• • •
Additional Information
Spread Distal Radial-Ulna Right
• • •
Additional Information
AROM
Left Wrist
Extension Left
• • •
Additional Information
Flexion Left
• • •
Additional Information
Ulnar Deviation Left
• • •
Additional Information
Radial Deviation Left
• • •
Additional Information
Pronation Left
• • •
Additional Information
Supination Left
• • •
Additional Information
Resisted Motion
Extension Left
• • •
Additional Information
Flexion Left
• • •
Additional Information
Ulnar Deviation Left
• • •
Additional Information
Radial Deviation Left
• • •
Additional Information
Pronation Left
• • •
Additional Information
Supination Left
• • •
Additional Information
Right Wrist
Extension Right
• • •
Additional Information
Flexion Right
• • •
Additional Information
Ulnar Deviation Right
• • •
Additional Information
Radial Deviation Right
• • •
Additional Information
Pronation Right
• • •
Additional Information
Supination Right
• • •
Additional Information
Resisted Movement
Extension Right
• • •
Additional Information
Flexion Right
• • •
Additional Information
Ulnar Deviation Right
• • •
Additional Information
Radial Deviation Right
• • •
Additional Information
Pronation Right
• • •
Additional Information
Supination Right
• • •
Additional Information
HIP/SI JOINT
Left
Left Hip AROM Flexion
• • •
Additional Information
Left Hip AROM Extension
• • •
Additional Information
Left Hip AROM IR
• • •
Additional Information
Left Hip AROM ER
• • •
Additional Information
Pain with AROM L HIP FLEXION
Left Hip Flexion
• • •
Additional Information
Left Hip Extension
• • •
Additional Information
Left Hip IR
• • •
Additional Information
Left Hip ER
• • •
Additional Information
Resisted Motion
Left Hip Flexion
• • •
Additional Information
Left Hip Extension
• • •
Additional Information
Left Hip IR
• • •
Additional Information
Left Hip ER
• • •
Additional Information
Right
Right Hip AROM Flexion
• • •
Additional Information
Right Hip AROM Extension
• • •
Additional Information
Right Hip AROM IR
• • •
Additional Information
Right Hip AROM ER
• • •
Additional Information
PAIN WIHT AROM
Right Hip Flexion
• • •
Additional Information
Right Hip Extension
• • •
Additional Information
Right Hip IR
• • •
Additional Information
Right Hip ER
• • •
Additional Information
Resisted Motion
Right Hip Flexion
• • •
Additional Information
Right Hip Extension
• • •
Additional Information
Right Hip IR
• • •
Additional Information
Right Hip ER
• • •
Additional Information
Knee
R Knee
Visual Inspection
Swelling Noted?
Swelling Amount
Swelling Position
• • •
Bruising Noted?
Additional Information
R Genu Varum
• • •
Additional Information
R Genu Valgum
• • •
Additional Information
R Femoral Torsion
• • •
Additional Information
R Genu Hyperextension
• • •
Additional Information
R Tibial Torsion
• • •
Additional Information
Palpation
Medial Joint Line Pain
Additional Information
Lateral Joint Line Pain
Additional Information
Superior Patellar Tendon Pain (quad)
Additional Information
Inferior Patellar Tendon Pain (Patellar Tendon)
Additional Information
Range of Motion
AROM KNEE EXT
• • •
Additional Information
AROM KNEE FLEX
• • •
Additional Information
PROM KNEE FLEX
• • •
Additional Information
PROM KNEE EXT
• • •
Additional Information
RESISTED MOTION
Resisted Flexion
• • •
Additional Information
Resisted Extension
• • •
Additional Information
REPEATED MOTION
Repeated Extension Active
• • •
Additional Information
Repeated Ext w/ IR Active
• • •
Additional Information
Repeated Ext w/ ER Active
• • •
Additional Information
Repeated Flexion Active
• • •
Additional Information
Repeated Flexion Passive
• • •
Additional Information
Repeated Ext w/ IR Passive
• • •
Additional Information
Repeated Ext W/ER Passive
• • •
Additional Information
Repeated Extension Passive
• • •
Additional Information
Functional Test
6 Inch Step Down R
• • •
Additional Information
6 Inch Step Down L
• • •
Additional Information
Circ of Knee inches (2 Inches prox patella)
Orthopedic Testing
Valgus Stress Test
Additional Information
Varus Stress Test
Additional Information
McIntosh Test (ER) Pop and Click
Additional Information
McMurray Test (IR) - Pop and Click
Additional Information
Anterior Drawer Test
Additional Information
Posterior Drawer Test
Additional Information
Lachman Test
Additional Information
Apley's Grind Test
Additional Information
Patellar Grind Test
Additional Information
Left Knee
Visual Inspection
Swelling Noted?
Swelling Amount
Swelling Position
• • •
Bruising Noted?
Additional Information
L Genu Varum
• • •
Additional Information
L Genu Valgum
• • •
Additional Information
L Genu Hyperextension
• • •
Additional Information
L Femoral Torsion
• • •
Additional Information
L Tibial Torsion
• • •
Additional Information
Palpation
Medial Joint Line Pain
Additional Information
Lateral Joint Line Pain
Additional Information
Superior Patellar Tendon Pain (quad)
Additional Information
Inferior Patellar Tendon Pain (Patellar Tendon)
Additional Information
Range of Motion
AROM KNEE EXT
• • •
Additional Information
AROM KNEE FLEX
• • •
Additional Information
PROM KNEE FLEX
• • •
Additional Information
PROM KNEE EXT
• • •
Additional Information
RESISTED MOTION
Resisted Flexion
• • •
Additional Information
Resisted Extension
• • •
Additional Information
REPEATED MOTION
Repeated Extension Active
• • •
Additional Information
Repeated Ext w/ IR Active
• • •
Additional Information
Repeated Ext w/ ER Active
• • •
Additional Information
Repeated Flexion Active
• • •
Additional Information
Repeated Extension Passive
• • •
Additional Information
Repeated Flexion Passive
• • •
Additional Information
Repeated Ext w/ IR Passive
• • •
Additional Information
Repeated Ext W/ER Passive
• • •
Additional Information
Functional Testing
Circ of Knee inches (2 Inches prox patella)
6 Inch Step Down R
• • •
Additional Information
6 Inch Step Down L
• • •
Additional Information
Orthopedic Testing
Valgus Stress Test
Additional Information
Varus Stress Test
Additional Information
Anterior Drawer Test
Additional Information
Posterior Drawer Test
Additional Information
McIntosh Test (ER) Pop and Click
Additional Information
McMurray Test (IR) - Pop and Click
Additional Information
Lachman Test
Additional Information
Apley's Grind Test
Additional Information
Patellar Grind Test
Additional Information
FOOT/ANKLE
L First Ray Valgosity
• • •
R First Ray Valgosity
• • •
L First Ray DF
• • •
R First Ray
• • •
L Rearfoot Palpation
• • •
R Midfoot Palpation
• • •
L Midfoot Palpation
• • •
R Rear Foot Palpation
• • •
L Loaded Midfoot Stance
• • •
R Loaded MidFoot Stance
• • •
AROM Ankle
Left Ankle
Left DF AROM
• • •
Additional Information
Left PF AROM
• • •
Additional Information
Left EV AROM
• • •
Additional Information
Left INV AROM
• • •
Additional Information
Pain with AROM
Left DF
• • •
Additional Information
Left PF
• • •
Additional Information
Left EV
• • •
Additional Information
Left IN
• • •
Additional Information
RESISTED MOTION
Left DF
• • •
Additional Information
Left PF
• • •
Additional Information
Left EV
• • •
Additional Information
Left IN
• • •
Additional Information
Right Ankle
Active Range of Motion
Right DF AROM
• • •
Additional Information
Right PF AROM
• • •
Additional Information
Right EV AROM
• • •
Additional Information
Right INV AROM
• • •
Additional Information
Pain with AROM
Right DF
• • •
Additional Information
Right PF
• • •
Additional Information
Right EV
• • •
Additional Information
Right IN
• • •
Additional Information
Resisted Motion Right
Right DF
• • •
Additional Information
Right PF
• • •
Additional Information
Right EV
• • •
Additional Information
Right IN
• • •
Additional Information
Breathing Assessment
Chest Breathing
Paradoxical Breathing
Rib Flare
• • •
Planes of Breathing
• • •
Improved w/Rib Depression
Abdominal Activation on cue.
Intra-abdominal Pressure Test Positive Findings:
• • •
Seated Hip Flexion Test:
• • •
Additional Breathing Findings
Gait
Lower Limb Static
L Genu Varum
• • •
R Genu Varum
• • •
L Genu Valgum
• • •
R Genu Valgum
• • •
L Femoral Torsion
• • •
R Femoral Torsion
• • •
L Genu Hyperextension
• • •
R Genu Hyperextension
• • •
L Bunion
R Bunion
L Hammer Toes
• • •
R Hammer Toes
• • •
PEDOGRAPH
PEDOGRAPH L FOOT
PEDOGRAPH R FOOT

Objective Medical Form

Chiropractor

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Published: July 10, 2015, 11:11 a.m.
Doctor: Dr. History Physical
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