|
Cervical Rotation (R) / 85 degre
|
With Pain?
|
|
Cervical Rotation (L) / 85 degre
|
With Pain?
|
|
Cervical Lat Flexion (R) / 45 de
|
With Pain?
|
|
Cervical Lat Flexion (L) / 45 de
|
WIth Pain?
|
|
Cervical Flexion / 65 degrees
|
With Pain?
|
|
Cervical Extension / 50 degrees
|
With Pain?
|
|
Lumbar Rotation (R) / 85 degrees
|
With Pain?
|
|
Lumbar Rotation (L) / 85 degrees
|
With Pain?
|
|
Lumbar Lateral Flex (R) / 35 deg
|
With Pain?
|
|
Lumbar Lateral Flex (L) / 35 deg
|
With Pain?
|
|
Lumbar Flexion / 95 degrees
|
With Pain?
|
|
Lumbar Extension / 35 degrees
|
With Pain?
|
|
Bilateral Scales: Left / Right i
/
|
Swelling & Inflammation
• • •
|
|
Tight Muscles
• • •
|
Restriction & Loss of Motion in
• • •
|
|
Palpation Notes: Cervical
|
Palpation Notes: Thoracic
|
|
Palpation Notes: Lumbar
|
Palpation Notes: Sacrum/ Pelvis
|
|
Palpation Notes: Other
|
|
|
Upper Ext MM Test WNL?
|
Upper Ext MM Comments:
|
|
Lower Ext. MM Test WNL?
|
Lower Ext. MM Comments:
|
|
Upper Ext. DTR WNL?
|
Upper Ext. DTR Comments:
|
|
Lower Ext. DTR WNL?
|
Lower Ext DTR Comments:
|
