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Opening Statements
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Onset
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Cervical Spine Flexion
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Pain with C/S flexion?
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Cervical Spine Extension
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Pain with C/S extension?
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Cervical spine rotation left 60-80.
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Pain with left rotation
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Cervical rotation right 60-80
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Pain with right rotation
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Cervical Spine Right Lateral Flex
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Pain with C/S Rt. lateral flex?
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Cervical Spine Left Lateral Flex
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Pain with C/S Lt. lateral flex?
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ROM WNL
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ROM comments
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Upper Dermatomes Intact
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Dermatome Deficit
• • •
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Upper DTR's
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Upper DTR deficit
• • •
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George's Maneuver Positive?
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Foramina Compression
• • •
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Shoulder Depression
• • •
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Cervical Distraction Positive?
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Bakody's Sign
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Adson's Sign
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Eden's Sign
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Valsalva
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Hypertonic Muscles - Neck Area
• • •
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Weak muscles
• • •
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Subluxations - Cervical, Thoracic, Ribs
• • •
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Notes
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Lumbar Flexion
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Pain with L/S flexion?
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Lumbar Extension
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Pain with L/S extension?
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Lumbar Right Rotation
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Pain with Right Rotation?
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Lumbar Left Rotation
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Pain with Left Lumbar Rotation?
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Right Lumbar Flexion
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Pain with Right Lumbar Flexion?
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Left Lumbar Flexion
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Pain with Left Lumbar Flexion?
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ROM WNL
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ROM comments
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Lower Dermatomes Intact
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Dermatome Deficit
• • •
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Lower DTR's
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Lower DTR deficit
• • •
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Straight Leg Raise Test
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Farfans Torsion Test
• • •
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Hibbs Test
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Ely's Heel to Buttock Test
• • •
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Yoeman's Test
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Valsalva Test
• • •
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Hypertonic Muscles
• • •
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Weak Muscles
• • •
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Subluxations
• • •
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Notes
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Imaging
• • •
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Additional Imaging
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Lab Work
• • •
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Additional Lab Work
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Treatment Plan
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Treatment to include as necessary:
• • •
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Treatment Today
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Treatment
• • •
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