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LS Flexion (60°)
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Pain with LS flexion?
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LS Extension (25°)
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Pain with LS extension?
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LS RR (45°)
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Pain with LS RR?
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LS LR (45°)
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Pain with LS LR ?
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LS RLF (40°)
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Pain with LS RLF?
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LS LLF (40°)
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Pain with LS LLF ?
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CS Flexion (80-90°)
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Pain with CS flexion?
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CS Extension (70°)
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Pain with CS extension?
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CS LR (90°)
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Pain with CS LR?
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CS RR (90°)
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Pain with CS RR?
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CS RLF (20-45°)
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Pain with CS RLF?
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CS LLF (20-45°)
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Pain with CS LLF?
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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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Shoulder Depression
• • •
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Cervical Compression
• • •
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Cervical Distraction Positive?
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Max CS Compression
• • •
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Hypertonic Muscles - Neck Area
• • •
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Notes
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ROM WNL
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ROM comments
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Lower Dermatomes Intact
|
Lower 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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Hibbs Test
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Kemp's Test
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Yoeman's Test
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FABRE Patrick Test
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Hypertonic Muscles
• • •
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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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